Radioembolization of Symptomatic, Unresectable Neuroendocrine Hepatic Metastases Using Yttrium-90 Microspheres

Paprottka, Philipp M.; Hoffmann, R.; Haug, Alexander; Sommer, Wieland H.; Raeßler, Franziska; Trumm, C.; Schmidt, Gerwin P.; Ashoori, Nima; Reiser, Maximilian; Jakobs, Tobias

doi:10.1007/s00270-011-0248-1

Cited by 100 publications

(58 citation statements)

References 46 publications

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“…When stratified by tumor proliferation index (B), median OS was 8 mo (95% CI, 5-11) in patients with index greater than 5%, whereas for Ki-67 of 5% or less, median OS was not reached after 54 mo (P 5 0.007). (14,16,18,19,21), median OS was not reached in 2 other reports after a median follow-up of 13-17 mo (17,20), and 1 large retrospective multicenter evaluation yielded an extraordinarily long median OS of 70 mo (15). Reported symptomatic and biochemical response rates were in the range of 75%-95% (17,(19)(20)(21) and 45%-67% (17,19,20), respectively.…”

Section: Discussionmentioning

confidence: 93%

“…There is a substantial database demonstrating the efficacy of radioembolization in hepatic NET as found by prospective and retrospective studies (14)(15)(16)(17)(18)(19)(20)(21). Most reported median OS rates range between 25 and 36 mo from treatment .…”

Section: Discussionmentioning

confidence: 98%

“…NETs are perfectly suited for transarterial treatment, and in particular for radioembolization, because of their typically prominent hypervascularity (11)(12)(13). The efficacy and safety of 90 Y-RE have been demonstrated in this tumor entity (14)(15)(16)(17)(18)(19)(20)(21), including patients after bland arterial embolization (22). However, no data are available on the safety of 90 Y-RE after internal radiation with targeted radionuclide treatment.…”

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confidence: 99%

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⁹⁰Y Radioembolization After Radiation Exposure from Peptide Receptor Radionuclide Therapy

et al. 2012

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Previous radiation therapy of the liver is a contraindication for performing 90 Y microsphere radioembolization, and its safety after internal radiation exposure through peptide receptor radionuclide therapy (PRRT) has not yet been investigated. Methods: We retrospectively assessed a consecutive cohort of 23 neuroendocrine tumor (NET) patients with liver-dominant metastatic disease undergoing radioembolization with 90 Y microspheres as a salvage therapy after failed PRRT. Toxicity was recorded throughout follow-up and reported according to Common Terminology Criteria for Adverse Events (version 3). Radiologic (response evaluation criteria in solid tumors), biochemical, and symptomatic responses were investigated at 3 mo after treatment, and survival analyses were performed with the Kaplan-Meier method (log-rank test, P , 0.05). Results: The median follow-up period after radioembolization was 38 mo (95% confidence interval, 18-58 mo). The mean previous cumulative activity of 177 Lu-DOTA-octreotate was 31.8 GBq. The mean cumulative treatment activity of 90 Y microspheres was 3.4 6 2.1 GBq, administered to the whole liver in a single session (n 5 8 patients), in a sequential lobar fashion (n 5 10 patients), or to only 1 liver lobe (n 5 5 patients). Only transient, mostly minor liver toxicity (no grade 4) was recorded. One patient (4.3%) developed a gastroduodenal ulcer (grade 2). The overall response rates for radiologic, biochemical, and symptomatic responses were 30.4%, 53.8%, and 80%, respectively. The median overall survival was 29 mo (95% confidence interval, 4-54 mo) from the first radioembolization session and 54 mo (95% confidence interval, 47-61 mo) from the first PRRT cycle. A tumor proliferation index Ki-67 greater than 5% predicted shorter survival (P 5 0.007). Conclusion: Radioembolization is a safe and effective salvage treatment option in advanced NET patients with liverdominant tumor burden who failed or reprogressed after PRRT. The lack of relevant liver toxicity despite high applied 90 Y activities and considerable previous cumulative activities of 177 Lu-octreotate is noteworthy and disputes internal radiation exposure by PRRT as a toxicity risk factor in subsequent radioembolization.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 98%

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⁹⁰Y Radioembolization After Radiation Exposure from Peptide Receptor Radionuclide Therapy

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“…The radiographic responses (hepatic ORR of 73% and DCR of 100%) appear favorable in comparison to the previously reported rates for ORR (23-64%) and DCR (67-98%) (9)(10)(11)(12)(34)(35)(36). The radiographic responses reported in this study represent best observed responses.…”

Section: Discussionmentioning

confidence: 38%

Radioembolization with 490Y glass microspheres for the treatment of unresectable metastatic liver disease from chemotherapy-refractory gastrointestinal cancers: final report of a prospective pilot study

Fidelman

Kerlan

Taylor

et al. 2015

Journal of Vascular and Interventional Radiology

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Background: This prospective pilot single-institution study was undertaken to document the feasibility, Majority of clinical AE were grade 1 or 2 in severity. Patients with colorectal cancer had hepatic objective response rate (ORR) of 25% and a hepatic disease control rate (DCR) of 80%. Median PFS and OS were 1.0 and 4.4 months, respectively. Patients with neuroendocrine tumors (NET) had hepatic ORR and DCR of 73% and 100%, respectively. Median PFS was 8.9 months for this cohort. DCR and median PFS and OS for patients with cholangiocarcinoma were 86%, 1.1 months, and 6.7 months, respectively. Conclusions: 90 Y glass microspheres device has a favorable safety profile, and achieved prolonged disease control of hepatic tumor burden in a subset of patients, including all patients enrolled in the neuroendocrine cohort.

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“…Among different forms of radioisotope treatment in NETs, including PNETs, radioembolisation of hepatic metastases with yttrium-labelled microspheres is used [142,251]. Since there are no reports on the use of radioembolisation in a larger group of patients, further studies in this field are necessary.…”

Section: Szkolenie Podyplomowementioning

confidence: 99%

Nowotwory neuroendokrynne trzustki — zasady diagnostyki i leczenia (rekomendowane przez Polską Sieć Guzów Neuroendokrynych)

Kos–Kudła¹,

Rosiek²,

Borowska³

et al. 2017

Endokrynologia Polska

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Radioembolization of Symptomatic, Unresectable Neuroendocrine Hepatic Metastases Using Yttrium-90 Microspheres

Cited by 100 publications

References 46 publications

⁹⁰Y Radioembolization After Radiation Exposure from Peptide Receptor Radionuclide Therapy

⁹⁰Y Radioembolization After Radiation Exposure from Peptide Receptor Radionuclide Therapy

Radioembolization with 490Y glass microspheres for the treatment of unresectable metastatic liver disease from chemotherapy-refractory gastrointestinal cancers: final report of a prospective pilot study

Nowotwory neuroendokrynne trzustki — zasady diagnostyki i leczenia (rekomendowane przez Polską Sieć Guzów Neuroendokrynych)

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Radioembolization of Symptomatic, Unresectable Neuroendocrine Hepatic Metastases Using Yttrium-90 Microspheres

Cited by 100 publications

References 46 publications

90Y Radioembolization After Radiation Exposure from Peptide Receptor Radionuclide Therapy

90Y Radioembolization After Radiation Exposure from Peptide Receptor Radionuclide Therapy

Radioembolization with 490Y glass microspheres for the treatment of unresectable metastatic liver disease from chemotherapy-refractory gastrointestinal cancers: final report of a prospective pilot study

Nowotwory neuroendokrynne trzustki — zasady diagnostyki i leczenia (rekomendowane przez Polską Sieć Guzów Neuroendokrynych)

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⁹⁰Y Radioembolization After Radiation Exposure from Peptide Receptor Radionuclide Therapy

⁹⁰Y Radioembolization After Radiation Exposure from Peptide Receptor Radionuclide Therapy