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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.
Gulec, Seza A; Pennington, Kenneth; Hall, Michael; Fong, Yuman.
Afiliación
  • Gulec SA; Center for Cancer Care at Goshen Health System, Goshen, IN, USA. sgulec@fiu.edu
World J Surg Oncol ; 7: 6, 2009 Jan 08.
Article en En | MEDLINE | ID: mdl-19133156
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.
Asunto(s)

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Radioisótopos de Itrio / Carcinoma de Células Escamosas / Hepatectomía / Neoplasias Hepáticas Tipo de estudio: Diagnostic_studies / Prognostic_studies Límite: Female / Humans / Middle aged Idioma: En Revista: World J Surg Oncol Año: 2009 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Radioisótopos de Itrio / Carcinoma de Células Escamosas / Hepatectomía / Neoplasias Hepáticas Tipo de estudio: Diagnostic_studies / Prognostic_studies Límite: Female / Humans / Middle aged Idioma: En Revista: World J Surg Oncol Año: 2009 Tipo del documento: Article País de afiliación: Estados Unidos