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Radioembolisation using yttrium 90 (Y-90) in patients affected by unresectable hepatic metastases

Radioembolizzazione mediante ittrio 90 (Y-90) in pazienti con metastasi epatiche inoperabili

  • Vascular and Interventional Radiology/Radiologia Vascolare ed Interventistica
  • Published:
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Abstract

Purpose

This study was done to evaluate the effectiveness of radioembolisation of liver metastases with yttrium 90 (Y-90) in patients with no response to chemotherapy.

Materials and methods

From February 2005 to January 2008, we treated 110 patients affected by liver metastatic disease from colorectal, breast, gastric, pancreatic, pulmonary, oesophageal and pharyngeal cancers and from cholangiocarcinoma and melanoma. We excluded patients with bilirubin level >1.8 mg/dl and pulmonary shunt >20% but not patients with minor extrahepatic metastases.

Results

We obtained a complete /partial response in 45 patients, stable disease in 42 patients and progressive disease in 23 patients. In 90 cases, we obtained a decrease in specific tumour marker level. The technical success rate was 96%, and technical effectiveness estimated at 3 months after treatment was 83.6%. Side effects were grade 4 hepatic failure in one case, grade 2 gastritis in six cases and grade 2 cholecystitis in two cases. The median survival and progression-free survival calculated by Kaplan-Meier analysis were 323 days and 245 days, respectively.

Conclusions

According to our 3-year experience, Y-90 radioembolisation (SIR-spheres) is a feasible and safe method to treat liver metastases with an acceptable level of complications and a good response rate.

Riassunto

Obiettivo

Lo scopo del nostro lavoro è stato valutare l’efficacia della radioembolizzazione con ittrio 90 (Y-90) delle metastasi epatiche in pazienti non responsivi alla chemioterapia.

Materiali e metodi

Da febbraio 2005 a gennaio 2008, sono stati trattati 110 pazienti affetti da malattia metastatica del fegato determinata da differenti tipi di tumore primitivo (colorettale, mammario, gastrico, pancreatico, polmonare, esofageo, faringeo, melanoma e colangiocarcinoma). Tutti i pazienti mostravano una progressione di malattia. Sono stati esclusi i pazienti con livelli di bilirubina superiori a 1,8 mg/dl e con shunt epato-polmonare >20%, ma non pazienti con localizzazioni metastatiche extraepatiche.

Risultati

La risposta è stata valutata come completa/parziale in 45 pazienti, come malattia stabile in 42 pazienti e come malattia in progressione in 23 pazienti. In 90 casi, è stato ottenuto un decremento dei livelli sierici dei markers tumorali specifici. La percentuale di successo tecnico è stata del 96% e l’efficacia tecnica stimata a 3 mesi dal trattamento dell’83,6%. Le complicanze sono rappresentate da 1 caso di insufficienza epatica di grado 4, da 6 casi di gastrite di grado 2 e da 3 casi di colecistite di grado 2. La sopravvivenza media e quella libera da malattia calcolate mediante l’analisi di Kaplan-Meier sono state rispettivamente di 323 giorni e 245 giorni.

Conclusioni

Sulla base della nostra esperienza di tre anni la radioembolizzazione con Y-90 rappresenta una metodica sicura ed efficace nel trattamento delle metastasi epatiche con un accettabile livello di complicanze ed una buona percentuale di risposta.

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References/Bibliografia

  1. Okuda K, Ohtsuki T, Obata H et al (1985) Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study on 850 patients. Cancer 56:918

    Article  CAS  PubMed  Google Scholar 

  2. Gilbert HA (1976) Metastases: incidence, detection and evaluation without histological confirmation. In: Weiss L (ed) Fundamentaln aspects of metastasis. American Elsevier, New York, pp 385–405

    Google Scholar 

  3. Seifert JK, Junginger T, Morris DL (1998) A collective review of the world literature on hepatic cryotherapy. J R Coll Surg Edimb 43:141–154

    CAS  Google Scholar 

  4. Curley SA, Izzo F, Delrio P et al (1999) Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies. Ann Surg 230:1–8

    Article  CAS  PubMed  Google Scholar 

  5. Popperl G, Helmberger T, Munzing W et al (2005) Selective internal radiation therapy with SIR-spheres in patients with non-resectable liver tumors. Cancer Biother Radiopharm 20:200–208

    Article  PubMed  Google Scholar 

  6. Goldberg RM, Sargent DJ, Morton RF et al (2004) A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer. J Clin Oncol 22:23–30

    Article  CAS  PubMed  Google Scholar 

  7. Grothey A, Sargent D, Goldberg RM et al (2004) Survival of patients with advanced colorectal cancer improves with the availability of fluorouracilleucovorin, irinotecan, and oxaliplatin in the course of treatment. J Clin Oncol 22:1209–1214

