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. 2021 Sep 2;2(3):e095.
doi: 10.1097/AS9.0000000000000095. eCollection 2021 Sep.

The Impact of Unilateral 90Y-radioembolization on Functional Changes in the Contralateral Hepatic Lobe: The Prospective, Open-label RadioEmbolization, Volumetry, and Liver FuncTion Measurements (REVoluTion) Study

Benjamin Garlipp  1 , Holger Amthauer  2 , Dennis Kupitz  3 , Oliver S Grosser  3 , Julian Jürgens  4 , Robert Damm  3 , Maciej Powerski  3 , Matthias Fabritius  5 , Osman Oecal  5 , Patrick Stuebs  6 , Christoph Benckert  7 , Ricarda Seidensticker  5 , Jens Ricke  5 , Maciej Pech  3 , Max Seidensticker  5
Affiliations

The Impact of Unilateral 90Y-radioembolization on Functional Changes in the Contralateral Hepatic Lobe: The Prospective, Open-label RadioEmbolization, Volumetry, and Liver FuncTion Measurements (REVoluTion) Study

Benjamin Garlipp et al. Ann Surg Open. .

Abstract

Objectives: To investigate how metabolic function of the contralateral liver lobe is affected by unilateral radioembolization (RE), and to compare the changes in volume and metabolic function.

Background: Unilateral RE induces contralateral liver hypertrophy, but it is unknown if metabolic liver function improves in line with volume increases.

Methods: This prospective open-label, nonrandomized, therapy-optimizing study included all consecutive patients undergoing right-sided or sequential 90Y-RE for liver malignancies without underlying liver disease or biliary obstruction at a single center in Germany. Magnetic resonance imaging volumetry and hepatobiliary scintigraphy were performed immediately before RE and approximately 6 weeks after RE.

Results: Twenty-three patients were evaluated (11 metastatic colorectal cancer, 4 cholangiocellular carcinoma, 3 metastatic breast cancer, 1 each of metastatic neuroendocrine tumor, hepatocellular carcinoma, renal cell carcinoma, oesophageal cancer, pancreatic ductal adenocarcinoma). In the untreated contralateral left liver lobe, mean (SD) metabolic function significantly increased from 1.34 (0.76) %/min/m2 at baseline to 1.56 (0.75) %/min/m2 6 weeks after RE (P = 0.024). The mean (SD) functional volume (liver volume minus tumor volume) of the left liver lobe significantly increased from baseline (407.3 [170.3] mL) to follow-up (499.1 [209.8] mL; P < 0.01), with an equivalent magnitude to the metabolic function increase. There were no reports of grade ≥3 adverse events.

Conclusion: This study indicates that unilobar RE produces a significant increase in the metabolic function, and equivalent volume increase, of the contralateral lobe. RE may be a useful option to induce hypertrophy of the future liver remnant before surgical resection of primary or secondary liver malignancies.

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Conflict of interest statement

B.G. has received research grants from Sirtex Medical as well as lecture honoraria and travel grants from Sirtex Medical, Amgen, Merck, Roche, Novartis and B. Braun Travacare, and receives honoraria for participation on advisory boards from Terumo, Sirtex Medical and Amgen. H.A. receives lecture fees from Norgine, Pfizer, Novartis, GE, Sirtex Medical as well as research grants from Pfizer. R.D. receives lecture honoraria from Sirtex Medical. M.P. receives research grants from Bayer and Sirtex Medical as well as lecture honoraria from Sirtex Medical. M.S. receives research grants from Bayer and Sirtex Medical as well as lecture honoraria from Siemens, Cook, Boston Scientific, Sirtex Medical, Falk Foundation, Bayer and receives honoraria for participation on advisory boards from Sirtex Medical, Bayer and Siemens. The remaining authors declare that they have nothing to disclose.

Figures

FIGURE 1.
FIGURE 1.
Study patient participation and exclusion.
FIGURE 2.
FIGURE 2.
Liver metabolic function normalized for body-surface area at baseline (before radioembolization) and 6 weeks after radioembolization (n = 23) measured by hepatobiliary scintigraphy.
See this image and copyright information in PMC

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