# Yittrium-90 radiation lobectomy: Dose optimization and prediction of FLR hypertrophy to enable resection of HCC

> **NIH NIH R01** · NORTHWESTERN UNIVERSITY · 2022 · $582,062

## Abstract

Project Summary / Abstract:
Liver transplantation is curative in patients with unresectable hepatocellular carcinoma (HCC).
However, the clinical need for organs greatly exceeds their availability. In addition, few patients
diagnosed with HCC are candidates for primary surgical resection, due to an insufficient future
liver remnant (FLR) in the presence of underlying liver disease. Portal vein embolization (PVE),
a technique known to induce FLR hypertrophy by redirecting portal flow, is relatively
contraindicated in cirrhosis due to concerns to induce liver failure and worsen pre-existent portal
hypertension following the procedure. We have recently demonstrated the potential efficacy of a
new paradigm to achieve locoregional HCC control while inducing FLR hypertrophy with lobar
infusion of 90Y impregnated glass beads (90Y radiation lobectomy [90Y-RL]). Although
preliminary data demonstrates the utility of this approach, the optimal dose strategy to induce
FLR hypertrophy while minimizing the risk of worsening liver function and portal hypertension is
unknown. Our proposed study investigates the underlying mechanisms of embolized liver
atrophy and FLR hypertrophy following 90Y-RL through improved dosimetry and advanced
quantitative MR imaging. Patients with unresectable HCC will be recruited at the time of referral
for 90Y-RL following review in our multidisciplinary HCC treatment conference. In Aim #1 we will
investigate the influence of proscribed radiation dose and glass bead embolic load on FLR
hypertrophy calculating actual parenchymal doses with the use of non-FDG PET/CT to visualize
glass bead distribution following 90Y-RL. The optimal dose/embolic load paradigm will be applied
in a prospective study of 64 subjects with unresectable HCC referred for 90Y-RL in Aim #2.
These subjects will undergo quantitative MR imaging, assessing changes in liver stiffness with
MR elastography, liver hemodynamics with non-contrast 4D flow MRI, and parenchymal
perfusion with accelerated time-resolved MR angiography before and at 1- and 3-months after
90Y-RL. Quantitative MRI derived biomarkers will be correlated with FLR hypertrophy and
trophic factors to delineate changes predictive of adequate FLR following 90Y-RL. Finally, we will
assess differences in recurrence-free survival 90Y-RL patients who underwent surgical resection
and those whose FLR deemed them candidates for surgical resection at presentation. This
project will deepen our understanding of the mechanisms leading to the liver atrophy-
hypertrophy complex following 90Y-RL endeavoring to make the procedure safer and more
effective. The results of this study will support a multicenter clinical trial evaluating the survival
of patients with unresectable HCC treated with 90Y-RL.

## Key facts

- **NIH application ID:** 10241994
- **Project number:** 5R01CA233878-03
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** Jeremy Douglas Collins
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $582,062
- **Award type:** 5
- **Project period:** 2019-08-01 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10241994

## Citation

> US National Institutes of Health, RePORTER application 10241994, Yittrium-90 radiation lobectomy: Dose optimization and prediction of FLR hypertrophy to enable resection of HCC (5R01CA233878-03). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10241994. Licensed CC0.

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