Radioembolization in Patients with Hepatic Metastases from Breast Cancer

Jakobs, Tobias; Hoffmann, Ralf; Fischer, T.; Stemmler, Hans Joachim; Tatsch, Klaus; Fougère, Christian la; Murthy, Ravi; Reiser, M; Helmberger, Thomas

doi:10.1016/j.jvir.2008.01.009

Cited by 99 publications

(95 citation statements)

References 36 publications

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“…The response rates in our patient population were comparable to previously published studies, with a similar overall survival of 47 wk (7)(8)(9). To date, only a limited number of prognostic factors such as performance status (as measured with the Eastern Cooperative Oncology Group criteria) have been validated for identifying patients at risk for poor outcomes after radioembolization.…”

Section: Discussionsupporting

confidence: 84%

“…Other factors, such as a tumor burden of less than 25% and a good performance status of the patient, were also associated with longer survival after radioembolization, though these factors did not reach statistical significance (7). Furthermore, the findings of a recent preliminary study suggested that response to SIRT as assessed by CT or MRI reliably predicts survival (9).…”

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confidence: 99%

“…In hepatic metastases of breast cancer (7)(8)(9), reported response rates to SIRT have ranged from 39% to 61%, with subsequent mean survival of 2-14 mo (9). The high variability of these findings is explained in part by differences in histologic tumor grading and by the presence of hormone receptors or the Her-2/neu receptor status on the surface of breast cancer cells, which are well-known prognostic factors influencing survival of metastasized breast cancer patients (10).…”

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confidence: 99%

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¹⁸F-FDG PET/CT Predicts Survival After Radioembolization of Hepatic Metastases from Breast Cancer

Haug

Donfack²,

Trumm³

et al. 2012

J Nucl Med

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90 Y radioembolization (selective internal radiation therapy [SIRT]) has emerged as a valuable therapeutic option in unresectable, chemotherapy-refractory hepatic metastases from breast cancer. The objective of the present study was to evaluate 18 F-FDG PET/ CT for predicting survival in these patients. Methods: Fifty-eight consecutive patients with hepatic metastases from breast cancer were treated with SIRT. Before therapy, all patients underwent MRI of the liver. 18 F-FDG PET/CT was performed at baseline and 3 mo after SIRT to calculate percentage changes in maximum 18 F-FDG standardized uptake value (SUV max ) relative to baseline. A decrease of more than 30% in the follow-up scan, compared with the baseline examination, indicated therapy response. Treatment response at 3 mo was also assessed in 43 patients using contrastenhanced MRI and CT on the basis of the Response Evaluation Criteria in Solid Tumors. All patients were followed to complete survival data. Results: Overall median survival after SIRT was 47 wk. Response as assessed with SUV max correlated significantly with survival after radioembolization, with responders having significantly longer survival (65 wk) than nonresponders (43 wk; P , 0.05). In multivariate analysis the change in SUV max was identified as the only independent predictor of survival (hazard ratio, 0.23; P , 0.005). Furthermore, a high pretherapeutic SUV max (.20) was associated with a significantly shorter median survival than was an SUV max of 20 or less (21 vs. 52 wk; P , 0.005). The presence of extrahepatic metastases (mean survival in both groups, 47 wk; P 5 0.92), hormone receptor status (estrogen, P 5 0.53; progesterone, P 5 0.79; Her-2/neu, P 5 0.49), and MRI/CT response (P 5 0.91) did not predict survival. Conclusion: The change in SUV max as assessed by 18 F-FDG PET/CT before and 3 mo after SIRT was identified as the only independent predictor of survival in patients with hepatic metastases of breast cancer. Breastcanceri s the most common malignancy affecting women in developed countries. Despite advances in adjuvant treatment, about 20% of patients with initially local disease will still develop metastases (1), frequently involving the liver. In most patients, curative surgical resection of liver metastases is not an option because of the presence of extrahepatic disease or multisegmental involvement of the liver. Other local therapies, such as radiofrequency ablation, are feasible in only a limited number of patients exhibiting only a few, small hepatic metastases. Despite significant advances in chemotherapeutic options in metastatic breast cancer, the presence of liver metastases limits survival in up to 60% of patients. Median survival in women exhibiting liver metastases of breast cancer has been estimated at about 18 mo (2).More recently, radioembolization using 90 Y-microspheres (selective internal radiation therapy [SIRT]) has emerged as a palliative treatment for hepatic metastases of various tumors (3-6). In hepatic metastases of breast cancer (7-9), reported...

