Treating and Downstaging Hepatocellular Carcinoma in the Caudate Lobe with Yttrium-90 Radioembolization

Abstract

Purpose

This study was designed to determine the technical feasibility, safety, efficacy, and potential to downstage patients to within transplantation criteria when treating patients with hepatocellular carcinoma (HCC) of the caudate lobe using Y90 radioembolization.

Methods

During a 4-year period, 8 of 291 patients treated with radioembolization for unresectable HCC had disease involving the caudate lobe. All patients were followed for treatment-related clinical/biochemical toxicities, serum tumor marker response, and treatment response. Imaging response was assessed with the World Health Organization (WHO) and European Association for the Study of the Liver (EASL) classification schemes. Pathologic response was reported as percent necrosis at explantation.

Results

Caudate lobe radioembolization was successfully performed in all eight patients. All patients presented with both cirrhosis and portal hypertension. Half were United Network for Organ Sharing (UNOS) stage T3 (n = 4, 50%). Fatigue was reported in half of the patients (n = 4, 50%). One (13%) grade 3/4 bilirubin toxicity was reported. One patient (13%) showed complete tumor response by WHO criteria, and three patients (38%) showed complete response using EASL guidelines. Serum AFP decreased by more than 50% in most patients (n = 6, 75%). Four patients (50%) were UNOS downstaged from T3 to T2, three of who underwent transplantation. One specimen showed histopathologic evidence of 100% complete necrosis, and two specimens demonstrated greater than 50% necrosis.

Conclusions

Radioembolization with yttrium-90 appears to be a feasible, safe, and effective treatment option for patients with unresectable caudate lobe HCC. It has the potential to downstage patients to transplantation.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. 1.

    (2004) TheraSphere Yttrium-90 microspheres package insert, MDS Nordion, Kanata, Canada

  2. 2.

    Bruix J, Castells A, Bosch J et al (1996) Surgical resection of hepatocellular carcinoma in cirrhotic patients: prognostic value of preoperative portal pressure. Gastroenterology 111(4):1018–1022

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Bruix J, Llovet JM, Castells A et al (1998) Transarterial embolization versus symptomatic treatment in patients with advanced hepatocellular carcinoma: results of a randomized, controlled trial in a single institution. Hepatology 27(6):1578–1583

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Bruix J, Sherman M, Llovet JM et al (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35(3):421–430

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Chaib E, Ribeiro MA Jr, de Silva F, Saad WA, Cecconello I (2007) Surgical approach for hepatic caudate lobectomy: review of 401 cases. J Am Coll Surg 204(1):118–127

    PubMed  Article  Google Scholar 

  6. 6.

    Hirooka M, Kisaka Y, Uesugi K et al (2009) Virtual puncture line in radiofrequency ablation for hepatocellular carcinoma of the caudate lobe. AJR Am J Roentgenol 193(2):W149–W151

    PubMed  Article  Google Scholar 

  7. 7.

    Ibrahim SM, Lewandowski RJ, Sato KT et al (2008) Radioembolization for the treatment of unresectable hepatocellular carcinoma: a clinical review. World J Gastroenterol 14(11):1664–1669

    PubMed  Article  Google Scholar 

  8. 8.

    Ibrahim SM, Nikolaidis P, Miller FH et al (2008) Radiologic findings following Y90 radioembolization for primary liver malignancies. Abdom Imaging 34:572

    Google Scholar 

  9. 9.

    Kim HC, Chung JW, Jae HJ et al (2010) Caudate lobe hepatocellular carcinoma treated with selective chemoembolization. Radiology 257(1):278–287

    PubMed  Article  Google Scholar 

  10. 10.

    Lewandowski RJ, Kulik LM, Riaz A et al (2009) A comparative analysis of transarterial downstaging for hepatocellular carcinoma: chemoembolization versus radioembolization. Am J Transplant 9(8):1920–1928

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Lewandowski RJ, Mulcahy MF, Kulik LM et al (2010) Chemoembolization for hepatocellular carcinoma: comprehensive imaging and survival analysis in a 172-patient cohort. Radiology 255(3):955–965

    PubMed  Article  Google Scholar 

  12. 12.

    Lewandowski RJ, Sato KT, Atassi B et al (2007) Radioembolization with (90)Y microspheres: angiographic and technical considerations. Cardiovasc Intervent Radiol 30(4):571–592

    PubMed  Article  Google Scholar 

  13. 13.

    Liu DM, Salem R, Bui JT et al (2005) Angiographic considerations in patients undergoing liver-directed therapy. J Vasc Interv Radiol 16(7):911–935

    PubMed  Article  Google Scholar 

  14. 14.

