Yttrium-90 radioembolization for the treatment of unresectable liver cancer: Results of a single center

Year 2014, , 10 - 16, 01.03.2014

Özhan Özgür Şeyda Gündüz Metin Erkılıç Hakan Şat Bozcuk Hakkı Timur Sindel

https://doi.org/10.5798/diclemedj.0921.2014.01.0365

Abstract

Objective: To determine the effects of yttrium-90 (Y-90) resin microsphere radioembolization therapy on patients with unresectable liver cancer who do not benefit from chemotherapy. Methods: Fifty-five patients underwent radioembolization therapy included in the study whose had unresectable primary or metastatic liver cancer originating from the gastrointestinal tract. Three were excluded from the study after pre-evaluation angiography. Thirteen (23.6%) of the remaining 52 patients had hepatocellular carcinoma and 39 (76.4%) had metastatic liver cancer. Fifty-two patients underwent Y-90 radioembolization treatment. Each patient's response to the administered treatment was evaluated using the Response Evaluation Criteria in Solid Tumors (RECIST) and the overall probability of survival was displayed graphically by the Kaplan-Meier method. Results: After Y-90 therapy, 47 patients were follow-up. While 57% of the patients responded to treatment as clinical benefit, the disease progressed in 43%. The median hepatic progression-free survival time of the patients was 3.4 months (95% confidence interval (ci):1.4-5.3) and the overall survival time was 11.3 months (95%, CI:8.7-14.03). Conclusion: This study emphasizes that Y-90 resin microsphere radioembolization treatment is effective in patients with unresectable liver cancer.

Keywords

Yttrium-90, radioembolization, angiography, liver cancer

Yttrium-90 radioembolization for the treatment of unresectable liver cancer: Results of a single center

Abstract

Amaç: Çalışmamızda kemoterapiden fayda görmeyen, rezeke edilemeyen karaciğer kanserlerinde yttrium-90 (Y-90) resin mikrosfer radyoembolizasyon terapisinin etkinliğinin ortaya konması amaçlanmıştır. Yöntemler: Çalışmaya radyoembolizasyon tedavisi uygulanan, rezeke edilemeyen primer veya gastrointestinal sistemden metastatik 55 hasta dahil edilmiştir. Üç hasta ön değerlendirme anjiografisi sonrasında çalışma dışı bırakılmıştır. Kalan 52 hastanın 13\'ü (%23.6) hepatosellüler karsinoma, 39\'u (%76.4) metastatik karaciğer kanseri hastasıdır. Elli iki hasta radyoembolizan tedavi görmüştür. Her hastaya verilen tedavi, Solid Tümörlerde Tedaviye Yanıt Kritirleri\'ne (RECIST) göre değerlendirilmiş ve tüm sürvi olasılığı Kaplan-Meier metoduna ile grafik olarak gösterilmiştir. Bulgular: Y-90 tedavisi sonrası 47 hasta takip edilebilmiştir. Hastaların %57\'sinde klinik fayda yanıtı alınmış, %43\'ünde hastalık progresyon göstermiştir. Hastaların medyan hepatik progresyonsuz survi süresi 3.4 ay (%95 confidence interval (ci): 1.4-5.3), tüm sürvi süresi 11.3 (%95 confidence interval (ci): 8.7-14.03) olarak saptanmıştır. Sonuç: Bu çalışma Y-90 resin mikrosfer radyoembolizan tedavinin rezeke edilemeyen karaciğer kanseri hastalarında etkin olduğunu ortaya koymaktadır.

