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Chemoembolic Hepatopulmonary Shunt Reduction to Allow Safe Yttrium-90 Radioembolization Lobectomy of Hepatocellular Carcinoma

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Abstract

Yttrium-90 (90Y) radioembolization represents an emerging transcatheter treatment option for the management of hepatocellular carcinoma (HCC). Elevation of the hepatopulmonary shunt fraction risks nontarget radiation to the lungs and may limit the use of 90Y therapy in patients with locally advanced disease with vascular invasion, who often demonstrate increased shunting. We present two cases in which patients with HCC and portal vein invasion resulting in elevated hepatopulmonary shunt fractions underwent chemoembolic shunt closure to allow safe 90Y radioembolization. Both patients demonstrated excellent tumor response and patient survival. On this basis, we propose a role for chemoembolic reduction of the lung shunt fraction before 90Y radioembolization in patients with extensive tumor-related hepatopulmonary shunting.

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Authors and Affiliations

  1. Department of Radiology, Section in Interventional Radiology, University of Illinois Medical Center at Chicago, 1740 West Taylor Street, MC 931, Chicago, IL, 60612, USA

    Ron C. Gaba

  2. Midwestern University School of Medicine, 555 31st Street, Downers Grove, IL, 60515, USA

    Kyle A. VanMiddlesworth

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  1. Ron C. Gaba
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  2. Kyle A. VanMiddlesworth
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Correspondence to Ron C. Gaba.

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Gaba, R.C., VanMiddlesworth, K.A. Chemoembolic Hepatopulmonary Shunt Reduction to Allow Safe Yttrium-90 Radioembolization Lobectomy of Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 35, 1505–1511 (2012). https://doi.org/10.1007/s00270-012-0371-7

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  • DOI: https://doi.org/10.1007/s00270-012-0371-7

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