Radiation Lobectomy: An Overview of Concept and Applications, Technical Considerations, Outcomes

2021 ◽  
Vol 38 (04) ◽  
pp. 419-424
Author(s):  
Pouya Entezari ◽  
Ahmed Gabr ◽  
Kristie Kennedy ◽  
Riad Salem ◽  
Robert J. Lewandowski
Keyword(s):  
Early Stage ◽  
Future Liver Remnant ◽  
High Dose ◽  
Hepatic Malignancy ◽  
Curative Intent ◽  
Liver Remnant ◽  
Y90 Radioembolization ◽  
Flr Hypertrophy ◽  
Hepatic Malignancies ◽  
Technical Considerations

AbstractSurgical resection has long been considered curative for patients with early-stage hepatocellular carcinoma (HCC). However, inadequate future liver remnant (FLR) renders many patients not amenable to surgery. Recently, lobar administration of yttrium-90 (Y90) radioembolization has been utilized to induce FLR hypertrophy while providing disease control, eventually facilitating resection in patients with hepatic malignancy. This has been termed “radiation lobectomy (RL).” The concept is evolving, with modified approaches combining RL and high-dose curative-intent radioembolization (radiation segmentectomy) to achieve tumor ablation. This article provides an overview of the concept and applications of RL, including technical considerations and outcomes in patients with hepatic malignancies.

scholarly journals MINI-ALPPS achieves adequate future liver remnant (FLR) hypertrophy to allow safe two stage liver resection

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S941
Author(s):  
T. Duncan ◽  
S. Junnarkar ◽  
Z. Kaposztas ◽  
D. O'Reilly ◽  
J. Rees ◽  
...  
Keyword(s):  
Liver Resection ◽  
Future Liver Remnant ◽  
Two Stage ◽  
Liver Remnant ◽  
Flr Hypertrophy

scholarly journals Surgical Treatment of Intrahepatic Cholangiocarcinoma: Current and Emerging Principles

2020 ◽  
Vol 10 (1) ◽  
pp. 104
Author(s):  
Eliza W. Beal ◽  
Jordan M. Cloyd ◽  
Timothy M. Pawlik
Keyword(s):  
Intrahepatic Cholangiocarcinoma ◽  
Early Stage ◽  
Preoperative Evaluation ◽  
Locally Advanced ◽  
Surgical Techniques ◽  
Future Liver Remnant ◽  
Surgical Morbidity ◽  
Early Stage Disease ◽  
Liver Remnant

Intrahepatic cholangiocarcinoma (ICC) is a rare, aggressive cancer of the biliary tract. It often presents with locally advanced or metastatic disease, but for patients with early-stage disease, surgical resection with negative margins and portahepatis lymphadenectomy is the standard of care. Recent advancements in ICC include refinement of staging, improvement in liver-directed therapies, clarification of the role of adjuvant therapy based on new randomized controlled trials, and advances in minimally invasive liver surgery. In addition, improvements in neoadjuvant strategies and surgical techniques have enabled expanded surgical indications and reduced surgical morbidity and mortality. However, recurrence rates remain high and more effective systemic therapies are still necessary to improve recurrence-free and overall survival. In this review, we focus on current and emerging surgical principals for the management of ICC including preoperative evaluation, current indications for surgery, strategies for future liver remnant augmentation, technical principles, and the role of neoadjuvant and adjuvant therapies.

scholarly journals A Comparison of Portal Vein Embolization With Poly(2-hydroxyethylmethacrylate) and a Histoacryl/Lipiodol Mixture in Patients Scheduled for Extended Right Hepatectomy

2015 ◽  
pp. 841-848 ◽  
Author(s):  
J. H. PEREGRIN ◽  
R. JANOUŠEK ◽  
D. KAUTZNEROVÁ ◽  
M. OLIVERIUS ◽  
E. STICOVÁ ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portal Vein Embolization ◽  
Future Liver Remnant ◽  
Right Hepatectomy ◽  
Portal Vein Branch ◽  
Liver Remnant ◽  
Extended Right Hepatectomy ◽  
The Right ◽  
Transhepatic Access ◽  
Flr Hypertrophy

ght hepatectomy and whether it is as effective as the currently used agent (a histoacryl/lipiodol mixture). Two groups of nine patients each scheduled for extended right hepatectomy for primary or secondary hepatic tumor, had right portal vein embolization in an effort to induce future liver remnant (FLR) hypertrophy. One group had embolization with PHEMA, the other one with the histoacryl/lipiodol mixture. In all patients, embolization was performed using the right retrograde transhepatic access. Embolization was technically successful in all 18 patients, with no complication related to the embolization agent. Eight patients of either group developed FLR hypertrophy allowing extended right hepatectomy. Likewise, one patient in each group had recanalization of a portal vein branch. Histology showed that both embolization agents reach the periphery of portal vein branches, with PHEMA penetrating somewhat deeper into the periphery. PHEMA has been shown to be an agent suitable for embolization in the portal venous system comparable with existing embolization agent (histoacryl/lipiodol mixture).

