Radioembolization of colorectal hepatic metastases using yttrium-90 microspheres (original) (raw)
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Patterns of Failure in Colorectal Patients With Liver Metastases After Yttrium-90 Radioembolization
American Journal of Clinical Oncology, 2014
Objectives: To assess patterns of failure and factors affecting recurrence patterns in colorectal cancer patients treated with 90 Y-labeled resin microspheres for metastatic liver disease. Methods: We retrospectively reviewed 30 colorectal patients treated with Yttrium-90 radioembolization and assessed follow-up computed tomography scans and positron emission tomography scans to determine disease outcomes. All patients were included in survival analysis. Twenty-six patients with hepatic metastases were assessed for patterns of failure after radioembolization treatment and grouped into 3 patterns: (1) hepatic; (2) extrahepatic; and (3) intrahepatic and extrahepatic. Results: The median overall survival and progression-free survival for all colorectal patients treated with radioembolization was 9.4 and 3.2 months, respectively. Overall survival and progression-free survival were not significantly different between patterns of failure (P = 0.43 and 0.26, respectively). Logistic regression analysis demonstrated a trend toward the predictive value of tumor volume in determining patterns of failure. Smaller tumor volumes had a higher predictive probability for extrahepatic failure than larger tumor volumes (P = 0.057). Tumor volumes <300 mL were predictive for extrahepatic failure patterns compared with hepatic recurrence (P = 0.046). Conclusions: Radioembolization with 90 Y-labeled resin microspheres continues to be an effective salvage treatment for colorectal liver metastases. Analysis of patterns of radiologic failure demonstrated that patients treated by radioembolization develop a greater proportion of extrahepatic failure. Tumor volumes >300 mL were predictive for hepatic recurrence, suggesting that increased dosing or retreatment of these lesions may lead to improved hepatic control of disease and better patient outcomes.
Journal of Vascular and Interventional Radiology, 2010
To determine in a retrospective study the potential benefit on survival outcomes of radioembolization using yttrium-90 ( 90 Y) resin microspheres in a cohort of patients presenting with chemotherapy-refractory liver metastases, primarily from colorectal cancer (CRC). MATERIALS AND METHODS: Over 3 years, 249 patients were referred to the authors' center to determine suitability for radioembolization as treatment for hepatic metastases. All patients were defined as salvage, having failed first-line and second-line chemotherapies. These patients were divided into group 1 (CRC) and group 2 (all other cancers, eg, breast, neuroendocrine) and assessed for overall survival (OS) as a whole and according to group. RESULTS: Using 90 Y resin microspheres, 208 patients were treated, undergoing 223 radioembolization treatments. The median OS was 8.3 months for the whole cohort, 7.9 months for group 1, and 8.7 months for group 2. At the 3-month follow-up, there was an overall adverse event rate of 9%. At the end of the data collection period, 62 patients were still alive.
European Journal of Nuclear Medicine and Molecular Imaging, 2014
The aim of this study was to analyze the safety, treatment characteristics and survival outcomes of Yttrium-90 (Y90) radioembolization for unresectable colorectal carcinoma (CRC) liver metastases refractory to standard of care therapy. Methods A total of 214 patients with CRC metastases were treated with Y90 radioembolization over 12 years. Toxicity was assessed using National Cancer Institute common terminology criteria. Overall survival was analyzed from date of diagnosis of primary cancer, hepatic metastases and from the first Y90. Uni/multivariate analyses were performed. Substratification by era of chemotherapeutics was performed. Results Most patients were male (60 %) and <65 years old (61 %). Of them, 98 % had been exposed to chemotherapy. Grade 3 lymphocyte, bilirubin, albumin, ALP and AST toxicities were observed in 39 %, 11 %, 10 %, 8 % and 4 % of patients, respectively. Grade 4 lymphocyte and ALP toxicities were observed in 5 % and 3 % of patients, respectively. Median overall survival was 43.0, 34.6, and 10.6 months from date of diagnosis of primary cancer, hepatic metastases and first Y90, respectively. Survival was significantly longer in patients: (1) who received ≤2 cytotoxic drugs (n=104) than those who received 3 (n=110) (15.2 vs. 7.5 months, p= 0.0001); and (2) who received no biologic agents (n=52) compared with those that did (n=162) (18.6 vs. 9.4 months, p=0.0001). Multivariate analyses identified ≤2 cytotoxic agents, no exposure to biologics, ECOG 0, tumor burden <25 %, lack of extrahepatic disease and albumin >3 g/dL as independent predictors of survival. Conclusion In this largest metastatic CRC series published to date, Y90 radioembolization was found to be safe; survival varied by prior therapy. Further studies are required to further refine the role of Y90 in metastatic CRC.
