Effect of selective internal radiation therapy and hepatic arterial chemotherapy on normal liver volume and spleen volume

Objective: To determine the effect of selective internal radiation therapy (SIRT) and hepatic arterial chemotherapy (HAC) on normal liver volume and s pleen volume in patients receiving these treatments for advanced liver canc er. Methods: In a phase III clinical trial to assess the benefit of SIRT over H AC one group of patients received SIRT + HAC while a second group received HAC only. All patients in this trial who had abdominal CT scans available b efore treatment, and at 3, 6, and 12 months after treatment were evaluated. Changes in normal hepatic parenchyma (NHP) volume, portal vein diameter an d spleen volume were calculated for each patient and analysed for significa nt trends. Results: The mean NHP volume decreased by 17% (P = 0.001) 12 months after t reatment among patients receiving SIRT + HAC (N = 22), while the mean NHP v olume among patients treated with HAC only (N = 15) was unchanged at 12 mon ths. The mean portal vein diameter increased by 9% in both treatment groups , P = 0.048 and P < 0.001, respectively. The mean spleen volume increased b y 48% (P<0.001) and 26% (P=0.001), respectively, in the two groups 12 month s after treatment started. There was no clinical evidence of hepatic failur e, portal hypertension or splenic dysfunction in any of the patients. Conclusions: Treatment of patients with SIRT + HAC causes contraction of th e normal hepatic parenchyma, while treatment with HAC alone has no signific ant effect. Treatment with either SIRT + HAC or HAC alone causes a signific ant increase in portal vein diameter and spleen volume by 12 months after t reatment. The increase in spleen volume and portal vein size is likely to b e due to portal hypertension resulting from scarring within the liver as a result of chemical and radiation hepatitis. J. Surg. Oncol. 2001;78:248-252 . (C) 2001 Wiley-Liss, Inc.