Interventional Oncology

Session: Educational Exhibit Presentations - Station 7: Imaging and Interventional Oncology

Radiation Lobectomy to Facilitate Liver Resection: Volumetric and Dosimetric Considerations

Monday, March 6, 2023

5:10 PM – 5:15 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

Muhamad Serhal, MD

PGY1
Northwestern University

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

YA

Yousr Ahmed, MD

Research Fellow
Northwestern University
AG

Ahmed Gabr, MD

Resident
Northwestern University
PE

Pouya Entezari, MD

Research Fellow
Northwestern University
JC

Jeremy Collins, MD

Professor of Radiology
Mayo Clinic
Ahsun Riaz, MD

Interventional Radiologist
Northwestern University
Bartley Thornburg, MD

Vascular and Interventional Radiologist
Northwestern Medicine
Beau Toskich, MD, FSIR

Professor
Mayo Clinic Jacksonville
Riad Salem, MD

Chief of Vascular and Interventional Radiology in the Department of Radiology
Northwestern Memorial Hospital
Robert Lewandowski, MD

Professor of Radiology, Medicine and Surgery
Northwestern University, Dept. of Radiology, IR section

Disclosure(s):

Muhamad Serhal, MD: No financial relationships to disclose

Ahsun Riaz, MD: Boston Scientific: Consultant (Ongoing)

Bartley Thornburg, MD: No financial relationships to disclose

Beau Toskich, MD, FSIR: No relevant disclosure to display

Robert Lewandowski, MD: ABK Biomedical: Consultant (Ongoing); Acerta/AstraZeneca: Advisory Committee or Review Panel Member (Ongoing); BD: Consultant (Ongoing); boston scientific: Consultant (Ongoing), Speaking and Teaching (Ongoing); Varian Interventional Solutions: Consultant (Ongoing)

Learning Objectives:

1) Update on the role of radiation lobectomy (RL) as a tool to induce future liver remnant (FLR) hypertrophy to facilitate surgical resection.

2) Provide specific details regarding best patient selection, radioembolization techniques, imaging considerations, and volumetric calculations.

3) Use case examples to illustrate the concepts of radiation lobectomy.

Background: Surgical resection is considered a first line curative treatment for early-stage hepatocellular carcinoma (HCC). However, some patients do not qualify for surgical resection due to insufficient FLR, increasing the risk of hepatic decompensation following surgery. RL has become a tool to facilitate future surgical resection through the creation of an atrophy-hypertrophy complex. The techniques of RL to ensure appropriate tumor control while optimizing FLR hypertrophy (kinetic growth and overall hypertrophy) are evolving. FLR imaging strategies and volumetric considerations are also expanding. The intent of this educational exhibit is to provide a comprehensive review of current best practice of RL, illustrated by case examples.

Clinical Findings/Procedure Details: Evidence-based patient selection criteria will be presented to identify patients that are optimal candidates for RL. This will include a discussion on necessary FLR for surgical resection, with a critical review of available volumetric algorithms. Technical aspects of RL, planning and treatment, will be reviewed, with technical tips to provide tumor control and initiate the atrophy-hypertrophy complex. The optimal embolic load and radiation absorbed dose to the targeted tumor and hepatic parenchyma will be discussed, in the context of pre-treatment macro-aggregated albumin scan and post-treatment imaging. Finally, evolving imaging techniques to assess size and function of the FLR will be reported.

Conclusion and/or Teaching Points: The application of RL to facilitate surgical resection in those patients initially presenting with inadequate FLR is evolving. Best outcomes will come from optimization of this therapy and patient selection, to dosimetry and post-treatment imaging and evaluation.