Modified radiation lobectomy as a bridge to curative surgery: tumor response, future liver remnant hypertrophy, and surgical outcomes

Abstract Background Few studies support modified radiation lobectomy (mRL) as a bridge to curative resection. This retrospective study reviews outcomes after mRL. Methods Patients with primary hepatic tumors undergoing mRL 90 Y radioembolization to grow the future liver remnant (FLR) were reviewed. Outcomes included tumor response, FLR kinetics, tumor progression, surgical conversion, and pathologic outcomes. Results Fifteen patients (7 women, 8 men; mean age 66) with hepatocellular carcinoma (HCC, n = 7) and intrahepatic cholangiocarcinoma (ICC, n = 8) with mean tumor size 7.8 ± 3.7 cm were included. HCC patients were intermediate (BCLC B, n = 6) or advanced (BCLC C, n = 1) stage. No severe adverse events occurred. All patients had initial objective response at 30 days: 40% complete response, 60% partial response. Median FLR increased by 12% at 30 days and 30% at 90 days. Twelve patients (80%) became technically eligible for curative-intent surgery. Ultimately, 10 underwent major hepatectomy ( n = 9) or transplant ( n = 1) all with negative margins, at a mean of 122 ± 77 days post-treatment. Despite variable rates of pathologic necrosis, overall survival remained 80% after surgery. Conclusions Large primary hepatic tumors can be down-staged with mRL, promoting sufficient liver remnant hypertrophy while controlling tumor progression, suggesting that mRL may facilitate curative-intent surgery in carefully selected patients.