• Immunotherapy
• Liver Cancer
• Radioembolization
• Therapy

• Case report
• Conversion therapy
• Hepatic arterial infusion chemotherapy
• Hepatocellular carcinoma
• Selective internal radiation therapy
• Yttrium-90 resin microspheres

• ALPPS
• Future liver remnant
• LVD
• Liver hypertrophy
• Liver regeneration
• Liver venous deprivation
• PHLF
• Portal vein embolization

• Humans
• Hepatectomy/methods
• Liver Regeneration
• Liver Neoplasms/surgery
• Liver Neoplasms/pathology
• Liver/surgery
• Liver/pathology
• Liver/diagnostic imaging
• Hypertrophy
• Liver Failure/etiology
• Liver Failure/surgery
• Organ Size
• Postoperative Complications
• Prognosis

• Future liver remnant
• Liver venous deprivation
• Portal vein embolization
• Radiation lobectomy

• Humans
• Liver Neoplasms/surgery
• Liver Neoplasms/radiotherapy
• Liver Neoplasms/diagnostic imaging
• Carcinoma, Hepatocellular/surgery
• Carcinoma, Hepatocellular/diagnostic imaging
• Carcinoma, Hepatocellular/therapy
• Carcinoma, Hepatocellular/radiotherapy
• Embolization, Therapeutic/methods
• Hepatectomy/methods
• Portal Vein
• Surgery, Computer-Assisted/methods

• contralateral hypertrophy
• hepatocellular carcinoma
• statistical analysis
• transarterial radioembolization
• yttrium-90

• Humans
• Carcinoma, Hepatocellular/therapy
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/radiotherapy
• Chemoembolization, Therapeutic/methods
• Vascular Surgical Procedures

• P30 CA008748 NCI NIH HHS

• future liver remnant
• hepatocellular carcinoma
• liver hypertrophy
• liver volume
• radioembolization
• selective internal radiation therapy

• Cirugía
• Downstaging
• Hipertrofia
• Hypertrophy
• Liver resection
• Radioembolización
• Radioembolization
• Resección hepática
• Surgery

• DEBIRI-TACE
• TACE
• TARE
• colorectal metastases
• hepatic colorectal metastases
• interventional oncology
• interventions in colorectal metastases
• percutaneous ablation

• hepatocellular carcinoma
• intrahepatic cholangiocarcinoma
• liver resection
• liver transplantation
• radioembolization

• Embolization, Therapeutic/methods
• Hepatectomy/adverse effects
• Humans
• Liver/surgery
• Portal Vein/pathology
• Treatment Outcome

• Liver
• Lobar
• Lobectomy
• Radioembolization
• Volumetry

Liver surgery after radioembolization (RE) entails highly demanding and challenging procedures due to the frequent combination of large tumors, severe RE-related adhesions, and the necessity of conducting major hepatectomies. Laparoscopic liver resection (LLR) and its associated advantages could provide benefits, as yet unreported, to these patients. The current study evaluated feasibility, morbidity, mortality, and survival outcomes for major laparoscopic liver resection after radioembolization.

In this retrospective, single-center study patients diagnosed with hepatocellular carcinoma, intrahepatic cholangiocarcinoma or metastases from colorectal cancer undergoing major laparoscopic hepatectomy after RE were identified from institutional databases. They were matched (1:2) on several pre-operative characteristics to a group of patients that underwent major LLR for the same malignancies during the same period but without previous RE.

From March 2011 to November 2020, 9 patients underwent a major LLR after RE. No differences were observed in intraoperative blood loss (50 vs. 150 ml; p = 0.621), operative time (478 vs. 407 min; p = 0.135) or pedicle clamping time (90.5 vs 74 min; p = 0.133) between the post-RE LLR and the matched group. Similarly, no differences were observed on hospital stay (median 3 vs. 4 days; p = 0.300), Clavien–Dindo ≥ III complications (2 vs. 1 cases; p = 0.250), specific liver morbidity (1 vs. 1 case p = 1.000), or 90 day mortality (0 vs. 0; p = 1.000).

