13th Annual Global Embolization Symposium & Technologies
Purpose : Radiation lobectomy (RL) with Yttrium-90 (Y90) has been used to treat liver malignancy and also to grow the functional liver remnant prior to surgical resection. Our study aimed to measure change in splenic volume and assess clinical symptoms of portal hypertension (PH) post-RL.
Material and Methods : Retrospective analysis was performed of 19 patients who underwent RL with intent for surgical resection or palliative therapy to either the right (n=17) or left (n=2) liver. 17 of 19 patients had a Childs-Pugh score of A, eight of which were planned for surgical resection. Two patients had preexisting PH that precluded surgical resection. Both Y90 glass (n=18) and resin (n=1) microspheres were used. There was a median duration of 5.75 months (1.5-9 months) from RL to the time of splenic volume measurement. Clinical status and laboratory values were assessed pre-RL through the time of post-procedural imaging. Splenic volume was calculated using Vitrea Enterprise Imaging software (Vital Images, Minnetonka, MN). Data was compared pre- to post-RL using a two-tailed paired T-test.
Results : 19 patients with HCC underwent RL with a mean radiation dose of 2.92 Gbq. There was a mean increase in splenic volume after RL of 25% (p=0.003). There was a mean decrease in platelet count of 15% (p=0.038). Four patients experienced worsening of preexisting thrombocytopenia newly below 100,000. Four patients developed new trace abdominal ascites after RL, which did not correlate with an increase in splenic volume. Both patients with preexisting large volume ascites did not experience worsening of symptoms of PH. 10 patients had preexisting varices, mostly small in size, which remained radiographically stable post-RL. Overall patients did not have significant change in symptoms of PH or deterioration of liver function post-RL. Four of 19 patients underwent uncomplicated surgical resection.
Conclusions : Radiation lobectomy is associated with a mean increase in splenic size of 25% at approximately six month follow up without new or worsened symptoms of portal hypertension or decompensation of liver function. RL patients experienced a significant drop in platelet count of 15% which may be related to splenic sequestration.