Hepatopulmonary shunting after surgical, interventional and systemic therapy in patients with liver malignancies scheduled for radioembolization

Background Hepatopulmonary shunts (HPS) lead to radiation exposure of the lungs in patients undergoing radioembolization (RE) of malignant liver tumors. Purpose To retrospectively analyze how HPS is affected by prior systemic or local therapy of the liver. Material and Methods The percentage HPS was calculated from SPECT/CT scans obtained after technetium-99 m macroaggregated albumin administration into hepatic arteries in 316 patients evaluated for RE. Results Patients with partial liver resection (n = 80) did not differ in HPS from the remaining patient population (n = 236) (HPS (median [range]) = 10.2 [2.1–48.3]resection% vs. 8.9 [2.3–32.9]no resection%; P = 0.527). In patients undergoing sequential RE, HPS was significantly higher in the liver lobe treated second (n = 10; HPS = 6.4 [2.1–10.2]firstlobe/session% vs. 12.0 [2.0–24.6]second lobe/session%; P = 0.019). (Chemo-)embolization (n = 19; HPS = 11.0 [2.8–48.3]%) or transcutaneous ablation (n = 63; HPS = 8.8 [3.0–32.9]%) had no effect on HPS compared to patients without prior interventions (no (chemo-)embolization: n = 297; HPS = 9.3 [2.1–47.3]%; P = 0.489; no ablation: n = 253; HPS = 9.5 [2.1–48.3]%; P = 0.382). Pretreatment with sorafenib (HPS = 9.5 [2.3–35.9]yes% vs. 10.2 [2.8–42.0]no%; P = 0.777) orbevacizumab (HPS = 10.7 [2.1–30.6]yes% vs. 9.0 [3.9–23.3]no%; P = 0.870) had no effect on HPS. Conclusion Sequential RE results in an increase in the HPS in the contralateral liver lobe at the time of the second RE session. Other investigated therapy do not affect HPS.