The laparoscopic approach for post radioembolization patients may be a feasible and safe procedure with excellent surgical and oncological outcomes and meets the current standards for laparoscopic liver resections. Further studies with larger series are needed to confirm the results herein presented.

The online version contains supplementary material available at 10.1007/s00423-022-02474-z.

• Colorectal liver metastases
• Hepatocellular carcinoma
• Intrahepatic cholangiocarcinoma
• Laparoscopic liver resection
• Radioembolization

Lobar selective internal radiation therapy (SIRT) is widely used to treat liver tumors inducing atrophy of the treated lobe and contralateral hypertrophy. The lack of animal model has precluded further investigations to improve this treatment. We developed an animal model of liver damage and atrophy–hypertrophy complex after SIRT. Three groups of 5–8 rabbits received transportal SIRT with Yttrium 90 resin microspheres of the cranial lobes with different activities (0.3, 0.6 and 1.2 GBq), corresponding to predicted absorbed radiation dose of 200, 400 and 800 Gy, respectively. Another group received non-loaded microspheres (sham group). Cranial and caudal lobes volumes were assessed using CT volumetry before, 15 and 30 days after SIRT. Liver biochemistry, histopathology and gene expression were evaluated. Four untreated rabbits were used as controls for gene expression studies. All animals receiving 1.2 GBq were euthanized due to clinical deterioration. Cranial SIRT with 0.6 GBq induced caudal lobe hypertrophy after 15 days (median increase 34% -ns-) but produced significant toxicity. Cranial SIRT with 0.3 GBq induced caudal lobe hypertrophy after 30 days (median increase 82%, p = 0.04). No volumetric changes were detected in sham group. Transient increase in serum transaminases was detected in all treated groups returning to normal values at 15 days. There was dose-dependent liver dysfunction with bilirubin elevation and albumin decrease. Histologically, 1.2 GBq group developed permanent severe liver damage with massive necrosis, 0.6 and 0.3 GBq groups developed moderate damage with inflammation and portal fibrosis at 15 days, partially recovering at 30 days. There was no difference in the expression of hepatocyte function and differentiation genes between 0.3 GBq and control groups. Cranial SIRT with 0.3 GBq of ⁹⁰Y resin microspheres in rabbits is a reliable animal model to analyse the atrophy–hypertrophy complex and liver damage without toxicity.

• Chemotherapy
• HCC
• Immunotherapy
• Locoregional treatment
• SIRT
• TARE
• TKI
• Yttrium-90

• ALBI score
• Hepatocellular carcinoma
• Radioembolization
• Selective internal radiation therapy
• Sorafenib

• Aged
• Carcinoma, Hepatocellular/drug therapy
• Carcinoma, Hepatocellular/epidemiology
• Carcinoma, Hepatocellular/physiopathology
• Female
• Humans
• Liver Function Tests/methods
• Liver Function Tests/statistics & numerical data
• Liver Neoplasms/drug therapy
• Liver Neoplasms/epidemiology
• Liver Neoplasms/physiopathology
• Male
• Middle Aged
• Prospective Studies
• Radiotherapy/methods
• Radiotherapy/standards
• Radiotherapy/statistics & numerical data
• Sorafenib/pharmacology
• Sorafenib/therapeutic use
• Spain/epidemiology
• Treatment Outcome

Hepatocellular carcinoma (HCC) is one of the deadliest forms of cancer. Selective internal radiation therapy (SIRT) is one of the therapeutic options for treatment of advanced HCC. Studies show that SIRT has a high objective response rate, but lack of survival benefit when compared to different treatment modalities. We hypothesized that this is due to potential damage in healthy liver parenchyma as a side-effect of SIRT, resulting in functional changes to the liver. This can ultimately result in liver decompensation and potentially death. The aim of this retrospective study was to assess long-term liver-related complications after SIRT in patients with HCC. We analyzed patients who underwent SIRT and found that liver decompensation occurred more often after SIRT when compared to sorafenib. However, careful patient selection may result in a survival benefit after SIRT when compared to other treatments. The ABLI score may be a valuable prognostic score for selecting patients.

