Abstract
Abstract
Background
Few studies support modified radiation lobectomy (mRL) as a bridge to curative resection. This retrospective study reviews outcomes after mRL.
Methods
Patients with primary hepatic tumors undergoing mRL
90
Y radioembolization to grow the future liver remnant (FLR) were reviewed. Outcomes included tumor response, FLR kinetics, tumor progression, surgical conversion, and pathologic outcomes.
Results
Fifteen patients (7 women, 8 men; mean age 66) with hepatocellular carcinoma (HCC,
n
= 7) and intrahepatic cholangiocarcinoma (ICC,
n
= 8) with mean tumor size 7.8 ± 3.7 cm were included. HCC patients were intermediate (BCLC B,
n
= 6) or advanced (BCLC C,
n
= 1) stage. No severe adverse events occurred. All patients had initial objective response at 30 days: 40% complete response, 60% partial response. Median FLR increased by 12% at 30 days and 30% at 90 days. Twelve patients (80%) became technically eligible for curative-intent surgery. Ultimately, 10 underwent major hepatectomy (
n
= 9) or transplant (
n
= 1) all with negative margins, at a mean of 122 ± 77 days post-treatment. Despite variable rates of pathologic necrosis, overall survival remained 80% after surgery.
Conclusions
Large primary hepatic tumors can be down-staged with mRL, promoting sufficient liver remnant hypertrophy while controlling tumor progression, suggesting that mRL may facilitate curative-intent surgery in carefully selected patients.