Brief report
Selective Internal Radiation Therapy of Hepatocellular Carcinoma: Potential Hepatopulmonary Shunt Reduction after Sorafenib Administration

https://doi.org/10.1016/j.jvir.2012.04.007Get rights and content

Abstract

Sorafenib, a protein kinase inhibitor, is a systemic drug that has been licensed for the treatment of hepatocellular carcinoma (HCC). This retrospective study assessed whether the administration of sorafenib can result in a reduction of the hepatopulmonary shunt (HPS) before selective internal radiation therapy (SIRT). After exclusion from SIRT because of high HPS, computed tomography scan indicated a shunt reduction in seven patients with HCC receiving sorafenib. Repeated measurements revealed HPS reduction (from 26.5% to 7.5% on average), and subsequent SIRT became possible. In conclusion, sorafenib may reduce HPS in patients with advanced HCC in some cases.

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Materials and Methods

A waiver of institutional review board requirements was obtained because of the retrospective character of this study.

Results

Four of seven patients with high HPS as a contraindication for SIRT (three men, one woman; mean age, 62.5 y; age range, 50–83 y) received sorafenib for an average of 138 days (range, 72–297 d) before a repeat angiogram followed by lung shunt calculation. The remaining three patients were not rescheduled for SIRT because of progressive disease and increasingly reduced liver function. In three of the four patients who were reevaluated, the initial estimated lung dose was > 30 Gy. In one patient,

Discussion

The administration of sorafenib may lead to a reduction of HPS in patients with advanced stage HCC. We first considered the reevaluation of patients with increased HPS for SIRT during CT follow-up examinations of patients receiving sorafenib treatment. Reduction of arteriovenous shunts could be observed on CT, which encouraged us to repeat DSA in conjunction with MAA injection. Eventually, these patients became eligible for SIRT despite initially increased HPS. CT and angiographic features of

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None of the authors have identified a conflict of interest.

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