Selective internal radiation therapy (SIRT) is used as a treatment for hepatocellular carcinoma (HCC). The aim of this study was to assess long-term liver-related complications of SIRT in patients who had not developed radioembolization-induced liver disease (REILD). The primary outcome was the percentage of patients without REILD that developed Child-Pugh (CP) ≥ B7 liver decompensation after SIRT. The secondary outcomes were overall survival (OS) and tumor response. These data were compared with a matched cohort of patients treated with sorafenib. Eighty-five patients were included, of whom 16 developed REILD. Of the remaining 69 patients, 38 developed liver decompensation CP ≥ B7. The median OS was 18 months. In patients without REILD, the median OS in patients with CP ≥ B7 was significantly shorter compared to those without CP ≥ B7; 16 vs. 31 months. In the case-matched analysis, the median OS was significantly longer in SIRT-treated patients; 16 vs. 8 months in sorafenib. Liver decompensation CP ≥ B7 occurred significantly more in SIRT when compared to sorafenib; 62% vs. 27%. The ALBI score was an independent predictor of liver decompensation (OR 0.07) and OS (HR 2.83). After SIRT, liver decompensation CP ≥ B7 often developed as a late complication in HCC patients and was associated with a shorter OS. The ALBI score was predictive of CP ≥ B7 liver decompensation and the OS, and this may be a valuable marker for patient selection for SIRT.

• hepatocellular carcinoma
• liver decompensation
• long-term response
• overall survival
• selective internal radiation therapy

• future liver remnant
• hepatocellular carcinoma
• interventional radiology
• radiation lobectomy
• radioembolization

• Liver resection
• future remnant liver (FRL)
• hypertrophy
• liver failure
• liver function
• liver volume

• Dosimetry
• Hypertrophy
• Radioembolization
• SIRT
• Yttrium-90

Selective internal radiotherapy (SIRT) with yttrium-90 (Y-90) is an intra-arterial therapy for hepatic malignancy in patients who are unsuitable for surgical resection. This treatment is considered palliative, although some patients can demonstrate a response that is adequate to facilitate surgical resection with curative intent.

All patients who underwent liver resection post SIRT were reviewed. Data gathered included patient demographics, tumor type, surgical details, and post-operative outcomes.

Twelve patients underwent SIRT followed by liver resection (7 males and 5 females). Pathologies were hepatocellular carcinoma (n = 5), metastatic colorectal cancer (n = 5), and neuroendocrine tumor (n = 2). Lesional response (size, volume, and RECIST (response evaluation criteria in solid tumors)) was calculated and where appropriate functional liver remnant (FLR) is presented. Mean FLR increase was 264cm³ (range − 123 to 909), and all cases demonstrated a partial response according to RECIST with a mean largest lesion volume reduction of 475cm³ (range 14–1632). No post-SIRT complications were noted. Hepatectomy occurred at a mean of 322 days from SIRT treatment. Ninety-day morbidity was 67% (n = 6), complications post-surgery were analyzed according to the Clavien-Dindo classification scale; a total of 15 events occurred in 6 patients. Ninety-day mortality of 11% (n = 1).

In selected cases, liver resection is possible post SIRT. As this can represent a potentially curative option, it is important to reconsider resection in the follow-up of patients undergoing SIRT. Post-operative complications are noted following major and extended liver resection. Therefore, further studies are needed to improve patient selection.

