SIRT for downsizing to resection

Background: Different strategies have been developed to achieve resectability in patients initially considered as unresectable. Selective internal radiation therapy (SIRT) has emerged as an effective therapy for patients with primary non-resectable malignancies of the liver. Our group combined SIRT with liver surgery for downsizing for resection. Methods: Starting 2010 all patients with liver malignancies were evaluated in an interdisciplinary tumor board. Patients with marginally resectable liver metastases treated by SIRT followed by liver resection were identified and prospectively documented in a database for subsequent retrospective analysis. Results: Fifteen patients (7 female, 8 male) with marginally resectable liver metastases were planned for liver resection after SIRT. In thirteen patients (87%) liver metastases were from colorectal malignancies, and in two patients from breast cancer. After performing SIRT (90Y resin microspheres, mean administered activity 1260 MBq, range: 600 – 1990 MBq), twelve patients had potentially curative hepatic resection. In three patients liver resection after SIRT could not be performed due to the appearance of new extrahepatic metastases. Analyzing the effect of SIRT, we observed a decrease in tumor size with central scaring. Due to the selectivity of SIRT the future liver remnant was not effected in all patients. Conclusion: The combination of SIRT with modern liver surgery enables new therapeutic options in patients with marginally resectable liver metastases.