106:
with RL. The main difference between the two is the time interval necessary for appropriate hypertrophy, greater for RL. PVE requires a shorter time frame to achieve comparable results, ranging between 2–6 weeks, while the hypertrophy kinetics of RL are slower but more constant, without significant plateau (some studies report continued hypertrophy up to 9 months). Some authors have even raised concerns regarding PVE and the potential interval disease progression in the embolized and treatment naive lobes while allowing hypertrophy, which is of less concern with RL due to its added tumoricidal effect. Additionally, RL has been demonstrated to aid surgical resection in some cases by inducing a “vascular shift” of tumor masses via necrosis and contraction away from major vascular pedicles, converting patients to resectable status. One study has shown preliminary 600-day survival in 12 out of 13 patients who received RL and subsequent resection. Ultimately, further studies are needed to prospectively compare survival and recurrence outcomes in patients receiving RL versus PVE.
93:. Surgical resection is considered the only curative treatment for liver cancer (other than liver transplantation for hepatocellular carcinoma) but it can only be performed in patients with sufficient remnant liver after resection (amongst other criteria). Both PVE and RL are performed in patients who are not surgical candidates due to insufficient future liver remnant (FLR), which is advised to be between 20-30% and 30-40% of the native liver volume in healthy and cirrhotic livers, respectively.
151:, gastroduodenal, proper hepatic, left hepatic, right hepatic and phrenic arteries. The purpose of this planning angiogram is to evaluate for anatomical variants and collaterals that need to be coil embolized, in order to minimize the risk of non-target radioembolization. At this point, once the vascular anatomy has been delineated and necessary vessels have been embolized, the physician will inject 4-5 mCi of
155:
macroaggregated albumin (MAA) in order to evaluate hepatopulmonary shunting, which serves as a proxy in assessing the risk of developing radiation pneumonitis. The dose of yttrium-90 to be infused is calculated with the manufacturer's formula based on lung shunting, body surface area, liver and tumor
105:
and results are mainly reported in the form of retrospective chart review studies and case reports, without any prospective validation. Most authors report a comparable future liver remnant hypertrophy between portal vein embolization and RL, ranging between 10 and 47% with cases reaching up to 119%
118:
Complications are abscess formation, biliary complications (biloma, radiation induced cholecystitis and cholangitis, biliary necrosis), gastrointestinal complications (diarrhea, radiation induced gastritis and gastrointestinal ulceration), radiation induced pancreatitis, dermatitis, pneumonitis and
332:
Lewandowski, Robert J.; Donahue, Larry; Chokechanachaisakul, Attasit; Kulik, Laura; Mouli, Samdeep; Caicedo, Juan; Abecassis, Michael; Fryer, Jonathan; Salem, Riad (2016-07-01). "90Y radiation lobectomy: Outcomes following surgical resection in patients with hepatic tumors and small future liver
159:
Radiation lobectomy: after gaining femoral artery access and advancing a catheter in the right hepatic artery (most often), Y microspheres are infused in a lobar fashion, optimizing tumor and parenchymal coverage. Once the procedure has been completed, the patient is usually sent to the nuclear
114:
Common side effects include fatigue, abdominal pain, nausea and anorexia, usually self-limiting. Post-radioembolization syndrome occurs in 20-70% of patients that undergo traditional radioembolization, presenting with shakes, chills, fatigue, nausea/vomiting, abdominal pain/discomfort, and/or
115:
cachexia and possibly hemodynamic changes, rarely requiring admission. Unfortunately, most data, if not all, is derived from traditional radioembolization outcomes studies and more will be needed to assess the actual incidence and risk of post-radioembolization syndrome in RL.
185:
undergone by the contralateral side (as assessed by future liver remnant) and to assess tumor burden. At this time, the surgeons and/or a multi-specialty tumor board will convene to determine if the patient can/should undergo safe surgical resection.
160:
medicine department where a
Bremsstrahlung scan will demonstrate the distribution of the radioactive material and assess for non-target embolization. Often, patients are started on proton pump inhibitors (with the addition of
69:. It is performed in patients that would be surgical candidates for resection, but cannot undergo surgery due to insufficient remaining liver tissue. It consists of injecting small radioactive beads loaded with
131:
suite, in a fashion similar to radioembolization. The procedure is composed of two different portions, a planning phase and the actual radiation lobectomy, usually performed in two different sessions:
384:
Fernández-Ros, Nerea; Silva, Nuno; Bilbao, Jose
Ignacio; Iñarrairaegui, Mercedes; Benito, Alberto; D'Avola, Delia; Rodriguez, Macarena; Rotellar, Fernando; Pardo, Fernando (March 2014).
