Hepatopulmonary Shunting: A Prognostic Indicator of Survival in Patients with Metastatic Colorectal Adenocarcinoma Treated with <sup>90</sup>Y Radioembolization

Narsinh, Kazim; Buskirk, Mark Van; Kennedy, Andrew S.; Suhail, Mohammed; Alsaikhan, Naif; Hoh, Carl K.; Thurston, Kenneth G.; Minocha, Jeet; Ball, David S.; Cohen, Steven J.; Cohn, Michael; Coldwell, Douglas M.; Drooz, Alain; Ehrenwald, Eduardo; Kanani, Samir; Nutting, Charles; Moeslein, Fred; Savin, Michael A.; Schirm, Sabine; Putnam, Samuel; Sharma, Navesh K.; Wang, Eric A.; Rose, Steven C.

doi:10.1148/radiol.2016152100

Cited by 28 publications

(24 citation statements)

References 24 publications

(24 reference statements)

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“…Similar favorable pooled outcome results have been reported with systematic review and meta-analysis of data on unresectable intrahepatic cholangiocarcinoma and meta-static NETs [57, 58]. Moreover, interestingly, overall survival progressively decreases as lung shunt fraction increases from less than 5% to more than 20% [59, 60]. …”

Section: Selective Internal Radioembolization Of Malignant Liver Lesionssupporting

confidence: 77%

Targeted Radionuclide Therapy: An Evolution Toward Precision Cancer Treatment

Jadvar

2017

American Journal of Roentgenology

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Objective This article reviews recent developments in targeted radionuclide therapy (TRT) approaches directed to malignant liver lesions, bone metastases, neuroendocrine tumors, and castrate-resistant metastatic prostate cancer and discusses challenges and opportunities in this field. Conclusion TRT has been employed since the first radioiodine thyroid treatment almost 75 years ago. Progress in the understanding of the complex underlying biology of cancer and advances in radiochemistry science, multimodal imaging techniques including the concept of “see and treat” within the framework of theranostics, and universal traction with the notion of precision medicine have all contributed to a resurgence of TRT.

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Section: Selective Internal Radioembolization Of Malignant Liver Lesionssupporting

confidence: 77%

Targeted Radionuclide Therapy: An Evolution Toward Precision Cancer Treatment

Jadvar

2017

American Journal of Roentgenology

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“…Adverse events (AEs), baseline patient tumor characteristics, and treatment histories were previously collected as described (8,14). Briefly, data were collected at baseline, on the day of the first 90 Y-RE treatment (day 0), and at all subsequent visits or until death.…”

Section: Data Collection and Analysismentioning

confidence: 99%

Updated survival outcomes and analysis of long-term survivors from the MORE study on safety and efficacy of radioembolization in patients with unresectable colorectal cancer liver metastases

Kennedy

Cohn

Coldwell

et al. 2017

J. Gastrointest. Oncol.

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Background: The Metastatic colorectal cancer liver metastases Outcomes after RadioEmbolization (MORE) study was a retrospective analysis of 606 patients with unresectable colorectal liver metastases treated with radioembolization (RE) using 90 Y-labeled resin microspheres. The first analysis of this study was completed with a last patient follow-up of 77.7 months. We now provide an updated survival analysis through September 15, 2016, with a last patient follow-up of 125 months. Methods: 90 Y-RE was considered for patients with advanced liver-only or liver-dominant metastatic colorectal cancer which was deemed not suitable for surgery, ablation, or systemic therapy, and which had progressed or become refractory to at least one line of systemic therapy. All patients with a diagnosis of metastatic colorectal cancer who had received at least 1 RE treatment and 1 follow-up visit were included in the analysis. Patients were treated between July 2002 and December 2011 at one of 11 U.S. tertiary care centers. Data were collected at baseline, on the day of the first 90 Y-RE treatment (day 0), and at all subsequent visits or until death. Patient medical charts and/or public records were accessed to obtain dates of death. Results: Dates of death were obtained for 574 out of a total of 606 patients, and overall survival (OS) data analyzed. Updated median OS was 10.0 months (95% CI: 9.2-11.8 months) at a median follow-up of 9.5 months versus the originally reported median OS of 9.6 months (95% CI: 9.0-11.1 months) at a follow-up of 8.6 months in the first MORE analysis. Patients received a median (range) of 2 (0 to 6) lines of chemotherapy. Baseline characteristics and factors significantly associated with patient survival (P<0.01) are consistent with those reported in the first safety analysis of the MORE study. These factors include poor ECOG performance status, markers of advanced disease such as increased extent of tumor-to-target liver involvement, poor baseline liver function, pre-treatment anemia, lung shunt fraction, and number of lines of prior chemotherapy. Patient age did not significantly affect survival outcomes. Conclusions: Long-term follow-up confirms that 90 Y-RE treatment offers favorable survival benefits for patients with unresectable metastatic colorectal cancer, even among patients who received 3 or more prior lines of chemotherapy. Our analysis also supports earlier reported prognostic factors for survival after 90 Y-RE. Overall, our updated analysis confirms that 90 Y-RE treatment provided a meaningful response and survival advantage for MORE patients across all ages and across diverse community and academic centers in the U.S.

