Safety of Hepatic Resection in Metastatic Disease to the Liver After Yttrium-90 Therapy

Whitney, Ryan; Tatum, Cliff; Hahl, Mike; Ellis, Susan; Scoggins, Charles R.; McMasters, Kelly M.; Martin, Robert C.G.

doi:10.1016/j.jss.2009.05.021

Cited by 49 publications

(38 citation statements)

References 14 publications

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“…In a study by Whitney et al , the investigators have briefly described the histology in four patients with metastatic disease to the liver from different primary sites who underwent hepatic resection 15. Their emphasis was predominantly on the percentage of tumour necrosis, which ranged from 45% to 80%, but the authors did also note moderate to severe hepatic inflammation and fibrosis.…”

Section: Discussionmentioning

confidence: 99%

“…15 Their emphasis was predominantly on the percentage of tumour necrosis, which ranged from 45% to 80%, but the authors did also note moderate to severe hepatic inflammation and fibrosis. Specific details describing the 'hepatic inflammation' referred to were not included in the paper.…”

Section: Discussionmentioning

confidence: 99%

“…3 12 There is current debate regarding the principal mechanism of action of SIRT in treating cancer. [13][14][15] Does it act primarily via arterially directed delivery of high dose radiotherapy in and around the vascular tumour bed, or by micro-arterial embolisation, cutting off the blood supply to malignancies similar to the mechanism described by Breedis and Young? Although large case series of patients having surgery after SIRT are difficult to obtain since SIRT is not used to treat patients with resectable disease, that is, only patients downsized from inoperable disease are considered for subsequent liver surgery, we describe three clinical cases in detail to help to inform the current debate.…”

Section: Introductionmentioning

confidence: 99%

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Anatomical basis and histopathological changes resulting from selective internal radiotherapy for liver metastases

et al. 2012

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BackgroundKnowledge that liver tumours preferentially take their blood supply from the arterial blood supply rather than the portal venous system can be used for local delivery of treatment or for embolisation to cut off the blood supply to tumours.AimsTo present histological evaluation of malignant and non-malignant hepatic tissue of one such therapy, selective internal radiation therapy (SIRT) with yttrium-90 microspheres, to decipher its principal mechanism of action.MethodsThe H&E stained sections of hepatic resection specimens from three patients with liver metastases from colorectal (CRC) cancer, who underwent hepatic surgery 4–9 months following SIRT, were examined and the pathological changes documented.ResultsResin microspheres were identified in the vascular tumour bed and vessels within the portal tracts of the background liver parenchyma. Microspheres were usually associated with giant cell reaction or histiocytes. In the tumour bed, tumour necrosis, mucinous alteration, collections of foamy histiocytes, ectatic vessels, calcification and fibrosis were observed. There was minimal cellular inflammatory response observed, suggestive of direct radiation injury as a non-immune mediated process.ConclusionsWe describe in detail the spectrum of histopathological changes in malignant tissue and liver parenchyma in patients with metastatic CRC treated with SIRT. Our findings are consistent with the hypothesis that the principal mechanism of action of SIRT appears to be via arterially directed delivery of highly radioactive microspheres in and around the vascular tumour bed rather than by micro-arterial embolisation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Anatomical basis and histopathological changes resulting from selective internal radiotherapy for liver metastases

et al. 2012

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“…Because of the degree of vascularity of these lesions, response rates have been as high as 70%-90%. Several published reports have demonstrated that TACE can reduce hormonal levels, palliate symptoms, and reduce tumor burden in many patients with hepatic carcinoid metastases [4,5].…”

Section: Introductionmentioning

confidence: 99%

Transarterial Chemoembolization and Selective Internal Radiation for the Treatment of Patients with Metastatic Neuroendocrine Tumors: A Comparison of Efficacy and Cost

et al. 2011

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Background. Hepatic arterial therapy (HAT) has been proven to be effective at palliation of hormonal symptoms of metastatic neuroendocrine tumors (NETs), as well as a means of cytoreduction. Recently, the newer modalities of yttrium-90 and drug-eluting beads with doxorubicin (DEBDOX) have been reported to be effective in the treatment of metastatic NETs. The aim of this study was to compare the safety, efficacy, and cost of selective internal radiation with DEB therapy.Methods. An institutional review board-approved, multicenter, multinational prospective treatment registry to investigate the safety and efficacy of yttrium-90 and doxorubicin microspheres was reviewed.Results. In all, 43 patients underwent a combined 69 HAT treatments, with 15 patients receiving 23 yttrium-90 treatments and 28 patients receiving 46 DEB-

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“…At present only single case reports or small uncontrolled series describe neo-adjuvant strategies with radio-receptor (90)Y-DOTATOC therapy,63 resin (90)Y-microspheres radio-embolisation64 or chemotherapy for downsizing hepatic metastasis of NEC before liver surgery. Neo-adjuvant strategies are not yet established in liver surgery of NEC.…”

Section: Surgery Of Liver Metastasesmentioning

confidence: 99%

Therapeutic strategies for advanced neuroendocrine carcinomas of jejunum/ileum and pancreatic origin

Auernhammer

Göke

2011

Gut

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Safety of Hepatic Resection in Metastatic Disease to the Liver After Yttrium-90 Therapy

Cited by 49 publications

References 14 publications

Anatomical basis and histopathological changes resulting from selective internal radiotherapy for liver metastases

Anatomical basis and histopathological changes resulting from selective internal radiotherapy for liver metastases

Transarterial Chemoembolization and Selective Internal Radiation for the Treatment of Patients with Metastatic Neuroendocrine Tumors: A Comparison of Efficacy and Cost

Therapeutic strategies for advanced neuroendocrine carcinomas of jejunum/ileum and pancreatic origin

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