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Section: Discussionsupporting

confidence: 84%

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confidence: 99%

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confidence: 99%

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¹⁸F-FDG PET/CT Predicts Survival After Radioembolization of Hepatic Metastases from Breast Cancer

Haug

Donfack²,

Trumm³

et al. 2012

J Nucl Med

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“…Previous trials, including 1 study from our department, reported a high incidence of postembolization syndrome (67% and 100%) after radioembolization for BRCLM (5,9). In our expanded cohort, we likewise found mild to moderate symptoms of fever, nausea, or abdominal pain in 23%-72% of patients.…”

Section: Discussionsupporting

confidence: 71%

“…However, radioembolization is associated with adverse events, which range in severity from a mild postembolization syndrome, including fatigue, abdominal pain, nausea, or fever, to serious complications such as radioembolization-induced liver disease (REILD), pancreatitis, or gastrointestinal ulceration (7,8). Indeed, lethal outcomes after radioembolization for BRCLM have been reported (9,10). Radioembolization is performed at a stage of terminal disease, with an aim to prolong patient survival without limiting quality of life.…”

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confidence: 99%

Safety, Efficacy, and Prognostic Factors After Radioembolization of Hepatic Metastases from Breast Cancer: A Large Single-Center Experience in 81 Patients

et al. 2016

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The present study evaluated safety, efficacy, and prognostic factors for 90 Y-yttrium microsphere radioembolization of unresectable liver metastases from breast cancer. Methods: Eighty-one patients were treated with radioembolization. Acute toxicity was monitored through daily physical examination and serum tests until 3 d after radioembolization; late toxicity was evaluated until 12 wk after radioembolization. Overall survival and response according to 18 F-FDG PET (.30% decrease of tracer uptake) and CA15-3 serum level (any decline) were recorded. Pretherapeutic characteristics, including pretreatment history, liver function tests, and PET/CT parameters, were assessed by univariate and subsequent multivariate Cox regression for predicting patient survival. Results: A toxicity grade of 3 or more based on clinical symptoms, bilirubin, ulcer, pancreatitis, ascites, or radioembolization-induced liver disease occurred in 10% or less of patients. Two patients eventually died from radioembolization-induced liver disease. Sequential lobar treatment and absence of prior angiosuppressive therapy were both associated with a lower rate of serious adverse events. On the basis of PET/CA15-3 criteria, 52/61% of patients responded to treatment. Median overall survival after radioembolization was 35 wk (interquartile range, 41 wk). Pretherapeutic tumor burden of the liver greater than 50% or more (P , 0.001; hazard ratio, 5.67; 95% confidence interval, 2.41-13.34) and a transaminase toxicity grade of 2 or more (P 5 0.009; hazard ratio, 2.15; 95% confidence interval, 1.21-3.80) independently predicted short survival. Conclusion: Radioembolization for breast cancer liver metastases shows encouraging local response rates with low incidence of serious adverse events, especially in those patients with sequential lobar treatment or without prior angiosuppressive therapy. High hepatic tumor burden and liver transaminase levels at baseline indicate poor outcome.

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Internal Radiation Therapy for Liver Tumors

Riaz

Kulik

Abécassis

et al. 2009

Malignant Liver Tumors

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Radioembolization in Patients with Hepatic Metastases from Breast Cancer

Cited by 99 publications

References 36 publications

¹⁸F-FDG PET/CT Predicts Survival After Radioembolization of Hepatic Metastases from Breast Cancer

¹⁸F-FDG PET/CT Predicts Survival After Radioembolization of Hepatic Metastases from Breast Cancer

Safety, Efficacy, and Prognostic Factors After Radioembolization of Hepatic Metastases from Breast Cancer: A Large Single-Center Experience in 81 Patients

Internal Radiation Therapy for Liver Tumors

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Radioembolization in Patients with Hepatic Metastases from Breast Cancer

Cited by 99 publications

References 36 publications

18F-FDG PET/CT Predicts Survival After Radioembolization of Hepatic Metastases from Breast Cancer

18F-FDG PET/CT Predicts Survival After Radioembolization of Hepatic Metastases from Breast Cancer

Safety, Efficacy, and Prognostic Factors After Radioembolization of Hepatic Metastases from Breast Cancer: A Large Single-Center Experience in 81 Patients

Internal Radiation Therapy for Liver Tumors

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¹⁸F-FDG PET/CT Predicts Survival After Radioembolization of Hepatic Metastases from Breast Cancer

¹⁸F-FDG PET/CT Predicts Survival After Radioembolization of Hepatic Metastases from Breast Cancer