Predictors of response to radio-embolization (TheraSphere®) treatment of neuroendocrine liver metastasis

Abstract

Radio-embolization increased the necrosis of NET liver metastasis mainly in patients with less bulky disease. This may imply that surgical therapy before radio-embolization would increase the response rates.

The Efficacy of Hepatic 90Y Resin Radioembolization for Metastatic Neuroendocrine Tumors: A Meta-Analysis

“…It has been suggested that many factors, including prior surgery (33), size of target lesions (34), performance status (35,36), baseline chemistry values (35), Ki-67 index (17), presence of extrahepatic disease (16), and inability to deliver a specified dose (34), influence patient outcomes for treatment of hepatic mNETs with 90 Y radioembolization. Unfortunately, despite publication reporting standards (13), publications do not conform to these standards and such clinical factors are often absent or incomplete, which limited the ability of this meta-analysis to analyze other factors potentially contributing to the pooled results.…”

Y90 Selective Internal Radiation Therapy

“…They found that the patients who had prior surgical therapies had a significantly better response to radioembolization. 68 They also found that patients with bilateral hepatic lesions or lesions involving a large percentage of the liver did not respond as favorably to the treatment. 68 In comparing glass versus resin SIRT microspheres, Rhee and colleagues 51 studied 42 patients with NETLM who were treated with radioembolization using either glass or resin microspheres.…”

“…68 They also found that patients with bilateral hepatic lesions or lesions involving a large percentage of the liver did not respond as favorably to the treatment. 68 In comparing glass versus resin SIRT microspheres, Rhee and colleagues 51 studied 42 patients with NETLM who were treated with radioembolization using either glass or resin microspheres. Ninety-two percent of the glass microsphere group demonstrated either a partial response or stable disease, whereas 94% of the resin microsphere group demonstrated either a partial response or stable disease.…”

“…They found that using the RECIST criteria, the mean percentage of necrosis following a single radioembolization session was 48%. 68 In addition, they assessed the predictors of responders and nonresponders to SIRT in NETLM. They found that the patients who had prior surgical therapies had a significantly better response to radioembolization.…”

Combined Sorafenib and Yttrium-90 Radioembolization for the Treatment of Advanced Hepatocellular Carcinoma

“…Microspheres with 90 Y exert their local radiotherapeutic effect primarily from beta-particle emission, which has an average therapeutic range of 2.5 mm in tissue (0.94 MeV per beta particle), with a maximal range of less than 1 cm. The isotope has a physical half-life of 64.2 hours and decays to stable 90 Zr 18,24,25 .…”