Yttrium-90 radioembolization for the treatment of chemorefractory colorectal liver metastases: Technical results, clinical outcome and factors potentially influencing survival

Abstract

90 Y radioembolization to treat chemorefractory colorectal liver metastases were identified. Demographic, laboratory, imaging and dosimetry data were collected. Post-treatment technical and clinical outcomes were analyzed as well as overall survival; finally several factors potentially influencing survival were analyzed. Results: In total 88 patients were selected for angiographic workup; 71 patients (81%) finally underwent catheter-directed 90 Y microsphere infusion into the hepatic artery 25 days (standard deviation 13 days) after angiographic workup. Median infused activity was 1809 MBq; 30-day toxicity included: fatigue (n ¼ 39; 55%), abdominal discomfort (n ¼ 33; 47%), nausea (n ¼ 5; 7%), fever (n ¼ 14; 20%), diarrhea (n ¼ 6; 9%), liver function abnormalities and elevated bilirubin (transient) (n ¼ 3; 4%). Gastric ulcer was found in five patients (7%). A late complication was radioembolization-induced portal hypertension (REIPH) in three patients (4%). Median time to progression in the liver was 4.4 months. Estimated survival at six and 12 months was 65% and 30%, respectively, with a 50% estimated survival after 8.0 months in this group of chemorefractory patients. Prognostic factors for worse survival were high preprocedural bilirubin, alkaline phosphatase and tumor volume levels. Conclusion:90 Y microsphere radioembolization for chemorefractory colorectal liver metastases has an acceptable safety profile with a 50% estimated survival after 8.0 months. Pretreatment high bilirubin, alkaline phosphatase and tumor volume levels were associated with early death.

Radiopharmaceutical therapy in cancer: clinical advances and challenges

“…Clinical trials using yttrium-90-labelled antibodies as RPT agents initially focused on ovarian cancer 38 , 39 and subsequently on haematological cancers 40 – 42 , as well as radiopeptide therapy 43 . Yttrium-90 continues to be a popular radionuclide for RPT because of the clinical impact of yttrium-90-impregnated microspheres that are used for treatment of hepatic metastases 44 – 48 . Although yttrium-90 has been imaged, imaging generally requires high activities (more than 300 MBq) 49 .…”

Characterization of Liver Metastases During Catheter-Directed Liver Interventions: A Comparison between Dual Phase Cone-Beam Computed Tomography and Conventional Contrast-Enhanced Computed Tomography

“…First, the patient sample size is small and only metastases of three different origins (colorectal cancer, breast cancer and neuroendocrine tumors) were included. However, the number of patients with metastases referred to catheter-directed liver interventions is still low owing to the paucity of data [ 4 5 7 ] to support these referrals and not all tumors are primarily metastasizing to the liver. Second, in this study DP-CBCT was compared to venous phase CE-CT, as this is the routine cross-sectional imaging method of choice for the follow-up of patients with liver metastases at our institution.…”

“…For these patients, chemotherapy and best supportive care are the backbone of oncologic treatment [ 1 ]. However, for liver-only or liver-dominant metastatic disease in conjunction with acceptable liver function, catheter-directed liver therapies including transarterial chemoembolization (TACE) [ 3 4 ], hepatic arterial infusion therapy (HAIT) [ 5 ], liver chemosaturation [ 6 ] or Yttrium-90 radioembolization [ 7 ] can be performed. Today, most of the catheter-directed liver interventions are performed as salvage therapy.…”

Sequential intra-arterial infusion of 90Y-resin microspheres and mitomycin C in chemo refractory liver metastatic breast cancer patients: a single centre pilot study

“…Previously published work describes the details of the 90 Y treatment. 13 Briefly, patients first underwent a detailed baseline angiogram and embolization of enterohepatic arteries with micro-coils according to the expertise of the interventional radiologist. Technetium-99mmacroaggregated albumin ( 99m TC-MAA) was injected in the target vessels and a planar scintigraphy was performed to determine the lung shunt fraction.…”