Pre-therapeutic factors for predicting survival after radioembolization: a single-center experience in 389 patients

Paprottka, Karolin J.; Schoeppe, Franziska; Ingrisch, Michael; Rübenthaler, Johannes; Sommer, Nora N.; Toni, E. De; Ilhan, Harun; Zacherl, Mathias J.; Todica, Andrei; Paprottka, Philipp M.

doi:10.1007/s00259-017-3646-z

Cited by 27 publications

(37 citation statements)

References 34 publications

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“…It demonstrates the feasibility of performing transarterial radioembolization in the treatment of both primary and secondary liver tumors in a low-volume, non-referral, private medical center with subsequent survival benefit and a low rate of complications. Median OS for patients included in our study is comparable to other recent studies involving mixed tumors types, ranging from 11.7 to 19.0 months [18,19].…”

Section: Discussionsupporting

confidence: 84%

Single-Institution Experience with Selective Internal Radiation Therapy (SIRT) for the Treatment of Primary and Secondary Hepatic Tumors

Yammine

Kamar²,

Nasser

et al. 2020

Cureus

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Purpose: We aim to provide results of the real-world experience of a single center in Lebanon on the use of radioembolization to treat liver-only or liver-dominant tumors.Methods: This retrospective review included patients who were evaluated for radioembolization between January 2015 and June 2017 and who had a lung shunt fraction of 20% or less. Tumor responses were determined using the response evaluation criteria in solid tumors (RECIST).Results: Of the 23 Arab patients with a median age of 64 years (range, 36-87 years), eight had hepatocellular carcinoma, four had cholangiocarcinoma, and 11 had liver-only or liverdominant metastases from other primary cancers. Most (n=17) had multifocal lesions, and 13 had a history of branched (n=8) or main (n=5) portal vein thrombosis. When appropriate, the gastroduodenal artery and middle hepatic artery were embolized for consolidation of radiotherapy; 18 patients required arterial coil occlusion, two had their cystic artery occluded, and one developed cholecystitis, which was successfully treated with antibiotics and supportive care. Another patient developed a post-radioembolization complication-a peptic ulcer unrelated to arterial reflux of microspheres because both the gastroduodenal and right gastric arteries were occluded. The median time to progression was seven months (range, 3-36 months), and median overall survival from radioembolization was 12 months (range, 3-40 months). Tumor responses included five complete responses, 13 partial responses, one stable disease, and four cases of progressive disease.Conclusion: Performing radioembolization in a non-referral, private center in Lebanon resulted in good patient outcomes with few complications.

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Section: Discussionsupporting

confidence: 84%

Single-Institution Experience with Selective Internal Radiation Therapy (SIRT) for the Treatment of Primary and Secondary Hepatic Tumors

Yammine

Kamar²,

Nasser

et al. 2020

Cureus

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“…This retrospective study analyzed patients from a previously described cohort (9). This cohort comprised consecutive patients with hepatocellular carcinoma; cholangiocellular carcinoma; metastases of colorectal carcinoma, neuroendocrine tumors, or breast cancer; or other hepatic metastases who underwent radioembolization at our institution between January 2009 and December 2012.…”

Section: Patientsmentioning

confidence: 99%

“…Because of their simplicity, these approaches may impose overly strong assumptions, such as on the linearity of the effect of predictive variables, and may not use the full information that is contained in baseline variables. An established statistical concept for prediction of risk is based on multivariate Cox proportionalhazards models (6,9). Here, a statistical model for the individual hazard ratio is derived; multivariate situations are addressed by, for example, using stepwise variable selection or including interaction terms.…”

mentioning

confidence: 99%

“…Here, a statistical model for the individual hazard ratio is derived; multivariate situations are addressed by, for example, using stepwise variable selection or including interaction terms. In a recent study (9), multivariate Cox regression determined type of primary tumor, tumor burden, presence of extrahepatic disease, and baseline level of cholinesterase as independent predictors of overall survival. Cox regression relies on strong and potentially restrictive assumptions about linearity, and the selection of appropriate variables and interaction terms is an art in itself and often considered unintuitive and a ''black box'' from the perspective of the clinician.…”