• Hepatic malignancy
• Radioembolization
• Resection after SIRT
• SIRT
• Selective internal radiotherapy
• Surgical resection
• Y90

Interventional oncology represents a relatively new clinical discipline based upon minimally invasive therapies applicable to almost every human organ and disease. Over the last several decades, rapidly evolving research developments have introduced a newer generation of treatment devices, reagents, and image-guidance systems to expand the armamentarium of interventional oncology across a wide spectrum of disease sites, offering potential cure, control, or palliative care for many types of cancer patients. Due to the widespread use of locoregional procedures, a comprehensive review of the methodologic and technical considerations to optimize patient selection with the aim of performing a safe procedure is mandatory. This article summarizes the expert discussion and report from the Mediterranean Interventional Oncology Live Congress (MIOLive 2020) held in Rome, Italy, integrating evidence-reported literature and experience-based perceptions as a means for providing guidance on prudent ways to reduce complications. The aim of the paper is to provide an updated guiding tool not only to residents and fellows but also to colleagues approaching locoregional treatments.

• ablation
• cancer
• chemoembolization
• complications
• locoregional treatment
• radioembolization
• safety

• ALPPS
• Associating liver partition and portal vein ligation for staged heaptectomy
• Bile leakage
• Cirrhosis
• Hepatectomy
• Hepatocellular carcinoma
• ICG
• Liver failure
• Liver resection
• Portal vein embolization
• Robotic liver surgery
• Volumetry

• Hepatectomy/methods
• Hepatectomy/trends
• Humans
• Liver/surgery
• Liver Cirrhosis/surgery
• Liver Regeneration
• Postoperative Complications/etiology
• Treatment Outcome

• Ablation
• Colorectal cancer
• Liver metastases
• Radioembolization

• Hepatic regeneration
• embolization
• future liver remnant

• P30 CA008748 NCI NIH HHS
• UL1 TR001863 NCATS NIH HHS

• Radioembolization
• downstaging
• hepatocellular carcinoma

Radioembolization with ⁹⁰Y-microspheres has been reported to induce contralateral liver hypertrophy with simultaneous ipsilateral control of tumor growth. The aim of the present systematic review was to summarize the evidence of contralateral liver hypertrophy and oncological outcome following unilateral treatment with radioembolization. A systematic literature search using the MEDLINE, EMBASE, and Cochrane libraries for studies published between 2008 and 2020 was performed. A total of 16 studies, comprising 602 patients, were included. The median kinetic growth rate per week of the contralateral liver lobe was 0.7% and declined slightly over time. The local tumor control was 84%. Surgical resection after radioembolization was carried out in 109 out of 362 patients (30%). Although the available data suggest that radioembolization prior to major hepatectomy is safe with a promising oncological outcome, the definitive role of radioembolization requires assessment within controlled clinical trials.

• SIRT
• hepatectomy
• liver resections
• neoadjuvant
• preconditioning
• selective internal radiation therapy

• Radiation lobectomy
• Radiation segmentectomy
• Segmental radioembolization
• Y90 lobectomy
• Y90 segmentectomy

To review the conversion therapy for initially unresectable hepatocellular carcinoma (HCC) patients and the suitable timing for subsequent salvage surgery.

A PubMed search was undertaken from 1987 to 2017 to identify articles using the keywords including “unresectable” “hepatocellular carcinoma”, ”hepatectomy”, ”conversion therapy”, “resection”, “salvage surgery” and “downstaging”. Additional studies were investigated through a manual search of the references from the articles. The exclusion criteria were duplicates, case reports, case series, videos, contents unrelated to the topic, comments, and editorial essays. The main and widely used conversion therapies and the suitable timing for subsequent salvage surgery were discussed in detail. Two members of our group independently performed the literature search and data extraction.