    Article  CAS  PubMed  Google Scholar 

  8. Kato I, Severson RK, Schwartz AG (2001) Conditional median survival of patients with advanced carcinoma: surveillance, epidemiology, and end results data. Cancer 92:2211–2219

    Article  CAS  PubMed  Google Scholar 

  9. Gates VL, Atassi B, Lewandowski RJ et al (2007) Radioembolization with Yttrium-90 microspheres: review of an emerging treatment for liver tumors. Future Oncol 3:73–81

    Article  CAS  PubMed  Google Scholar 

  10. Breedis C, Young G (1954) The blood supply in neoplasms in the liver. Am J Pathol 30:969–977

    CAS  PubMed  Google Scholar 

  11. Bienert M, McCook B, Carr BI et al (2005) 90Y microspheres treatment of unresectable liver metastases: changes in 18 F-FDG uptake and tumor size on PET/CT. Eur J Nucl Med Mol Imaging 32:778–787

    Article  CAS  PubMed  Google Scholar 

  12. Dawson LA, Normolle D, Balter JM et al (2002) Analysis of radiation induced liver disease using the Lyman NTCP model. Int J Radiat Oncol Biol Phys 53:810–821

    PubMed  Google Scholar 

  13. Gray BN, Burton MA, Kelleher DK et al (1989) Selective internal radiation (SIR) therapy for treatment of liver metastases: Measurement of response rate. J Surg Oncol 42:192–196

    Article  CAS  PubMed  Google Scholar 

  14. Oken MM, Creech RH, Tormey DC et al (1982) Toxicity and response criteria of the eastern cooperative oncology group. Am J Clin Oncol 5:649–655

    Article  CAS  PubMed  Google Scholar 

  15. Ariel IM, Pack GT (1967) Treatment of inoperable cancer of the liver by intraarterial radioactive isotopes and chemotherapy. Cancer 20:793–804

    Article  CAS  PubMed  Google Scholar 

  16. Ariel IM, Padula G (1978) Treatment of symptomatic metastatic cancer to the liver from primary colon and rectal cancer by the intra-arterial administration of chemotherapy and radioactive isotopes. J Surg Oncol 10:327–336

    Article  CAS  PubMed  Google Scholar 

  17. Stribley KV, Gray BN, Chmiel RL et al (1983) Internal radiotherapy for hepatic metastases: the homogeneity of hepatic arterial blood flow. J Surg Res 34:17–24

    Article  CAS  PubMed  Google Scholar 

  18. Ariel IM (1964) Radioactive isotopes for adjuvant cancer therapy. Arch Surg 89:244–249

    CAS  PubMed  Google Scholar 

  19. Grady ED, Sale WT, Rollins LC (1963) Localization of radioactivity by intravascular injection of large radioactive particles. Ann Surg 157:97–114

    Article  CAS  PubMed  Google Scholar 

  20. Nolan T, Grady ED, Crumbley AJ (1973) Regional internal radiation for hepatic cancer. Minerva Oncol 1:104–106

    Google Scholar 

  21. Nolan T, Grady ED, Crumbley AJ et al (1975) Internal hepatic radiotherapy: I. Organ distribution of colloidal Cr32 PO4 injected into a peripheral vein, the portal vein, or the arterial supply of the gastrointestinal tract in the rat. Am J Roentgenol Radium Ther Nucl Med124:590–595

    CAS  PubMed  Google Scholar 

  22. Grady ED, Nolan T, Larose JH et al (1975) Internal hepatic radiotherapy: II. Intra-arterial radiocolloid therapy for hepatic tumors. Am J Roentgenol Ther Nucl Med 124:596–599

    CAS  Google Scholar 

  23. Grady ED (1979) Internal radiation therapy of hepatic cancer. Dis Colon Rectum 22:371–375

    Article  CAS  PubMed  Google Scholar 

  24. Ariel IM (1965) Treatment of inoperable primary pancreatic and liver cancer by the intraarterial administration of radioactive isotopes (Y-90 radiating microspheres). Ann Surg 162:267–278

    Article  CAS  PubMed  Google Scholar 

  25. Mantravadi RV, Spigos DG, Tan WS et al (1982) Intraarterial yttrium 90 in the treatment of hepatic malignancy. Radiology 142:783–786

    CAS  PubMed  Google Scholar 

  26. Blanchard RJW (1983) Treatment of liver tumours with yttrium-90 microspheres. Can J Surg. 26:442–443

    Google Scholar 

  27. Kennedy AS, Coldwell D, Nutting C et al (2006) Resin 90Y-microsphere brachytherapy for unresectable colorectal liver metastases: modern USA experience. Int J Radiat Oncol Biol Phys 65:412–425

    CAS  PubMed  Google Scholar 

  28. Jakobs TF, Hoffmann RT, Dehm K et al (2008) Hepatic yttrium-90 radioembolization of chemotherapyrefractory colorectal cancer liver metastases. J Vasc Interv Radiol 19:1187–1195

