Is Y-90 Treatment After Major Hepatic Resection Safe and Effective?

Radioembolization with yttrium-90 (Y90) in patients who have previously undergone major hepatic resection seems to be safe and effective, researchers reported.

The retrospective study evaluated data from 15 patients (10 male, 5 female) with primary or secondary hepatic malignancies who underwent radioembolization with Y90-resin microspheres for hepatic tumor that had recurred after lobectomy. Eight patients had right hepatic lobectomy, and 7 patients had left hepatic lobectomy. The subsequent radioembolization with Y90 occurred between March 2011 and January 2016. 

A single radioembolization session was used to treat the whole liver remnant in 8 patients, whereas the other 7 patients underwent selective radioembolization up to 3 times, at intervals of 1 to 2 months, until the whole liver remnant received Y-90 treatment.

Body surface area (BSA) method was used to calculate administered patient activity in all 15 patients, and the retrospective analysis included evaluation of whether signs of radioembolization-induced liver disease (REILD) were evident. REILD was defined as bilirubin greater than 3.0 mg/dL and ascites within 1 to 2 months following treatment without tumor progression or bile duct occlusion.

“The early response to treatment was generally positive,” the study’s authors wrote. None of the 15 patients developed a REILD, and 14 of the 15 patients responded to Y90. Only 1 patient had signs of progressive disease on follow up within 2 months of radioembolization, and that patient may have been underdosed due to hypertrophy of the liver remnant and a small BSA.

According to the researchers, the mean administered Y90-activity was 1.31 ± 0.74 GBq, and the calculated mean absorbed dose in the liver was 42.8 ± 20.6 Gy. The measured mean volume of liver remnants was 1.471 ± 341 mL, and the mean liver weight was 1514 ± 351 g.

The study was limited by retrospective design, small sample size, and potential confounders that could not be evaluated because of the small sample size. Nonetheless, the researchers believe the study can “be used to justify and encourage further investigations of radioemobolization in patients after extensive liver surgery.”

They added, “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.” Further studies, they said, will need to confirm whether the issue negatively impacts toxicity and outcome.

Reference

Zimmermann M, Schulze-Hagen M, Liebl M, et al. Safety and efficacy of Y-90 radioembolization after prior major hepatic resection. Cardiovasc Intervent Radiol. 2017;40(8):1206-1212.