Journal of Vascular and Interventional Radiology, 2009
To compare transarterial chemoembolization (CE) versus yttrium-90 (90 Y) radioembolization (RE) for liver-dominant metastatic colorectal adenocarcinoma as salvage therapy. MATERIALS AND METHODS: Of 36 patients, 21 underwent CE (37 procedures; 11 men; mean age, 67 years; 16 with Child-Pugh class A disease) and 15 underwent 90 Y RE (19 procedures; 11 men; mean age, 64 years; 13 with Child-Pugh class A disease) for liver-dominant colorectal adenocarcinoma. Mean index dominant lesion sizes were 9.3 cm and 8.2 cm in the CE and RE groups, respectively. Multilobar disease was seen in 67% and 87% of the respective groups, and extrahepatic metastases were seen in 43% and 33%, respectively. Mean times from diagnosis of liver metastasis to CE or RE were 17.6 months and 22.6 months, respectively. RESULTS: A total of 37 CE procedures with cisplatin, doxorubicin, and mitomycin were performed, and 19 RE procedures with 90 Y were performed; 43% of patients in the CE group and 20% in the RE group received multiple treatment sessions, and 100% of procedures were technically successful. Median survival times were 7.7 months for the CE group and 6.9 months for the RE group (P ؍ .27). The 1-, 2-, and 5-year survival rates were 43%, 10%, and 0%, respectively, in the CE group; and 34%, 18%, and 0%, respectively, in the RE group. There was one major complication (2.7%) in the CE group (pulmonary embolism), with a 30-day mortality rate of 5.4% (n ؍ 2). There were no major complications in the RE group, with a 30-day mortality rate of 5.2% (n ؍ 1). CONCLUSIONS: Patients with unresectable liver colorectal metastases that progress despite systemic chemotherapy can undergo palliative treatment with CE or RE with similar survival benefit.
Cancer Biotherapy & Radiopharmaceuticals, 2010
The objective of this retrospective study was to assess the likelihood of extrahepatic metastases based on tumor metabolic load index (TMLI) for patients with colorectal liver metastases to determine the potential intermediate endpoint of yttrium-90 (Y-90) microsphere liver-directed therapy. Forty-eight (48) patients with colorectal metastatic cancer of the liver who were referred for Y-90 microsphere therapy and F-18 fluoro-2deoxy-d-glucose positron emission tomography (PET) imaging were included. All patients had baseline computed tomography, hepatic angiography, and planning intra-arterial technetium-99m macro-aggregated albumin scans. Pretreatment PET images were analyzed by visual inspection of extrahepatic metastases and by computer quantification of total liver tumor metabolism. For each patient, regions of interest were drawn along the liver edge to measure total liver standard uptake value on axial images, covering the entire span of the liver. The total liver standard uptake value was then converted by logarithm in equivalent volumes of liver mass to obtain TMLI for comparison. A Levene test for equality of variances and t-tests were used for comparing pretreatment TMLIs of patients with or without extrahepatic metastasis. Discriminant and ROC AU1 c analyses were used to obtain a cutoff value with highest specificity in predicting negative extrahepatic metastasis. There were 21 and 27 patients identified as negative and positive for extrahepatic metastasis, respectively. The TMLI of the group with negative extrahepatic metastasis was significantly lower than that with positive extrahepatic metastasis (10.22 þ 0.32 versus 10.74 þ 0.57, p < 0.0005). The cutoff TMLI with 100% specificity was found to be 10.65. There was a significant difference in liver tumor load with respect to the presence or absence of an extrahepatic metastatic tumor as evaluated objectively with PET. This leads to the identification of TMLI threshold, below which extrahepatic metastases are unlikely and thus may provide guidance for Y-90 therapy.