scholarly journals MINI-ALPPS Achieves Adequate Future Liver Remnant (FLR) Hypertrophy To Allow Safe Two Stage Liver Resection

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S618
Author(s):  
T. Duncan ◽  
S. Junnarkar ◽  
Z. Kaposztas ◽  
D. O'Reilly ◽  
J. Rees ◽  
...  
Keyword(s):  
Liver Resection ◽  
Future Liver Remnant ◽  
Two Stage ◽  
Liver Remnant ◽  
Flr Hypertrophy

scholarly journals The CHOP Study – Cholestatic Influence on Portal Vein Embolization (PVE) Induced Future Liver Remnant (FLR) Hypertrophy – A Maastricht Aachen Analysis

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S734-S735
Author(s):  
R. Korenblik ◽  
X. Chang ◽  
B. Olij ◽  
R. Knapen ◽  
C. Van der Leij ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portal Vein Embolization ◽  
Future Liver Remnant ◽  
Liver Remnant ◽  
Flr Hypertrophy

scholarly journals 90Y Radiation lobectomy followed by liver resection for hepatic malignancies with insufficient future liver remnant: First experience.

HPB ◽  
2020 ◽  
Vol 22 ◽  
pp. S389-S390
Author(s):  
J. Jongen ◽  
J. Hagendoorn ◽  
W. Te Riele ◽  
A. Braat ◽  
H. Van Santvoort ◽  
...  
Keyword(s):  
Liver Resection ◽  
Future Liver Remnant ◽  
Liver Remnant ◽  
Hepatic Malignancies

scholarly journals Induction of Robust Future Liver Remnant Hypertrophy Before Hepatectomy With a Modified Liver Venous Deprivation Technique Using a Trans-venous Access for Hepatic Vein Embolization

2021 ◽  
Vol 1 ◽  
Author(s):  
Nils Degrauwe ◽  
Rafael Duran ◽  
Emmanuel Melloul ◽  
Nermin Halkic ◽  
Nicolas Demartines ◽  
...  
Keyword(s):  
Hepatic Vein ◽  
Surgical Outcome ◽  
Primary Liver Cancer ◽  
Future Liver Remnant ◽  
Venous Access ◽  
Liver Remnant ◽  
Wide Range ◽  
Oncologic Patients ◽  
Flr Hypertrophy ◽  
Hepatic Vein Embolization

Purpose: Hepatic and/or portal vein embolization are performed before hepatectomy for patients with insufficient future liver remnant and usually achieved with a trans-hepatic approach. The aim of the present study is to describe a modified trans-venous liver venous deprivation technique (mLVD), avoiding the potential risks and limitations of a percutaneous approach to hepatic vein embolization, and to assess the safety, efficacy, and surgical outcome after mLVD.Materials and Methods: Retrospective single-center institutional review board-approved study. From March 2016 to June 2019, consecutive oncologic patients with combined portal and hepatic vein embolization were included. CT volumetric analysis was performed before and after mLVD to assess liver hypertrophy. Complications related to mLVD and surgical outcome were obtained from medical records.Results: Thirty patients (62.7 ± 14.5 years old, 20 men) with liver metastasis (60%) or primary liver cancer (40%) underwent mLVD. Twenty-one patients (70%) had hepatic vein anatomic variants. Technical success of mLVD was 100%. Four patients had complications (three minor and one major). FLR hypertrophy was 64.2% ± 51.3% (mean ± SD). Twenty-four patients (80%) underwent the planned hepatectomy and no surgery was canceled as a consequence of mLVD complications or insufficient hypertrophy. Fifty percent of patients (12/24) had no or mild complications after surgery (Clavien-Dindo 0–II), and 45.8% (11/24) had more serious complications (Clavien-Dindo III–IV). Thirty-day mortality was 4.2% (1/24).Conclusion: mLVD is an effective method to induce FLR hypertrophy. This technique is applicable in a wide range of oncologic situations and in patients with complex right liver vein anatomy.

scholarly journals Radiologically Occult Lung Cancer Curatively Treated with High-Dose Rate Endobronchial Brachytherapy

2021 ◽  
Vol 11 ◽  
pp. 45
Author(s):  
Deepinder Pal Singh ◽  
Khush Aujla ◽  
Michael Nead ◽  
Kevin Bylund
Keyword(s):  
Lung Cancer ◽  
Dose Rate ◽  
Early Stage ◽  
Primary Lung Cancer ◽  
Lower Lobe ◽  
High Dose Rate ◽  
High Dose ◽  
Curative Intent ◽  
Long Term Outcome ◽  
Early Stage Nsclc

