Some Patients May Be Eligible for Liver Resection After SIRT

Some patients who undergo selective internal radiotherapy (SIRT) with yttrium-90 (Y-90) may be eligible for liver resection, researchers reported.

SIRT is typically a palliative procedure, but certain patients have a response that warrants surgical resection with curative intent. To better understand the circumstances in which resection is possible, the investigators reviewed data on all patients who underwent liver resection following SIRT. Patient demographics, type of tumor, details of the surgery, and post-operative outcomes were evaluated as part of the review.

There were 12 patients who were treated with SIRT followed by liver resection. Of those patients, 5 had hepatocellular carcinoma, 5 had metastatic colorectal cancer, and 2 had neuroendocrine tumor. After calculation of lesional response and of functional liver remnant, when applicable, the researchers identified a mean functional liver remnant increase of 264 cm3, with a range of 123 to 909 cm3.

According to RECIST (response evaluation criteria in solid tumors), there was a partial response shown in all cases. The mean largest lesion volume reduction was 475 cm3. Patients underwent hepatectomy a mean of 322 days after SIRT, and no complications were observed after SIRT. Six patients (67%) experienced morbidity at 90 days, and there was a total of 15 events that occurred in those 6 patients. Mortality at 90 days was 11%, representing 1 patient.

“In selected cases, liver resection is possible post SIRT. As this can represent a potentially curative option, it is important to reconsider resection in the follow-up of patients undergoing SIRT,” the researchers said.

They added, “Post-operative complications are noted following major and extended liver resection. Therefore, further studies are needed to improve patient selection.”

Reference

Mafeld S, Littler P, Hayhurst H, et al. Liver resection after selective internal radiation therapy with yttrium-90: safety and outcomes. J Gastrointest Cancer. 2019 Mar 26. doi: 10.1007/s12029-019-00221-0. [Epub ahead of print]