Transarterial Radioembolization with Y90 is a Safe Bridge to Resection

A new study that looked at outcomes of surgical resection after yttrium-90 (Y90) transarterial radioembolization (TARE) in patients with hepatocellular carcinoma found that TARE can serve as a safe bridge to resection. The results were published in the Journal of Vascular and Interventional Radiology and found that TARE provided future liver remnant (FLR) hypertrophy and disease control.

Of the 31 patients with hepatocellular carcinoma (HCC) included in this longitudinal study, 25 underwent major hepatic resection (16 received right hepatectomy and 9 received trisegmentectomy) and 6 underwent partial hepatectomy. Clinical outcomes and FLR were recorded after and before and after yttrium-90 TARE, respectively. After resection, clinical outcomes and actual liver remnant volume was calculated. Radiologic response after TARE and pathologic necrosis were assessed. Researchers estimated overall and recurrence-free survivals after resection.

There was a median time of 2.9 months between TARE and resection. In patients who had radiation lobectomy, the median FLR hypertrophy after TARE and before resection was 23.3% and in patients who had radiation segmentectomy, the median FLR hypertrophy after TARE and before resection was 9% (P = 0.037).

Three months after resection, there was a 72% median augmented hypertrophy of the liver remnant in patients who had radiation lobectomy and 94% in patients who had radiation segmentectomy. Complete, 50%–99%, and < 50% pathologic tumor necrosis was identified in 14 (45%), 10 (32%), and 7 (23%) tumors.

In all 31 patients disease control was achieved. The survival rate at 1 year was 96% and at 3 years 86%. Median recurrence-free survival was 34.2 months.

The authors concluded that “TARE can serve as a safe bridge to resection providing FLR hypertrophy and disease control.”

 

Reference

Gabr A, Abouchaleh N, Ali R, et al. Outcomes of Surgical Resection after Radioembolization for Hepatocellular Carcinoma. JVIR. Epub ahead of print. DOI: https://doi.org/10.1016/j.jvir.2018.06.027.