    Article  PubMed  Google Scholar 

  29. Mancini R, Carpanese L, Sciuto R et al (2006) A multicentric phase II clinical trial on intra-arterial hepatic radiotherapy with 90yttrium SIRspheres in unresectable, colorectal liver metastases refractory to i.v. chemotherapy: preliminary results on toxicity and response rates. In Vivo 20(6A):711–714

    CAS  PubMed  Google Scholar 

  30. Coldwell DM, Kennedy AS, Nutting CW (2007) Use of yttrium-90 microspheres in the treatment of unresectable hepatic metastases from breast cancer. Int J Radiat Oncol Biol Phys 69:800–804

    CAS  PubMed  Google Scholar 

  31. Jakobs TF, Hoffmann RT, Fischer T et al (2008) Radioembolization in patients with hepatic metastases from breast cancer. J Vasc Interv Radiol 19:683–690

    Article  PubMed  Google Scholar 

  32. Sato KT, Lewandowski RJ, Mulcahy MF (2008) Unresectable chemorefractory liver metastases: radioembolization with 90Y microspheres-safety, efficacy, and survival. Radiology 247:507–515

    Article  PubMed  Google Scholar 

  33. Park JO, Lee SI, Song SY et al (2003) Measuring response in solid tumors: comparison of RECIST and WHO response criteria. Jpn J Clin Oncol 33:533–537

    Article  PubMed  Google Scholar 

  34. Atassi B, Bangash A, Bahrani A et al (2008) Multimodality imaging following 90Y radioembolization: a comprehensive review and pictorial essay. Radiographics 28:81–99

    Article  PubMed  Google Scholar 

  35. Wong C, Qing F, Savin M et al (2005) Reduction of metastatic load to liver after intraarterial hepatic yttrium-90 radioembolization as evaluated by [18F] fluorodeoxyglucose positron emission tomographic imaging. J Vasc Interv Radiol 16:1101–1106

    PubMed  Google Scholar 

  36. Kwee TC, Takahara T, Ochiai R et al (2008) Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS): features and potential applications in oncology. Eur Radiol 18:1937–1952

    Article  PubMed  Google Scholar 

  37. Stubbs RS, O’Brien I, Correia MM (2006) Selective internal radiation therapy with 90Y microspheres for colorectal liver metastases: singlecentre experience with 100 patients. ANZ J Surg 76:696–703

    Article  PubMed  Google Scholar 

  38. Sato K, Lewandowski R, Bui J et al (2006) Treatment of unresectable primary and metastatic liver cancer with yttrium-90 microspheres (Thera-Sphere®): assessment of hepatic arterial embolization. Cardiovasc Intervent Radiol 29:522–529

    Article  PubMed  Google Scholar 

  39. Salem R, Thurston K (2006) Radioembolization with 90yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies part 2: special topics. J Vasc Interv Radiol 17:1425–1439

    Article  PubMed  Google Scholar 

  40. Goin J, Dancey J, Roberts C et al (2004) Comparison of postembolization syndrome in the treatment of patients with unresectable hepatocellular carcinoma: transcatheter arterial chemo-embolization versus yttrium-90 glass microspheres. World J Nucl Med 3:49–56

    Google Scholar 

  41. Gulec SA, Siegel JA (2007) Posttherapy radiation safety considerations in radiomicrosphere treatment with 90Y-microspheres. J Nucl Med 48:2080–2086

    Article  CAS  PubMed  Google Scholar 

  42. Gulec SA (2008) Combining SIRspheres with first — or second- line chemotherapy for colorectal cancer: initial results. 2nd European Symposium on liver directed cancer therapy using microspheres, Roma 9–10 Feb 2008

  43. Vente MA, Wondergem M, van der Tweel I (2008) Yttrium-90 microsphere radioembolization for the treatment of liver malignancies: a structured metaanalysis. Eur Radiol 19:951–959

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Diagnostic and Interventional Radiology Department, SM Goretti General Hospital, Via G. Reni, 01400, Latina, Italy

    R. Cianni, C. Urigo, E. Notarianni, A. Saltarelli & M. Iozzino

  2. Nuclear Medicine Department, SM Goretti General Hospital, Via G. Reni, 01400, Latina, Italy

    A. D’Agostini

  3. University “La Sapienza”, Rome, Italy

    T. Dornbusch

  4. Oncology Department, Policlinico Umberto I, University “La Sapienza”, Rome, Italy

    E. Cortesi

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  1. R. Cianni
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Correspondence to C. Urigo.

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Cianni, R., Urigo, C., Notarianni, E. et al. Radioembolisation using yttrium 90 (Y-90) in patients affected by unresectable hepatic metastases. Radiol med 115, 619–633 (2010). https://doi.org/10.1007/s11547-010-0496-1

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  • DOI: https://doi.org/10.1007/s11547-010-0496-1

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