Liver volume measurements [future liver remnant (FLR)/total liver volume or residual liver volume/bodyweight ratio] and function tests (scoring systems and liver stiffness) were often performed in order to justify whether patients were suitable candidates for surgery. Successful conversion therapy was usually defined as downstaging the tumor, increasing FLR and providing subsequent salvage surgery, without increasing complications, morbidity or mortality. The requirements for performing salvage surgery after transcatheter arterial chemoembolization were the achievement of a partial remission in radiology, the disappearance of the portal vein thrombosis, and the lack of extrahepatic metastasis. Patients with a standardized FLR (sFLR) > 20% were good candidates for surgery after portal vein embolization, while other predictive parameters like growth rate, kinetic growth rate were treated as an effective supplementary. There was probably not enough evidence to provide a standard operation time after associating liver partition and portal vein ligation for staged hepatectomy or yttrium-90 microsphere radioembolization. The indications of any combinations of conversion therapies and the subsequent salvage surgery time still need to be carefully and comprehensively evaluated.

Conversion therapy is recommended for the treatment of initially unresectable HCC, and the suitable subsequent salvage surgery time should be reappraised and is closely related to its previous therapeutic effect.

• Unresectable
• Hepatocellular carcinoma
• Hepatectomy
• Conversion therapy
• Salvage surgery
• Downstaging

• Adult
• Aged
• Carcinoma, Hepatocellular/radiotherapy
• Hepatomegaly
• Humans
• Liver Neoplasms/radiotherapy
• Male
• Middle Aged
• Prospective Studies
• Yttrium Radioisotopes/therapeutic use

• Selective internal radiation therapy (SIRT)
• consensus
• cytotoxins
• liver neoplasms

• 8971 Cancer Research UK

This study aimed at identifying prior therapy dosimetric parameters using ^99mTc-labeled macro-aggregates of albumin (MAA) that are associated with contralateral hepatic hypertrophy occurring after unilobar radioembolization of hepatocellular carcinoma (HCC) performed with ⁹⁰Y–loaded glass microspheres.

The dosimetry data of 73 HCC patients were collected prior to the treatment with ⁹⁰Y–loaded microspheres for unilateral disease. The injected liver dose (ILD), the tumor dose (TD) and healthy injected liver dose (HILD) were calculated based on MAA quantification. Following treatment, the maximal hypertrophy (MHT) of an untreated lobe was calculated.

Mean MHT was 35.4 ± 40.4%. When using continuous variables, the MHT was not correlated with any tested variable, i.e., injected activity, ILD, HILD or TD except with a percentage of future remnant liver (FRL) following the ⁹⁰Y–microspheres injection  (r = −0.56). MHT ≥ 10% was significantly more frequent for patients with HILD ≥ 88 Gy, (52% of the cases), i.e., in 92.2% versus 65.7% for HILD < 88 Gy (p = 0.032). MHT ≥ 10% was also significantly more frequent for patients with a TD ≥ 205 Gy and a tumor volume (VT) ≥ 100 cm³ in patients with initial FRL < 50%. MHT ≥10% was seen in 83.9% for patients with either an HILD ≥ 88 Gy or a TD ≥ 205 Gy for tumors larger than 100cm³ (85% of the cases), versus only 54.5% (p = 0.0265) for patients with none of those parameters. MHT ≥10% was also associated with FRL and the Child-Pugh score. Using multivariate analysis, the Child-Pugh score (p < 0.0001), FRL (p = 0.0023) and HILD (p = 0.0029) were still significantly associated with MHT ≥10%.

This study demonstrates for the first time that HILD is significantly associated with liver hypertrophy. There is also an impact of high tumor doses in large lesions in one subgroup of patients. Larger prospective studies evaluating the MAA dosimetric parameters have to be conducted to confirm these promising results.

• 90Y–loaded glass microspheres
• 99mTc-labeled albumin
• Hepatocellular carcinoma
• Liver hypertrophy
• Predictive dosimetry
• Radioembolization

• Ablación tumoral
• Carcinoma hepatocelular
• Chemoembolization
• Hepatocellular carcinoma
• Quimioembolización
• Radioembolización
• Radioembolization
• Radiofrecuencia
• Radiofrequency
• Tumoral ablation