Radioembolization: Finding Patients Who Will Benefit Most in “Bridge-to-Resection” Setting

Younger patients with compensated cirrhosis may be best suited to benefit from radioembolization in a “bridge-to-resection” setting, according to PLoS One.

In this retrospective study, researchers sought to determine which factors are linked with hypertrophy of the untreated lobe after unilateral radioembolization. The study assessed data from 75 patients who had undergone right-lobar radioembolization for unresectable unilateral hepatocellular carcinoma (HCC) and who had computed tomography scans of the liver prior to radioembolization, as well as 1, 3, and at least 6 months following radioembolization.

The researchers measured and compared absolute and relative liver lobe volumes (LLV), and relative LLV (rLLV) change per month. “Absolute and relative contralateral LLV continuously increased after radioembolization,” the study’s authors wrote. Prior to radioembolization, mean relative contralateral LLV was 36±11.6%, while it rose to 50±15.3% six months after radioembolization. Within the first 6 months, there was a 2.5% median contralateral rLLV increase per month.

Patients with ascites or a platelet count of less than 100/nl had a significantly lower contralateral rLLV increase/month. Small spleen volume, younger patient age, low Child-Pugh score, and low tumor burden were associated with greater contralateral hypertrophy. Spleen volume and platelet count were used as surrogates to assess for portal hypertension, the authors noted.

Based on parameters that impact contralateral liver hypertrophy, the researchers wrote that “especially younger patients without obvious portal hypertension and with low Child Pugh scores may show pronounced contralateral liver hypertrophy, rendering them excellent candidates for a possible ‘bridge-to-resection’ (or ‘hypertrophy-to-resection’) setting.”

Reference

Goebel J, Sulke M, Lazik-Palm A, et al. Factors associated with contralateral liver hypertrophy after unilateral radioembolization for hepatocellular carcinoma. PLoS One. 2017 Jul 14;12(7):e0181488. doi: 10.1371/journal.pone.0181488. eCollection 2017.