    Liu P, Yang JM, Niu WY et al (2010) Prognostic factors in the surgical treatment of caudate lobe hepatocellular carcinoma. World J Gastroenterol 16(9):1123–1128

    PubMed  Article  Google Scholar 

  15. 15.

    Miller AB, Hoogstraten B, Staquet M, Winkler A (1981) Reporting results of cancer treatment. Cancer 47(1):207–214

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Riaz A, Lewandowski RJ, Kulik L et al (2009) Radiologic-pathologic correlation of hepatocellular carcinoma treated with chemoembolization. Cardiovasc Intervent Radiol 33:1143–1152

    PubMed  Article  Google Scholar 

  17. 17.

    Riaz A, Miller FH, Kulik LM et al (2010) Imaging response in the primary index lesion and clinical outcomes following transarterial locoregional therapy for hepatocellular carcinoma. JAMA 303(11):1062–1069

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Riaz A, Ryu RK, Kulik LM et al (2009) Alpha-fetoprotein response after locoregional therapy for hepatocellular carcinoma: oncologic marker of radiologic response, progression, and survival. J Clin Oncol 27(34):5734–5742

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Salem R, Lewandowski RJ, Mulcahy MF et al (2010) Radioembolization for hepatocellular carcinoma using Yttrium-90 microspheres: a comprehensive report of long-term outcomes. Gastroenterology 138(1):52–64

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Salem R, Thurston KG (2006) Radioembolization with 90Yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 1: technical and methodologic considerations. J Vasc Interv Radiol 17(8):1251–1278

    PubMed  Article  Google Scholar 

  21. 21.

    Seror O, Haddar D, N’Kontchou G et al (2005) Radiofrequency ablation for the treatment of liver tumors in the caudate lobe. J Vasc Interv Radiol 16(7):981–990

    PubMed  Article  Google Scholar 

  22. 22.

    Shibata T, Kubo S, Tabuchi T et al (2000) Percutaneous ethanol injection for hepatocellular carcinoma originating in the caudate lobe. Hepatogastroenterology 47(33):824–827

    PubMed  CAS  Google Scholar 

  23. 23.

    Shibata T, Maetani Y, Ametani F, Kubo T, Itoh K, Konishi J (2002) Efficacy of nonsurgical treatments for hepatocellular carcinoma in the caudate lobe. Cardiovasc Intervent Radiol 25(3):186–192

    PubMed  Article  Google Scholar 

  24. 24.

    Takayama T, Makuuchi M (1998) Segmental liver resections, present and future-caudate lobe resection for liver tumors. Hepatogastroenterology 45(19):20–23

    PubMed  CAS  Google Scholar 

  25. 25.

    Takayasu K, Muramatsu Y, Shima Y et al (1986) Clinical and radiologic features of hepatocellular carcinoma originating in the caudate lobe. Cancer 58(7):1557–1562

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Tanaka S, Shimada M, Shirabe K et al (2005) Surgical outcome of patients with hepatocellular carcinoma originating in the caudate lobe. Am J Surg 190(3):451–455

    PubMed  Article  Google Scholar 

  27. 27.

    Terayama N, Miyayama S, Tatsu H et al (1998) Subsegmental transcatheter arterial embolization for hepatocellular carcinoma in the caudate lobe. J Vasc Interv Radiol 9(3):501–508

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Trotti A, Colevas AD, Setser A et al (2003) CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol 13(3):176–181

    PubMed  Article  Google Scholar 

  29. 29.

    Yoon CJ, Chung JW, Cho BH et al (2008) Hepatocellular carcinoma in the caudate lobe of the liver: angiographic analysis of tumor-feeding arteries according to subsegmental location. J Vasc Interv Radiol 19(11):1543–1550 quiz 1550

    PubMed  Article  Google Scholar 

Download references

Conflict of interest

Saad M. Ibrahim, Laura Kulik, Talia Baker, Robert K. Ryu, Mary F. Mulcahy, Michael Abecassis, and Robert J. Lewandowski have no conflicts of interest. Riad Salem is a consultant for MDS Nordion.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Robert J. Lewandowski.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ibrahim, S.M., Kulik, L., Baker, T. et al. Treating and Downstaging Hepatocellular Carcinoma in the Caudate Lobe with Yttrium-90 Radioembolization. Cardiovasc Intervent Radiol 35, 1094–1101 (2012). https://doi.org/10.1007/s00270-011-0292-x

Download citation

Keywords

  • Interventional oncology
  • Clinical practice
  • Radioembolization/radioembolisation
  • Liver/hepatic
  • Hepatocellular carcinoma (HCC)