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“…1e, f). The activity in the lungs as quantified on 90 Y-PET/CT revealed an absorbed lung dose of approximately 17 Gy which was below the assumed threshold of 30 Gy [5]. Three weeks post-treatment, the patient developed symptoms of pneumonia that were unresponsive to antibiotic therapy, there were no anomalies on CECT ( Fig.…”

Section: Case #1: 90 Y-pet/ct To Detect Excessive Lung Shuntmentioning

confidence: 95%

The value of yttrium-90 PET/CT after hepatic radioembolization: a pictorial essay

Alsultan

Smits

Barentsz

et al. 2019

Clin Transl Imaging

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Introduction Distribution of microspheres after radioembolization can be accurately visualized using PET/CT. In this pictorial essay, we aim to demonstrate the value of 90 Y-PET/CT after radioembolization. Methods 90 Y-PET/CT imaging was routinely performed after radioembolization at our institute. Patients were scanned the same day or the day after treatment, using a scanner with time-of-flight technology. We retrospectively reviewed all 90 Y-PET/ CTs from patients treated with radioembolization (both glass and resin microspheres) between January 2011 and January 2019. Five cases were selected that are illustrative of the added value of PET/CT after radioembolization. Results 90 Y-PET/CT allows for distribution assessment and dosimetry of 90 Y-microspheres. It was used for the assessment of treatment success by visualization of tumor targeting, quantification of the absorbed dose, prediction of complications such as radioembolization-induced liver disease, and determining the required dosage for retreatment. Conclusion PET/CT is an excellent modality for post-treatment imaging of 90 Y-microspheres and could lead to improved dose planning and more personalized treatment.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Hepatopulmonary Shunting: A Prognostic Indicator of Survival in Patients with Metastatic Colorectal Adenocarcinoma Treated with ⁹⁰Y Radioembolization

Cited by 28 publications

References 24 publications

Targeted Radionuclide Therapy: An Evolution Toward Precision Cancer Treatment

Targeted Radionuclide Therapy: An Evolution Toward Precision Cancer Treatment

Updated survival outcomes and analysis of long-term survivors from the MORE study on safety and efficacy of radioembolization in patients with unresectable colorectal cancer liver metastases

The value of yttrium-90 PET/CT after hepatic radioembolization: a pictorial essay

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Hepatopulmonary Shunting: A Prognostic Indicator of Survival in Patients with Metastatic Colorectal Adenocarcinoma Treated with 90Y Radioembolization

Cited by 28 publications

References 24 publications

Targeted Radionuclide Therapy: An Evolution Toward Precision Cancer Treatment

Targeted Radionuclide Therapy: An Evolution Toward Precision Cancer Treatment

Updated survival outcomes and analysis of long-term survivors from the MORE study on safety and efficacy of radioembolization in patients with unresectable colorectal cancer liver metastases

The value of yttrium-90 PET/CT after hepatic radioembolization: a pictorial essay

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Hepatopulmonary Shunting: A Prognostic Indicator of Survival in Patients with Metastatic Colorectal Adenocarcinoma Treated with ⁹⁰Y Radioembolization