Here, we report findings from a series of 82 Y-90 microsphere brachytherapy treatments.
Craig J. Baden, MD, MPH, John D. Roberson, BS, AB, Rojymon Jacob, MD, Omer L. Burnett III, MD; University of Alabama, Birmingham
Introduction: By exploiting the liver’s dual blood supply and the beta-emission of yttrium-90 (Y-90), microsphere brachytherapy enables treatment of primary or metastatic liver tumors with tumoricidal radiation doses while preferentially sparing normal liver parenchyma. Though utilization of Y-90 microsphere brachytherapy continues to increase, data regarding toxicity and effectiveness remain limited. Here, we report findings from a series of 82 Y-90 microsphere brachytherapy treatments.
Patients and Methods: Between October 2010 and August 2013, a total of 59 patients underwent 82 treatments with Y-90 SIR-Spheres at our tertiary care academic medical center. Median patient age was 60 years (range: 33–82 yr), and median Karnofsky performance score (KPS) was 80% (range: 40%–90%). Seventy-two treatments were completed in patients with Child-Pugh class A disease and 10 in class B. Of the 82 treatments, 36 (43.9%) were to colorectal carcinoma metastases, 15 (18.3%) to neuroendocrine tumors, 11 (13.4%) to cholangiocarcinoma, 5 (6.1%) to hepatocellular carcinoma, 5 (6.1%) to breast carcinoma, and 10 (12.2%) to other tumor types. The majority of radioembolization treatments were preceded by other therapies, including systemic therapy in 87.8%, liver resection in 18.3%, transcatheter arterial chemoembolization (TACE) in 14.6%, and radiofrequency ablation in 4.9%. The median maximum radiographic lesion size was 49 mm (range: 12–200 mm). Median treated tumor volume was 90.7 mL (range: 5–3,096 mL), constituting a median of 9.1% (range: 1.1%–78.5%) of the treated lobe. Median activity of microspheres was 1.03 GBq (range: 0–2.1 GBq). Procedures were uncomplicated in 73.2% of cases, while 15.9% developed stasis and 9.8% developed reflux. We collected laboratory, imaging, and other clinical data from the pretreatment visit as well as at the 1-, 3-, and 6-month and subsequent follow-up visits in order to determine toxicity, effectiveness, and survival associated with treatment.
Results: Acute toxicities of treatment were generally very mild and included fatigue (45.1%), anorexia (15.9%), weight loss (6.1%), abdominal discomfort (36.6%), nausea (24.4%), hepatic encephalopathy (12.2%), jaundice (3.7%), and ascites (3.7%). Grade 2 or higher laboratory toxicities included derangements of alkaline phosphatase (24.4%), albumin (23.2%), total bilirubin (19.5%), aspartate aminotransferase (AST) (12.2%), alanine aminotransferase (ALT) (3.7%), and international normalized ratio (INR) (3.7%).
Radiographic response was measured at 3 and 6 months post-treatment. Of 48 treatments with available imaging after 3 months, 25.0% showed partial response, 29.2% stable disease, and 45.8% progression. Median change in the maximum lesion diameter after 3 months was +1 mm (range: -22–92 mm). Six-month imaging was available for 28 treatments, with 28.6% demonstrating partial response, 42.9% stable, and 28.6% progression. Median change after 6 months was +1 mm (range: -47–70 mm). At 3 months, only 22.2% of neuroendocrine tumors had progressed, whereas 72.2% of colorectal carcinoma had progressed (P = .04). Radiographic response was not significantly associated with tumor diameter, tumor volume, previous chemotherapy, TACE, or liver resection.
Median survival from time of first treatment was 37.4 weeks (95% confidence interval [CI], 24.4–45.7). There were no significant differences in survival with respect to Child-Pugh class, tumor volume, tumor diameter, previous TACE, or previous systemic therapy.
Conclusion: Findings from this institutional series corroborate the safety of Y-90 microsphere radioembolization and demonstrate its effectiveness in treating a variety of unresectable primary and metastatic liver tumors.
Frontline Chemo-Free Regimen Supported in HR+/HER2+ Breast Cancer Therapy
January 1st 2024Combining anastrozole with palbociclib, trastuzumab, and pertuzumab as a frontline therapy for hormone receptor–positive, HER2-positive breast cancer may avoid some of the toxicities associated with chemotherapy, says Amy Tiersten, MD.
Oncology On-The-Go Podcast: ASCO 2023 Recap
June 19th 2023Experts from University of California, Los Angeles Health and Mayo Clinic discuss key data presented at the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting in the gynecologic and gastrointestinal cancer spaces and how they may impact patient care.