title: Safety and Efficacy of Y-90 Radioembolization After Prior Major Hepatic Resection.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of yttrium-90 radioembolization (RE) following left or right hepatic lobectomy.
  
  
  METHODS
  Between 2011 and 2016, 15 patients underwent RE with Y90-resin microspheres following right (8/15) or left (7/15) hepatic lobectomy. In eight patients, the whole liver remnant was treated during a single session, whereas the remaining seven patients received up to 3 selective RE at 1- to 2-month intervals. The administered patient activity was calculated based on the body surface area (BSA) method in all cases. In addition, CT-based volumetry of the liver remnant was performed and used to calculate the absorbed liver dose. Patient follow-up data were retrospectively analyzed regarding signs of radioembolization-induced liver disease (REILD), defined as occurrence of bilirubin >3.0 mg/dl and ascites within 1-2 months after treatment without tumor progression or bile duct occlusion.
  
  
  RESULTS
  The mean volume of the liver remnant was 1.471 ± 341 ml, the mean administered amount of activity amounted to 1.31 ± 0.74 GBq, and the calculated mean absorbed dose was 42.8 ± 20.6 Gy. The early response to treatment was generally positive, with only one patient showing signs of progressive disease of the treated area on follow-up examinations within the first 2 months post-RE. None of the 15 patients developed a REILD.
  
  
  CONCLUSIONS
  Y-90 radioembolization following extended hepatic lobectomy appears to be safe and effective. Although the standard BSA-based dosing seems to suffice to avoid REILD, it results in quite variable liver doses due to variable hypertrophy of the liver remnant post-hepatectomy.
  
  
  METHODS
  Level IV, Case series.
authors.affiliation: Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany. mzimmermann@ukaachen.de.
authors.forename: Markus
authors.initials: M
authors.lastname: Zimmermann
authors.affiliation: Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Schulze-Hagen
authors.affiliation: Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Liebl
authors.affiliation: Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: Federico
authors.initials: F
authors.lastname: Pedersoli
authors.affiliation: Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Goerg
authors.affiliation: Department of General Surgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: Tom Florian
authors.initials: TF
authors.lastname: Ulmer
authors.affiliation: Department of Nuclear Medicine, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Heinzel
authors.affiliation: Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Isfort
authors.affiliation: Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Kuhl
authors.affiliation: Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Bruners
mesh_terms: D000368:Aged; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery / Q000628:therapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D012189:Retrospective Studies; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D015021:Yttrium Radioisotopes; C000615496:Yttrium-90
keywords: Hepatic lobectomy; Radioembolization; Safety; Yttrium-90