Keywords

Yttrium-90, radyoembolizasyon, anjiografi, karaciğer kanseri

References

• Jaffe BM, Donegan WL, Watson F, et al. Factors influencing the survival in patients with untreated hepatic metastases. Surg Gynec Obstet 1968;127:1-11.
• Bengmark S, Hafström, L. The natural history of primary and secondary malignant tumors of the liver. The prognosis for patients with hepatic metastases from colonic and rectal carcinoma by laparotomy. Cancer 1969;23:198-202.
• Marrero JA, Fontana RJ, Barrat A, et al. Prognosis of Hepa- tocellular Carcinoma: Comparison of 7 Staging Systems in an American Cohort. Hepatology 2005;42:707-716.
• Garreana S, Espat NJ. Yttrium-90 internal radiation therapy for hepatic malignancy. Surgical Oncology 2005;14:179- 193.
• Ariel IM. Treatment of inoperable primary pancreatic and liver cancer by the intra-arterial administration of radioac- tive isotopes (Y90 radiating microspheres). Ann Surgery 1965;162:267-278.
• Grindlay JH, Herrick JF, Mann FC. Measurement of the blood flow of the liver. Am J Physiol 1941; 132: 489-496.
• Dawson LA, Normolle D, Balter JM, McGinn CJ, Lawrence TS, Ten Haken RK. Analysis of radiation induced liver dis- ease using the Lyman NTCP model. Int J Radiat Oncol Biol Phys 2002;53:810–821.
• Herfarth KK, Debus J, Lohr F, et al. Stereotactic single dose radiation therapy of liver tumors: Results of a phase I/II trial. J Clin Oncol 2001;19:64-170.
• Breedis C, Young G. The blood supply of neoplasms in the liver. Am J Pathol 1954;30:969-984.
• Therasse P, Arbuck SG, Eisenhauer EA, et al. New Guide- lines to valuate the Response to Treatment in Solid Tumors. J National Cancer Inst 2000;92:205-216.
• Sato KT, Lewandowski RJ, Mulcahy MF, et al. Unresect- able Chemorefractory Liver Metastases: Radioemboliza- tion with 90Y Microspheres Safety, Efficacy and Survival. Radiology 2008;247:507-515.
• Peynircioglu B, Cil B, Bozkurt F, Aydemir E, Ugur O, Balkancı F. Radioembolization for the treatment of unre- sectable liver cancer: initial experience at a single center. Diagn Interv Radiol 2010;16:70-78.
• Garrean S, Espat NJ. Yttrium-90 internal radiation therapy for hepatic malignancy. Surgical Oncology 2005;14:179- 193.
• Gray BN, Burton MA, Kelleher D, et al. Tolerance of the liver to the effects of Yttrium-90 radiation. Int J Radiat On- col Biol Phys 1990;18:619-623.
• Sato KT, Lewandowski RJ, Mulcahy MF, et al. Unresect- able chemorefractory liver metastases: Radioembolization with Y90 microspheres safety, efficacy, and survival. Radi- ology 2008;247:507-515.
• Hendlisz A, Van den Eynde M, Peeters MPhase III Trial Comparing Protracted Intravenous Fluorouracil Infusion Alone or With Yttrium-90 Resin Microspheres Radioem- bolization for Liver-Limited Metastatic Colorectal Can- cer Refractory to Standard Chemotherapy. J Clin Oncol 2010;28:3687-3694.
• Sharma RA, Van Hazel GA, Morgan B. Radioembolization of Liver Metastases From Colorectal Cancer Using Yt- trium-90 Microspheres With Concomitant Systemic Oxali- platin, Fluorouracil,and Leucovorin Chemotherapy. J Clin Oncol 2007;25:1099-1106.
• Vente F, Wondergem M, Van der Tweel I, et al. Yttrium-90 microsphere radioembolization for the treatment of liv- er malignancies: a structured meta-analysis. Eur Radiol 2009;19:951-959.
• Coldwell DM, Kennedy AS, Nutting CW. Use of yttrium-90 microspheres in the treatment of unresectable hepatic me- tastases from breast cancer. Int J Radiat Oncol Biol Phys 2007;69:800-804.
• Jakobs TF, Hoffmann RT, Fischer T, et al. Radioemboliza- tion in patients with hepatic metastases from breast cancer. J Vasc Interv Radiol 2008;19:683-690.
• