Recommendations for Radioembolization of Hepatic Malignancies Using Yttrium-90 Microsphere Brachytherapy: A Consensus Panel Report from the Radioembolization Brachytherapy Oncology Consortium

Kennedy, Andrew S.; Nag, Subir; Salem, Riad; Murthy, Ravi; McEwan, Alexander; Nutting, Charles; Benson, Al B.; Espat, Joseph; Bilbao, J.I.; Sharma, Ricky A.; Thomas, James P.; Coldwell, Douglas M.

doi:10.1016/j.ijrobp.2006.11.060

Cited by 616 publications

(562 citation statements)

References 30 publications

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“…Centers were guided in the selection of patients, pretreatment work-up, and RE by the published consensus from the Radioembolization Brachytherapy Oncology Consortium (REBOC) and earlier reviews (15)(16)(17). In summary, 90 Y-RE was considered for advanced liver-only or liverdominant metastatic colorectal cancer, which was deemed not suitable for surgery, ablation, or systemic therapy, and which had progressed or become refractory to at least one line of systemic therapy.…”

Section: Study Design Patient Selection and Treatmentmentioning

confidence: 99%

Updated survival outcomes and analysis of long-term survivors from the MORE study on safety and efficacy of radioembolization in patients with unresectable colorectal cancer liver metastases

Kennedy

Cohn

Coldwell

et al. 2017

J. Gastrointest. Oncol.

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Background: The Metastatic colorectal cancer liver metastases Outcomes after RadioEmbolization (MORE) study was a retrospective analysis of 606 patients with unresectable colorectal liver metastases treated with radioembolization (RE) using 90 Y-labeled resin microspheres. The first analysis of this study was completed with a last patient follow-up of 77.7 months. We now provide an updated survival analysis through September 15, 2016, with a last patient follow-up of 125 months. Methods: 90 Y-RE was considered for patients with advanced liver-only or liver-dominant metastatic colorectal cancer which was deemed not suitable for surgery, ablation, or systemic therapy, and which had progressed or become refractory to at least one line of systemic therapy. All patients with a diagnosis of metastatic colorectal cancer who had received at least 1 RE treatment and 1 follow-up visit were included in the analysis. Patients were treated between July 2002 and December 2011 at one of 11 U.S. tertiary care centers. Data were collected at baseline, on the day of the first 90 Y-RE treatment (day 0), and at all subsequent visits or until death. Patient medical charts and/or public records were accessed to obtain dates of death. Results: Dates of death were obtained for 574 out of a total of 606 patients, and overall survival (OS) data analyzed. Updated median OS was 10.0 months (95% CI: 9.2-11.8 months) at a median follow-up of 9.5 months versus the originally reported median OS of 9.6 months (95% CI: 9.0-11.1 months) at a follow-up of 8.6 months in the first MORE analysis. Patients received a median (range) of 2 (0 to 6) lines of chemotherapy. Baseline characteristics and factors significantly associated with patient survival (P<0.01) are consistent with those reported in the first safety analysis of the MORE study. These factors include poor ECOG performance status, markers of advanced disease such as increased extent of tumor-to-target liver involvement, poor baseline liver function, pre-treatment anemia, lung shunt fraction, and number of lines of prior chemotherapy. Patient age did not significantly affect survival outcomes. Conclusions: Long-term follow-up confirms that 90 Y-RE treatment offers favorable survival benefits for patients with unresectable metastatic colorectal cancer, even among patients who received 3 or more prior lines of chemotherapy. Our analysis also supports earlier reported prognostic factors for survival after 90 Y-RE. Overall, our updated analysis confirms that 90 Y-RE treatment provided a meaningful response and survival advantage for MORE patients across all ages and across diverse community and academic centers in the U.S.