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confidence: 99%

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Prediction of ⁹⁰Y Radioembolization Outcome from Pretherapeutic Factors with Random Survival Forests

et al. 2017

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Our objective was to predict the outcome of Y radioembolization in patients with intrahepatic tumors from pretherapeutic baseline parameters and to identify predictive variables using a machine-learning approach based on random survival forests. In this retrospective study, 366 patients with primary ( = 92) or secondary ( = 274) liver tumors who had received Y radioembolization were analyzed. A random survival forest was trained to predict individual risk from baseline values of cholinesterase, bilirubin, type of primary tumor, age at radioembolization, hepatic tumor burden, presence of extrahepatic disease, and sex. The predictive importance of each baseline parameter was determined using the minimal-depth concept, and the partial dependency of predicted risk on the continuous variables bilirubin level and cholinesterase level was determined. Median overall survival was 11.4 mo (95% confidence interval, 9.7-14.2 mo), with 228 deaths occurring during the observation period. The random-survival-forest analysis identified baseline cholinesterase and bilirubin as the most important variables (forest-averaged lowest minimal depth, 1.2 and 1.5, respectively), followed by the type of primary tumor (1.7), age (2.4), tumor burden (2.8), and presence of extrahepatic disease (3.5). Sex had the highest forest-averaged minimal depth (5.5), indicating little predictive value. Baseline bilirubin levels above 1.5 mg/dL were associated with a steep increase in predicted mortality. Similarly, cholinesterase levels below 7.5 U predicted a strong increase in mortality. The trained random survival forest achieved a concordance index of 0.657, with an SE of 0.02, comparable to the concordance index of 0.652 and SE of 0.02 for a previously published Cox proportional hazards model. Random survival forests are a simple and straightforward machine-learning approach for prediction of overall survival. The predictive performance of the trained model was similar to a previously published Cox regression model. The model has revealed a strong predictive value for baseline cholinesterase and bilirubin levels with a highly nonlinear influence for each parameter.

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“…Paprottka and colleagues [53] reported on pretherapy factors that could predict overall survival after 90 Y SIRT. Baseline bilirubin and cholinesterase levels, extrahepatic disease, and hepatic tumor content were independent predictors of overall survival.…”

Section: Selective Internal Radioembolization Of Malignant Liver Lesionsmentioning

confidence: 99%

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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Pre-therapeutic factors for predicting survival after radioembolization: a single-center experience in 389 patients

Abstract: Pre-therapeutic baseline bilirubin and CHE levels, extrahepatic disease and hepatic tumor burden are associated with patient survival after RE. Such parameters may be used to improve patient selection for RE of primary or metastatic liver tumors.

Cited by 27 publications

References 34 publications

Single-Institution Experience with Selective Internal Radiation Therapy (SIRT) for the Treatment of Primary and Secondary Hepatic Tumors

Single-Institution Experience with Selective Internal Radiation Therapy (SIRT) for the Treatment of Primary and Secondary Hepatic Tumors

Prediction of ⁹⁰Y Radioembolization Outcome from Pretherapeutic Factors with Random Survival Forests

Targeted Radionuclide Therapy: An Evolution Toward Precision Cancer Treatment

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Pre-therapeutic factors for predicting survival after radioembolization: a single-center experience in 389 patients

Abstract: Pre-therapeutic baseline bilirubin and CHE levels, extrahepatic disease and hepatic tumor burden are associated with patient survival after RE. Such parameters may be used to improve patient selection for RE of primary or metastatic liver tumors.

Cited by 27 publications

References 34 publications

Single-Institution Experience with Selective Internal Radiation Therapy (SIRT) for the Treatment of Primary and Secondary Hepatic Tumors

Single-Institution Experience with Selective Internal Radiation Therapy (SIRT) for the Treatment of Primary and Secondary Hepatic Tumors

Prediction of 90Y Radioembolization Outcome from Pretherapeutic Factors with Random Survival Forests

Targeted Radionuclide Therapy: An Evolution Toward Precision Cancer Treatment

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Product

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Prediction of ⁹⁰Y Radioembolization Outcome from Pretherapeutic Factors with Random Survival Forests