Impact of Prior Hepatectomy on the Safety and Efficacy of Radioembolization With Yttrium-90 Microspheres for Patients With Unresectable Liver Tumors

Objectives: Yttrium-90(Y-90) radioembolization is increasingly used as a minimally invasive therapy for unresectable liver tumors; however, previous hepatectomy must be considered to avoid excessive hepatic insult. A retrospective analysis was undertaken to investigate the viability of performing radioembolization on a remnant liver. Methods: A retrospective analysis was performed on data collected from December 2005 to August 2011 to identify the effect of prior hepatectomy on radioembolization outcomes. Survival and complications were reviewed for up to 3 months after radioembolization. Results: Of 427 patients eligible for analysis, 89 underwent previous hepatectomy. Immediate adverse events included abdominal pain (7.9% of hepatectomy patients vs. 18.0% of non-hepatectomy patients; P=0.02), nausea (4.5% vs. 8.0%; P>0.05), and emesis (0.0% vs. 0.9%; P>0.05). The prevalence of intermediate complications 1 month after radioembolization was low. Late complications included radiation-induced liver disease (3.4% vs. 1.5%; F>0.05), ulceration (2.2% vs. 2.7%; P>0.05), and gallbladder and biliary tree related outcomes (2.2% vs. 1.8%; P>0.05). Imaging analysis demonstrated a significant relationship between prior hepatectomy patients and a partial response to radioembolization, as well as progressive disease. The median overall survival after radioembolization for hepatectomy patients was 7.8 months, versus 5.8 months for non-hepatectomy patients (P=0.108). Conclusions: Our results indicate that radioembolization is safe to be performed on a remnant liver. Although imaging analysis demonstrated varying responses to radioembolization when comparing hepatectomy patients to non-hepatectomy patients, overall survival was shown to be similar between the 2 groups.