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Section: Study Design Patient Selection and Treatmentmentioning

confidence: 99%

Updated survival outcomes and analysis of long-term survivors from the MORE study on safety and efficacy of radioembolization in patients with unresectable colorectal cancer liver metastases

Kennedy

Cohn

Coldwell

et al. 2017

J. Gastrointest. Oncol.

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“…This results in the tumor receiving a high dose of radiation [1][2][3][4]. Recently, Y-90 resin microspheres have been approved by the United States Food and Drug Administration (USFDA) and also by the Korean Food and Drug Administration (KFDA) as medical devices.…”

Section: Discussionmentioning

confidence: 99%

“…Although the majority of the technique is based on bland embolization and chemoembolization techniques, yttrium-90 (Y-90) microsphere radioembolization therapy (RET) represents an alternate transarterial embolization option. There are ample data that support the use of Y-90 microspheres for primary and metastatic liver tumors [1][2][3][4]. Meanwhile, the patient who has been administered radioisotopes acts as a radiation source to others: caring healthcare personnel, family members and also to non-related individuals in streets, commuters and public places.…”

Section: Introductionmentioning

confidence: 99%

Radiation Safety Issues in Y-90 Microsphere Selective Hepatic Radioembolization Therapy: Possible Radiation Exposure from the Patients

Kim

Uhm

et al. 2010

Nucl Med Mol Imaging

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Purpose The purpose of this study was to estimate the possible external radiation dose to other individuals from patients treated with Y-90 resin microspheres for unresectable hepatocellular carcinoma. Methods We designed the study prospectively to estimate the possible radiation dose to other individuals from patients who had been treated with Y-90 microspheres for unresectable hepatocellular carcinoma. We estimated the total effective dose equivalent (TEDE) using two methods: 'theoretical' TEDEs according to the administered activity and 'measured' TEDE based on the 'measured' ambient radiation exposure rate. We compared the results from each method to determine when we can release patients from confinement at the earliest time complying with the patient release criteria. Results A total of 20 administrations of Y-90 resin microspheres were done in 18 patients. The average administered activity was 1.2±0.77 (0.28-2.97) GBq. The 'theoretical' TEDEs were in the range of 0.8-10 μSv. The 'measured' TEDEs were in the range of 2.31-185 μSv. The measured TEDEs tend to be higher than the theoretical TEDEs. The values of theoretical and measured TEDE were both far less than 1 mSv, the upper limit at which the licensee can release a patient without any written documents. Conclusion The effective dose equivalent caused by the Y-90 microsphere administered patient is very low. It is safe in terms of radiation safety to the other individuals when Y-90 microsphere radioembolization therapy is done with dose less than 3 GBq. Because the measured TEDE tends to be higher than the theoretical TEDE, it is recommended to use 'measured' TEDE for determining patient release.

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“…A consensus panel consisting of experts from medical oncology, surgical oncology, nuclear medicine, interventional radiology, and radiation oncology have outlined patient selection criteria for radioembolization (Kennedy et al, 2007). Patients who are not resection candidates and who have a life expectancy longer than 3 months should be considered.…”

Section: Radioembolizationmentioning

confidence: 99%

Transarterial Therapies for Hepatocellular Carcinoma: a Comprehensive Review with Current Updates and Future Directions

Kumar¹,

Sharma²,

Bhatt³

et al. 2016

Asian Pacific Journal of Cancer Prevention

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Hepatocellular cancer is a very common cause of cancer related deaths worldwide. Only 30-40% of patients present with early-stage disease open to curative treatments, such as resection or transplantation, while others can only undergo local therapies or palliative care. Various trans-arterial approaches have been used for treatment of hepatocellular carcinoma in patients who need a down-staging to liver transplantation, and who are not candidates for transplantation or radiofrequency ablation. Transarterial chemoembolization (TACE), transarterial embolization (TAE), drug-eluting beads, and radioembolization have been used for locoregional control, and have been shown to prolong the overall survival when compared with supportive care. In this review, we discuss patient selection, pre-and post-procedure imaging, techniques, safety, and clinical outcomes related to these therapies. Newer advances with future directions in various fields related to trans-arterial therapies are also discussed.

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Recommendations for Radioembolization of Hepatic Malignancies Using Yttrium-90 Microsphere Brachytherapy: A Consensus Panel Report from the Radioembolization Brachytherapy Oncology Consortium

Cited by 616 publications

References 30 publications

Updated survival outcomes and analysis of long-term survivors from the MORE study on safety and efficacy of radioembolization in patients with unresectable colorectal cancer liver metastases

Updated survival outcomes and analysis of long-term survivors from the MORE study on safety and efficacy of radioembolization in patients with unresectable colorectal cancer liver metastases

Radiation Safety Issues in Y-90 Microsphere Selective Hepatic Radioembolization Therapy: Possible Radiation Exposure from the Patients

Transarterial Therapies for Hepatocellular Carcinoma: a Comprehensive Review with Current Updates and Future Directions

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