Preoperative Y-90 microsphere selective internal radiation treatment for tumor downsizing and future liver remnant recruitment: A novel approach to improving the safety of major hepatic resections Journal Article


Authors: Gulec, S. A.; Pennington, K.; Hall, M.; Fong, Y.
Article Title: Preoperative Y-90 microsphere selective internal radiation treatment for tumor downsizing and future liver remnant recruitment: A novel approach to improving the safety of major hepatic resections
Abstract: Background: Extended liver resections are being performed more liberally than ever. The extent of resection of liver metastases, however, is restricted by the volume of the future liver remnant (FLR). An intervention that would both accomplish tumor control and induce compensatory hypertrophy, with good patient tolerability, could improve clinical outcomes. Case presentation: A 53-year-old woman with a history of cervical cancer presented with a large liver mass. Subsequent biopsy indicated poorly differentiated carcinoma with necrosis suggestive of squamous cell origin. A decision was made to proceed with pre-operative chemotherapy and Y-90 microsphere SIRT with the intent to obtain systemic control over the disease, downsize the hepatic lesion, and improve the FLR. A surgical exploration was performed six months after the first SIRT (three months after the second). There was no extrahepatic disease. The tumor was found to be significantly decreased in size with central and peripheral scarring. The left lobe was satisfactorily hypertrophied. A formal right hepatic lobectomy was performed with macroscopic negative margins. Conclusion: Selective internal radiation treatment (SIRT) with yttrium-90 (Y-90) microspheres has emerged as an effective liver-directed therapy with a favorable therapeutic ratio. We present this case report to suggest that the portal vein radiation dose can be substantially increased with the intent of inducing portal/periportal fibrosis. Such a therapeutic manipulation in lobar Y-90 microsphere treatment could accomplish the end points of PVE with avoidance of the concern regarding tumor progression. © 2009 Gulec et al; licensee BioMed Central Ltd.
Keywords: adult; middle aged; unclassified drug; histopathology; case report; squamous cell carcinoma; carcinoma, squamous cell; fluorouracil; artificial embolism; liver neoplasms; cancer radiotherapy; preoperative care; positron emission tomography; metastasis; computer assisted tomography; multiple cycle treatment; tomography, x-ray computed; pathology; diagnostic agent; dosimetry; folinic acid; uterine cervix cancer; liver tumor; fluorodeoxyglucose f 18; fluorodeoxyglucose f18; positron-emission tomography; liver resection; hepatectomy; liver function test; preoperative treatment; oxaliplatin; absence of side effects; uterine cervical neoplasms; fluorodeoxyglucose; microsphere y 90; radioactive microsphere; yttrium; liver angiography; liver lobectomy; portal vein; uterine cervix tumor; embolization, therapeutic; yttrium radioisotopes
Journal Title: World Journal of Surgical Oncology
Volume: 7
ISSN: 1477-7819
Publisher: Biomed Central Ltd  
Date Published: 2009-01-08
Start Page: 6
Language: English
DOI: 10.1186/1477-7819-7-6
PUBMED: 19133156
PROVIDER: scopus
PMCID: PMC2655298
DOI/URL:
Notes: --- - "Cited By (since 1996): 4" - "Export Date: 30 November 2010" - "Art. No.: 6" - "Source: Scopus"
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  1. Yuman Fong
    775 Fong