"SIRT is a radioembolization procedure which is considered to be an effective liver-directed therapy with a favorable therapeutic ratio that offers meaningful benefits for selected patients [26,27]. SIRT is able to improve survival after intrahepatic recurrence of ICC . Of interest, the antitumor effect of SIRT is rather related to radiation than to embolization . "
[Show abstract][Hide abstract] ABSTRACT: Intra- or extrahepatic cholangiocarcinomas are the second most common primary liver malignancies behind hepatocellular carcinoma. Whereas the incidence for intrahepatic cholangiocarcinoma is rising, the occurrence of extrahepatic cholangiocarcinoma is trending downwards. The treatment of choice for intrahepatic cholangiocarcinoma remains liver resection. However, a case of liver resection after selective internal radiation therapy in order to treat a recurrent intrahepatic cholangiocarcinoma in a transplant liver is unknown in the literature so far. Herein, we present a case of a patient undergoing liver transplantation for Wilson's disease with an accidental finding of an intrahepatic cholangiocarcinoma within the explanted liver. Due to a recurrent intrahepatic cholangiocarcinoma after liver transplantation, a selective internal radiation therapy with yttrium-90 microspheres was performed followed by right hemihepatectomy. Four years later, the patient is tumor-free and in a healthy condition.
World Journal of Surgical Oncology 07/2014; 12(1):198. DOI:10.1186/1477-7819-12-198 · 1.41 Impact Factor
"In our study, the incidence of disease progression in the untreated left lobe was 2/8 in CRC and 2/8 in CC patients at any time during follow-up. As comparison, the literature reports 25% of metastatic recurrence in the FLR 3 weeks after PVE (CRC) and a disease-free survival of 46%, 1-year after hepatic resection for CC  . In contrast to the time-dependent reporting of FLRs in this report, comparison with the literature is difficult, since authors usually report a one-time static FLR following PVE. "
[Show abstract][Hide abstract] ABSTRACT: Portal vein embolization (PVE) is a standard technique for patients not amenable to liver resection due to small future liver remnant ratio (FLR). Radiation lobectomy (RL) with Y90-loaded microspheres (Y90) is hypothesized to induce comparable volumetric changes in liver lobes, while potentially controlling the liver tumor and limiting tumor progression in the untreated lobe. We aimed to test this concept by performing a comprehensive time-dependent analysis of liver volumes following radioembolization.
83 patients with right unilobar disease with hepatocellular carcinoma (HCC; N=67), cholangiocarcinoma (CC; N=8) or colorectal cancer (CRC; N=8) were treated by Y90 RL. The total liver volume, lobar (parenchymal) and tumor volumes, FLR and percentage of FLR hypertrophy from baseline (%FLR hypertrophy) were assessed on pre- and post-Y90 CT/MRI scans in a dynamic fashion.
Right lobe atrophy (p=0.003), left lobe hypertrophy (p<0.001) and FLR hypertrophy (p<0.001) were observed 1 month after Y90 and was consistent at all follow-up timepoints. Median%FLR hypertrophy reached 45% (5-186) after 9 months (p<0.001). The median maximal%FLR hypertrophy was 26% (-14→86). Portal vein thrombosis was correlated to%FLR hypertrophy (p=0.02). Median Child-Pugh score worsening (6→7) was seen at 1 to 3 months (p=0.03) and 3 to 6 months (p=0.05) after treatment. Five patients underwent successful right lobectomy (HCC N=3, CRC N=1, CC N=1) and 6 HCCs were transplanted.
Radiation lobectomy by Y90 is a safe and effective technique to hypertrophy the FLR. Volumetric changes are comparable (albeit slightly slower) to PVE while the right lobe tumor is treated synchronously. This novel technique is of particular interest in the bridge-to-resection setting.
Journal of Hepatology 06/2013; 59(5). DOI:10.1016/j.jhep.2013.06.015 · 11.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cholangiocarcinoma is a malignant neoplasm that originates from biliary epithelial cells. Complete tumor resection remains the most effective treatment of intra-hepatic or perihilar cholangiocarcinomas (PHCs). The objectives of this are to update and discuss methods that are likely to increase the resectability of cholangiocarcinomas, and to define the limits beyond which the risks of the treatments outweigh their benefits. We analyzed intra-hepatic cholangiocarcinomas and PHCs separately to determine the site of origin and the resectability of the tumor. We discussed the site at which to perform hepatic optimization prior to surgery, and whether liver transplantation might affect cholangiocarcinoma treatment.
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