Original Article
Use of yttrium-90 radioembolization for patients with unresectable liver metastases: experience from a single center
Abstract
Background: Yttrium-90 (Y-90) radioembolization is an intra-arterial, catheter-based therapy that delivers high doses of internal radiation to tumors while sparing normal surrounding tissue. Metastatic liver disease, in general, is associated with a poor prognosis from a variety of primary gastrointestinal malignancies. As a result, Y-90 radioembolization has an emerging role in locoregional control of patients with unresectable liver metastases.
Methods: Patients with cancer that metastasized to the liver and treated with Y-90 radioembolization between 2005 and 2015 (n=21) were evaluated retrospectively. Patients were selected based on multidisciplinary evaluation; inclusion criteria included data that were abstracted from medical records including patient records, laboratory data, and radiographic studies. Toxicities were recorded using Common Terminology Criteria 3.0. Response was recorded according to mRECIST criteria.
Results: Twenty-one patients received treatments with SIR-Spheres Y-90 radioembolization. The median treatment activity delivered was 1.3 gBq (range, 0.7–1.7 gBq). The median treatment dose delivered was 95.5 Gy (range, 50–120 Gy). The median lung shunt fraction was 2.0% (range, 0.5–5.8%). Toxicities as measured by laboratory values were overall low, with alkaline phosphatase (Alk Phos) being most commonly elevated following treatment in 52% of patients, followed by AST and ALT derangements in 29% and 33% of patients, respectively. The most common clinical toxicities among all patients were abdominal pain (43%), followed by nausea/vomiting (38%), fatigue (19%), anorexia (14%), and diarrhea (10%). A clinical benefit response was seen in 71% [defined as patients achieving complete response (CR), partial response (PR), or stable disease (SD)]. PR was seen in 33% of cases; progressive disease (PD) was noted in 29%. Post-initial treatment, patients survived for a median 9 months (range, 6.01–14.1 months) after their first radioembolization treatment, and survival from the time of diagnosis of liver metastasis was 21.8 months (range, 14.2–40.2 months).
Conclusions: For patients with nonresectable metastasis of cancer to the liver, Y-90 radioembolization is a safe and well-tolerated procedure and a potentially useful option in hepatic malignancies that are not satisfactorily addressed by existing treatment modalities. This data suggest that a significant percentage of patients achieve clinical benefit including many with PR. Survival after treatment from this single-center is consistent with preexisting evidence. Prospective, randomized data is required to compare radioembolization with other therapies including chemoembolization and systemic chemotherapy.
Methods: Patients with cancer that metastasized to the liver and treated with Y-90 radioembolization between 2005 and 2015 (n=21) were evaluated retrospectively. Patients were selected based on multidisciplinary evaluation; inclusion criteria included data that were abstracted from medical records including patient records, laboratory data, and radiographic studies. Toxicities were recorded using Common Terminology Criteria 3.0. Response was recorded according to mRECIST criteria.
Results: Twenty-one patients received treatments with SIR-Spheres Y-90 radioembolization. The median treatment activity delivered was 1.3 gBq (range, 0.7–1.7 gBq). The median treatment dose delivered was 95.5 Gy (range, 50–120 Gy). The median lung shunt fraction was 2.0% (range, 0.5–5.8%). Toxicities as measured by laboratory values were overall low, with alkaline phosphatase (Alk Phos) being most commonly elevated following treatment in 52% of patients, followed by AST and ALT derangements in 29% and 33% of patients, respectively. The most common clinical toxicities among all patients were abdominal pain (43%), followed by nausea/vomiting (38%), fatigue (19%), anorexia (14%), and diarrhea (10%). A clinical benefit response was seen in 71% [defined as patients achieving complete response (CR), partial response (PR), or stable disease (SD)]. PR was seen in 33% of cases; progressive disease (PD) was noted in 29%. Post-initial treatment, patients survived for a median 9 months (range, 6.01–14.1 months) after their first radioembolization treatment, and survival from the time of diagnosis of liver metastasis was 21.8 months (range, 14.2–40.2 months).
Conclusions: For patients with nonresectable metastasis of cancer to the liver, Y-90 radioembolization is a safe and well-tolerated procedure and a potentially useful option in hepatic malignancies that are not satisfactorily addressed by existing treatment modalities. This data suggest that a significant percentage of patients achieve clinical benefit including many with PR. Survival after treatment from this single-center is consistent with preexisting evidence. Prospective, randomized data is required to compare radioembolization with other therapies including chemoembolization and systemic chemotherapy.
