Sequential tumor-directed and lobar radioembolization before major hepatectomy for hepatocellular carcinoma

doi:10.4254/wjh.v9.i36.1372

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World Journal of Hepatology

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Case Report

World J Hepatol. Dec 28, 2017; 9(36): 1372-1377
Published online Dec 28, 2017. doi: 10.4254/wjh.v9.i36.1372

Sequential tumor-directed and lobar radioembolization before major hepatectomy for hepatocellular carcinoma

Vincent Donckier, Patrick Flamen, Alain Hendlisz, Maria Gomez Galdon, Philippe Delatte, Fikri Bouazza, Thierry Degrez, Michael Vouche

Michael Vouche, Philippe Delatte, Department of Radiology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels 1000, Belgium

Thierry Degrez, Department of Gastroenterology, CHR Sambre et Meuse, Namur 5000, Belgium

Fikri Bouazza, Department of Abdominal Surgery, Institut Jules Bordet, Université Libre de Bruxelles, Brussels 1000, Belgium

Maria Gomez Galdon, Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels 1000, Belgium

Alain Hendlisz, Department of Digestive Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels 1000, Belgium

Patrick Flamen, Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels 1000, Belgium

Vincent Donckier, Department of Abdominal Surgery, Institut Jules Bordet, Centre de Chirurgie Hépato-Biliaire de l’ULB (CCHB-ULB), Université Libre de Bruxelles, Brussels1000, Belgium

Author contributions: Degrez T, Bouazza F, Delatte P, Gomez Galdon M, Hendlisz A and Flamen P performed research; Vouche M and Donckier V performed research and wrote the paper.

Informed consent statement: An informed consent was obtained from the patient for surgery and potential publication of this case report and any accompanying images.

Conflict-of-interest statement: There is no conflict of interest. None of the authors received any financial support for this work.

Correspondence to: Vincent Donckier, MD, PhD, Professor of Surgery, Department of Abdominal Surgery, Institut Jules Bordet, Université Libre de Bruxelles, Rue Héger-Bordet 1, Brussels 1000, Belgium. vincent.donckier@bordet.be

Telephone: +32-2-5417348 Fax: +32-2-5413141

Received: September 24, 2017
Peer-review started: September 25, 2017
First decision: October 9, 2017
Revised: November 20, 2017
Accepted: December 5, 2017
Article in press: December 5, 2017
Published online: December 28, 2017
Processing time: 93 Days and 18.7 Hours

Core Tip

Core tip: Preoperative radioembolization may improve resectability of hepatocellular carcinoma in cirrhotic patient, inducing tumor downsizing, atrophy of radio-embolized sector and regeneration of non-embolized liver. We describe a patient with a segment IV hepatocellular carcinoma where the presence of two separated left hepatic arteries permitted to deliver sequentially high-dose ⁹⁰Yttrium to the tumor and lower dose to future resected liver, allowing uneventful left hepatectomy 3 mo later. This observation suggests that, when different arterial accesses exist to tumor and future resected non-tumor liver, sequential radioembolization with different radiation doses could represent a new preoperative strategy, optimizing the tumoricidal effect while minimizing the risk of radiation-induced liver damage.