Most patients diagnosed with early-stage non-small cell lung cancer (NSCLC) can be easily cured with surgery or stereotactic body radiotherapy (SBRT). Modalities such as photodynamic therapy, cryotherapy, or laser therapy only offer temporary palliation. A 79-year-old gentleman with early-stage NSCLC who underwent a left lower lobe lobectomy in 2009 presented to us again in 2010 with hemoptysis. A friable ~5 cm tumor along the bifurcation of anterior and the posterior segment of the right upper lobe was noted on bronchoscopic examination, and biopsy confirmed this to be squamous cell carcinoma. Because of his previous surgery, the patient was not a candidate for another surgery. SBRT was not possible as the lesion could not be seen on radiologic imaging. The patient was, therefore, treated with curative intent high-dose rate endobronchial brachytherapy (HDR-EBBT) in 4 weekly sessions of 7 Gy per fraction delivered at a depth of 8 mm, covering ~5 cm tumor plus 1 cm margin proximally and distally. He tolerated the treatment well without any acute or late side effects and was followed every 3 months thereafter with bronchoscopy examinations for 6 months and subsequently with computerized tomography (CT) imaging. In July 2018, the patient started having episodes of hemoptysis and evaluation leads to diagnosis of a third primary lung cancer, which was successfully treated with SBRT with image-guided radiotherapy using a five-fraction regimen. The patient’s most recent CT from July 2019 showed no evidence of disease. We conclude that in patients with early-stage NSCLC, when surgery or SBRT is not feasible due to radiologic occult nature, HDR-EBBT can yield excellent long-term outcome.

Relapse After Early-Stage, Favorable Hodgkin Lymphoma: Disease Characteristics and Outcomes With Conventional or High-Dose Chemotherapy

2021 ◽  
Vol 39 (2) ◽  
pp. 107-115
Author(s):  
Paul J. Bröckelmann ◽  
Horst Müller ◽  
Teresa Guhl ◽  
Karolin Behringer ◽  
Michael Fuchs ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Early Stage ◽  
High Dose Chemotherapy ◽  
Sensitivity Analyses ◽  
High Dose ◽  
Second Line ◽  
Second Line Therapy ◽  
Line Therapy ◽  
Significant Difference ◽  
First Diagnosis

PURPOSE We evaluated disease and treatment characteristics of patients with relapse after risk-adapted first-line treatment of early-stage, favorable, classic Hodgkin lymphoma (ES-HL). We compared second-line therapy with high-dose chemotherapy and autologous stem cell transplantation (ASCT) or conventional chemotherapy (CTx). METHODS We analyzed patients with relapse after ES-HL treated within the German Hodgkin Study Group HD10+HD13 trials. We compared, by Cox proportional hazards regression, progression-free survival (PFS) after relapse (second PFS) treated with either ASCT or CTx and performed sensitivity analyses with overall survival (OS) from relapse and Kaplan-Meier statistics. RESULTS A total of 174 patients’ disease relapsed after treatment in the HD10 (n = 53) and HD13 (n = 121) trials. Relapse mostly occurred > 12 months after first diagnosis, predominantly with stage I-II disease. Of 172 patients with known second-line therapy, 85 received CTx (49%); 70, ASCT (41%); 11, radiotherapy only (6%); and 4, palliative single agent therapies (2%). CTx was predominantly bleomycin, etoposide, doxorubicin cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP [68%]), followed by the combination regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine (19%), or other regimens (13%). Patients aged > 60 years at relapse had shorter second PFS (hazard ratio [HR], 3.0; P = .0029) and were mostly treated with CTx (n = 33 of 49; 67%) and rarely with ASCT (n = 8; 16%). After adjustment for age and a disadvantage of ASCT after the more historic HD10 trial, we did not observe a significant difference in the efficacy of CTx versus ASCT for second PFS (HR, 0.7; 95% CI, 0.3 to 1.6; P = .39). In patients in the HD13 trial who were aged ≤ 60 years, the 2-year, second PFS rate was 94.0% with CTx (95% CI, 85.7% to 100%) versus 83.3% with ASCT (95% CI, 71.8% to 94.8%). Additional sensitivity analyses including OS confirmed these observations. CONCLUSION After contemporary treatment of ES-HL, relapse mostly occurred > 12 months after first diagnosis. Polychemotherapy regimens such as BEACOPP are frequently administered and may constitute a reasonable treatment option for selected patients with relapse after ES-HL.

Sign in / Sign up

Export Citation Format

Share Document