Radiation Lobectomy: An Overview of Concept and Applications, Technical Considerations, Outcomes

Surgical resection has long been considered curative for patients with early-stage hepatocellular carcinoma (HCC). However, inadequate future liver remnant (FLR) renders many patients not amenable to surgery. Recently, lobar administration of yttrium-90 (Y90) radioembolization has been utilized to induce FLR hypertrophy while providing disease control, eventually facilitating resection in patients with hepatic malignancy. This has been termed “radiation lobectomy (RL).” The concept is evolving, with modified approaches combining RL and high-dose curative-intent radioembolization (radiation segmentectomy) to achieve tumor ablation. This article provides an overview of the concept and applications of RL, including technical considerations and outcomes in patients with hepatic malignancies.

Radioembolization of Intrahepatic Cholangiocarcinoma: Patient Selection, Outcomes, and Competing Therapies

Intrahepatic cholangiocarcinoma is the second most common primary hepatic malignancy and poses a therapeutic challenge owing to its late-stage presentation and treatment-resistant outcomes. Most patients are diagnosed with locally advanced, unresectable disease and are treated with a combination of systemic and local regional therapies. Transarterial radioembolization offers a survival benefit and a favorable side effect profile, with a growing body of evidence to support its use. Herein, we review patient selection and detail outcomes of radioembolization for intrahepatic cholangiocarcinoma, together with mention of competing treatments.

Radioembolization for Cholangiocarcinoma

Cholangiocarcinoma is the second most common primary hepatic malignancy which accounts for 13% of total cancer mortality worldwide. Surgical resection is the only curative treatment for localized disease; however, the majority of patients present when the tumor is unresectable. The incidence of the intrahepatic subtype of cholangiocarcinoma is increasing worldwide. Current standard of care in patients with unresectable intrahepatic cholangiocarcinoma is systemic chemotherapy; however, yttrium-90 transarterial radioembolization (Y90-TARE) is under investigation for the treatment of intrahepatic cholangiocarcinoma with promising trials and published clinical experience. This review critically evaluates the role of Y90-TARE in the management of intrahepatic cholangiocarcinoma.