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2015
Hepatic metastases of colorectal carcinoma are a leading cause of cancer-related mortality. The vast majority of colorectal liver metastases become refractory to chemotherapy and biologic agents, at which point the median overall survival declines to 4-5 months. Radioembolization with yttrium-90 has been used in the salvage setting with favorable outcomes. This study reports the survival and safety outcomes of 531 patients treated with glass-based (90)Y microspheres at eight institutions, making it the largest (90)Y study for patients with Patients and METHODS: Data were retrospectively compiled from eight institutions for all (90)Y glass microsphere treatments for colorectal liver metastases. Exposure to chemotherapeutic/biologic agents, prior liver therapies, biochemical parameters prior to and following treatment, radiation dosimetry and complications were recorded. Uni- and multivariate analyses for predictors of survival were performed. Survival outcomes, clinical/biochemical a...
Safety of Hepatic Resection in Metastatic Disease to the Liver After Yttrium-90 Therapy
Journal of Surgical Research, 2011
Background. Unresectable hepatic metastases from aerodigestive cancers are common and in most cases herald a poor prognosis. A small percentage of patients maybe amenable to surgical resection or ablation once the biology of the disease and the burden of hepatic disease are better understood. The use of hepatic arterial resin microspheres containing the b emitter, yttrium-90, has been reported in the treatment of unresectable hepatic metastases. The goal of this review was to evaluate the use of yttrium-90 hepatic arterial therapy in the management of hepatic metastases and surgical downstaging.
British journal of cancer, 2010
This multi-centre phase II clinical trial is the first prospective evaluation of radioembolisation of patients with colorectal liver metastases (mCRC) who failed previous oxaliplatin- and irinotecan-based systemic chemotherapy regimens. Eligible patients had adequate hepatic, haemopoietic and renal function, and an absence of major hepatic vascular anomalies and hepato-pulmonary shunting. Gastroduodenal and right gastric arteries were embolised before hepatic arterial administration of yttrium-90 resin microspheres (median activity, 1.7 GBq; range, 0.9-2.2). Of 50 eligible patients, 38 (76%) had received > or =4 lines of chemotherapy. Most presented with synchronous disease (72%), >4 hepatic metastases (58%), 25-50% replacement of total liver volume (60%) and bilateral spread (70%). Early and intermediate (>48 h) WHO G1-2 adverse events (mostly fever and pain) were observed in 16 and 22% of patients respectively. Two died due to renal failure at 40 days or liver failure at ...
Yttrium-90 Radioembolization for Liver Malignancies: Prognostic Factors Associated with Survival
Journal of Vascular and Interventional Radiology, 2010
PURPOSE: To identify key prognostic clinical and imaging variables in patients undergoing yttrium-90 radioembolization ( 90 Y) for liver malignancies. MATERIALS AND METHODS: Patients with liver malignancies that progressed despite standard-of-care therapy were treated with 90 Y from 2002 to 2006. Baseline functional status, laboratory values, and diagnostic imaging were assessed before therapy. Imaging follow-up was performed 1 month after treatment and subsequently at 3-month intervals. Patients were followed for survival from the time of their first 90 Y treatment. RESULTS: Patients with follow-up imaging after radioembolization (N ؍ 130) were included in this analysis. Primary malignancies included colon, neuroendocrine, and others. The following clinical variables had a significant effect on survival on multivariate analysis: Eastern Cooperative Oncology Group (ECOG) performance status (PS) greater than 0 (hazard ratio [HR], 7.98; 95% CI, 3.98 -16), hepatic tumor burden of 51%-75% (HR, 2.46; 95% CI, 1.01-6.02), bilirubin level greater than 1.3 mg/dL (HR, 2.60; 95% CI, 1.27-5.34), hepatic metastases from breast cancer (HR, 2.51; 95% CI, 1.13-5.61), response on imaging based on World Health Organization (WHO) criteria (HR, 0.48; 95% CI, 0.24 -0.94), and lymphocyte depression (HR, 0.56; 95% CI, 0.31-0.96). Among patients with colorectal cancer metastases to the liver, the HR for survival on univariate analysis for responders compared with nonresponders (per WHO criteria) was 0.26 (95% CI, 0.10 -0.69).