Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany.
Clin Radiol. 2014 Feb;69(2):172-8. doi: 10.1016/j.crad.2013.09.009. Epub 2013 Oct 25.
To assess volume changes of treated and non-treated liver segments after selective internal radiation therapy (SIRT) in patients with hepatocellular carcinoma (HCC) and compromised hepatic function due to cirrhosis over a time course of 12 months after SIRT.
All patients underwent SIRT of the right liver lobe with yttrium 90 (Y-90). Absolute volumes of the right liver lobe (RLV) and left liver lobe (LLV) were assessed using computed tomography (CT) before and 1, 3, 6, 9, and 12 months after SIRT. Changes at follow-up relative to baseline volumes were analysed ("normalized" volumes). Furthermore, the relative volume of the LLV [LLV/(RLV + LLV)] was calculated ("relative" volumes). For statistical analysis p < 0.05 was considered statistically significant.
Forty-five HCC patients (36 men, nine women, mean age 71.9 years, range 55-90 years) were studied. The mean baseline RLV and LLV reached 1116 ml [95% confidence intervals (CI): 1006-1226 ml] and 601 ml (95% CI: 514-688 ml), respectively. At 6 months following radioembolization, the LLV increased by 30.8% (RLV -33.9%), with the relative LLV increasing from 35% (pre-radioembolization) to 50.5%. RLV further decreased and LLV increased 12 months after SIRT (nRLV -44.9%, nLLV +40.1%, relative LLV 56.5%). All changes were significant.
Constraints of liver function after radioembolization of one liver lobe can be partially compensated through hypertrophy of the contralateral lobe. The rate of volumetric changes is the highest in the first 6 months following radioembolization. The present data can also be the basis to propagate radiation lobectomy for selected patients, simultaneously providing tumour control and future remnant liver hypertrophy before curative hemihepatectomy.
评估因肝硬化导致肝功能受损的肝细胞癌（HCC）患者在接受选择性内部放射治疗（SIRT）后 12 个月内，经 SIRT 治疗和未经治疗的肝段的体积变化。
所有患者均接受钇 90（Y-90）右肝叶 SIRT。在 SIRT 前后，通过计算机断层扫描（CT）评估右肝叶（RLV）和左肝叶（LLV）的绝对体积。使用基线体积分析随访时的变化（“归一化”体积）。此外，计算左肝叶的相对体积[左肝叶/（右肝叶+左肝叶）]（“相对”体积）。统计学分析中，p＜0.05 被认为具有统计学意义。
研究了 45 例 HCC 患者（36 名男性，9 名女性，平均年龄 71.9 岁，范围 55-90 岁）。平均基线 RLV 和 LLV 分别达到 1116ml[95%置信区间（CI）：1006-1226ml]和 601ml（95%CI：514-688ml）。在 SIRT 后 6 个月，LLV 增加了 30.8%（RLV-33.9%），相对 LLV 从 35%（SIRT 前）增加到 50.5%。SIRT 后 12 个月，RLV 进一步减少，LLV 增加（nRLV-44.9%，nLLV+40.1%，相对 LLV 56.5%）。所有变化均具有统计学意义。
一侧肝脏接受放射栓塞治疗后的肝功能限制可以通过对侧肝脏的代偿性肥大来部分补偿。在 SIRT 后 6 个月内，体积变化率最高。目前的数据也可以为选择性患者的放射叶切除术提供依据，同时在根治性半肝切除前提供肿瘤控制和未来剩余肝组织的代偿性肥大。
