Liver Metastases in Pancreatic Acinar Cell Carcinoma Treated with Selective Internal Radiation Therapy with Y-90 Resin Microspheres

Abstract

Background Pancreatic acinar cell carcinoma (PACC) is a rare tumor. Surgical resection is the treatment of choice when feasible, but there are no clear recommendations for patients with advanced disease. Liver-directed therapy with Y-90 selective internal radiation therapy (SIRT) has been used to treat hepatic metastases from pancreatic tumors. We describe a case of PACC liver metastases treated with SIRT. Case Report 59-year-old man was admitted with an infiltrative, solid lesion in pancreatic tail diagnosed as PACC. Lymph nodes in the hepatic hilum were enlarged, and many metastatic liver nodules were observed. After partial pancreatectomy, the left and right lobes of the liver were separately treated with Y-90 resin microspheres. Follow-up imaging revealed that all hepatic nodules shrank by at least 50%, and 3 nodules disappeared completely. Lipase concentration was 8407 U/L at baseline, rose to 12,705 U/L after pancreatectomy, and declined to 344 U/L after SIRT. Multiple rounds of chemotherapy in the subsequent year shrank the hepatic tumors further; disease then progressed, but a third line of chemotherapy shrank the tumors again, 16 months after SIRT treatment. Conclusion SIRT had a positive effect on liver metastases from PACC. In conjunction with systemic therapy, SIRT can achieve sustained disease control.

Transarterial Selective Internal Radiation Therapy with Yttrium-90 for Liver Metastatic Urothelial Carcinoma of the Ureter as a Bridging Therapy to Immunotherapy: A Case Report with a 10-Year Follow-Up

“…With the development of glass and resin Y90 microspheres in the 1990s, several studies demonstrated its potential role for advanced-stage hepatocellular carcinoma [16]. Nowadays, its applications have evolved for several types of malignancies and for different situations in the treatment pathway for patients with cancer, not more restricted to the salvage setting for patients with chemorefractory disease [11,12,[17][18][19].…”

“…This locoregional therapy was used from palliative care to neoadjuvant treatment in the treatment of several types of liver metastatic disease with encouraging outcomes [10][11][12]. Herein, we present a first-of-its-kind case where SIRT was successfully used in combination with other pre-established treatment options for metastatic upper urinary tract urothelial carcinoma.…”

Surgical resection of hepatic and rectal metastases of pancreatic acinar cell carcinoma (PACC): a case report

“…We chose resection of the liver metastases for two reasons. First, liver metastases are often multiple in PACC [ 19 ]; however, in this case, it was solitary, slow growing, and relatively small even 24 months after the primary pancreatectomy. Second, additional chemotherapy was not favorable for this patient due to the severe side effects of the previous treatment with S-1.…”

Pancreatic acinar cell carcinoma: A comprehensive review

“…Rarely do patients with ACC are diagnose with lung, cervical lymph nodes, and ovary metastases. Metastatic illness is typically detected in regional lymph nodes and the liver[ 69 ]. Patients presenting as their first disease symptom with distant metastases are infrequent.…”