chapter  6
20 Pages

Radioembolization in segmentectomy, lobectomy, and future liver remnant hypertrophy

As the role of 90Y transarterial radioembolization has evolved, specic treatment paradigms have led to the development of radioembolization applications analogous to surgical liver interventions. e rst such application is “radiation lobectomy,” in which radioembolization is performed to treat an unresectable right lobe liver lesion with the

threefold intention of treating the tumor, allowing a biological test of time to select for less aggressive lesions and causing le lobe hypertrophy as a means of enabling right lobe surgical resection. e second analogous concept is “radiation segmentectomy,” in which a large dose of radiation is delivered to a small volume of liver thereby imparting a highly tumoricidal dose to the perfused target, while sparing adjacent and nontarget liver parenchyma. ese concepts have broadened the armament physicians

6.1 Introduction 113 6.2 Treatment planning and delivery 114 6.3 Radiation lobectomy and future liver

remnant hypertrophy 114 6.3.1 Definition and treatment rationale 114 6.3.2 Radiation biology and radiation lobectomy 115 6.3.3 Patient selection 116 6.3.4 Lobectomy dosimetry 116 6.3.5 Radiation lobectomy and

the future liver remnant hypertrophy outcome data 117

6.4 Radiation segmentectomy 119 6.4.1 Definition and treatment rationale 119 6.4.2 Patient selection 120 6.4.3 Segmentectomy dosimetry 120 6.4.4 Radiation segmentectomy

outcome data 120

6.5 Radioembolization toxicities and complications 122 6.5.1 Radiation segmentectomy toxicities 123

6.6 Posttreatment patient management 123 6.6.1 Patient care in the immediate postprocedure setting 123 6.6.2 Follow-up evaluation 124 6.6.3 Imaging response 124

6.7 Clinical case examples 124 6.7.1 Sample radiation lobectomy and the future liver remnant

hypertrophy case 124 6.7.2 Sample radiation segmentectomy case 126

6.8 Conclusions 128 References 128

have available to treat liver tumors by allowing for treatment of lesions with complex anatomic locations and by expanding the patient population eligible for interventions. e radiation biology, physics, nuclear medicine, and interventional radiology concepts related to these treatment entities are discussed in this chapter.