73:
into the hepatic artery feeding the hepatic lobe in which the tumor is located. This is done with the intent of inducing growth in the contralateral hepatic lobe, not dissimilarly from
243:
Vouche, Michael; Lewandowski, Robert J.; Atassi, Rohi; Memon, Khairuddin; Gates, Vanessa L.; Ryu, Robert K.; Gaba, Ron C.; Mulcahy, Mary F.; Baker, Talia (November 2013).
292:
Gaba, RC; Carroll, JJ; Carrillo, TC (2011). "Chemoembolic lobectomy: imaging findings of hepatic lobar volume reduction after transcatheter arterial chemoembolization".
135:
Planning phase: the patient undergoes planning angiography of the abdominal aorta and its major vessels. The interventional radiologist accesses the femoral artery via
433:
Shah, Jehan L.; Zendejas-Ruiz, Ivan R.; Thornton, Linday M.; Geller, Brian S.; Grajo, Joseph R.; Collinsworth, Amy; George Jr, Thomas J.; Toskich, Beau (2017-12-04).
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Simoneau, Eve; Aljiffry, Murad; Salman, Ayat; Abualhassan, Nasser; Cabrera, Tatiana; Valenti, David; Baage, Arwa El; Jamal, Mohammad; Kavan, Petr (July 2012).
435:"Neoadjuvant transarterial radiation lobectomy for colorectal hepatic metastases: a small cohort analysis on safety, efficacy, and radiopathologic correlation"
147:, injecting contrast in order to delineate the patient's anatomy. Utilizing smaller catheters and wires, he does the same thing evaluating the
102:
543:
Lienden, K. P. van; Esschert, J. W. van den; Graaf, W. de; Bipat, S.; Lameris, J. S.; Gulik, T. M. van; Delden, O. M. van (2013-02-01).
737:
245:"Radiation lobectomy: Time-dependent analysis of future liver remnant volume in unresectable liver cancer as a bridge to resection"
386:"Partial liver volume radioembolization induces hypertrophy in the spared hemiliver and no major signs of portal hypertension"
181:
Patients undergo cross-sectional imaging at approximately 30–60 days from the procedure for evaluation of the degree of
742:
140:
86:
74:
62:
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Madoff, David C.; Vauthey, Jean-Nicolas (2013-06-01). "Re: Portal Vein
Embolization: What Do We Know?".
148:
602:"Portal vein embolization stimulates tumour growth in patients with colorectal cancer liver metastases"
203:
Garcea, G.; Ong, S.L.; Maddern, G.J. (2009). "Predicting liver failure following major hepatectomy".
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164:- based on each center's protocol) for gastro-hepatic protection with or without a low-dose
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545:"Portal Vein Embolization Before Liver Resection: A Systematic Review"
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antibiotic when the gallbladder is present (both per center protocol).
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RL is performed in people with liver cancer, both primary such as
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for prevention of post radioembolization syndrome and a
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RL is performed by an interventional radiologist in the
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Radiation lobectomy is a relatively new application of
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and advances a wire and catheter to the level of the
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656:Handbook of Interventional Radiologic Procedures
672:Riaz, Ahsun; Awais, Rafia; Salem, Riad (2014).
674:"Side Effects of Yttrium-90 Radioembolization"
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549:CardioVascular and Interventional Radiology
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654:Kandarpa, K; Machan, L (2012).
306:10.4261/1305-3825.DIR.3166-09.1
1:
335:Journal of Surgical Oncology
89:and metastatic such as from
205:Digestive and Liver Disease
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261:10.1016/j.jhep.2013.06.015
141:superior mesenteric artery
561:10.1007/s00270-012-0440-y
506:10.1007/s00270-012-0407-z
217:10.1016/j.dld.2009.01.015
41:
738:Interventional radiology
294:Diagnostic Interv Radiol
87:hepatocellular carcinoma
75:portal vein embolization
63:interventional radiology
37:interventional radiology
691:10.3389/fonc.2014.00198
452:10.21037/jgo.2017.01.26
678:Frontiers in Oncology
249:Journal of Hepatology
149:common hepatic artery
658:(4td ed.). LWW.
162:ursodeoxycholic acid
91:colon adenocarcinoma
137:Seldinger technique
55:Radiation lobectomy
19:Radiation lobectomy
333:remnant volumes".
743:Surgical oncology
402:10.1111/hpb.12095
347:10.1002/jso.24269
103:radioembolization
59:radiation therapy
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612:(7): 461–468.
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67:liver cancer
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183:hypertrophy
145:celiac axis
129:angiography
24:Other names
732:Categories
190:References
71:yttrium-90
700:2234-943X
569:0174-1551
514:0174-1551
461:2219-679X
355:1096-9098
177:Follow-up
123:Procedure
65:to treat
33:Specialty
718:25120955
636:22672548
587:22806245
522:22584753
479:28736649
420:23530966
371:42996741
363:27103352
314:20683817
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225:19303376
143:and the
61:used in
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270:5085290
156:volume.
97:Results
77:(PVE).
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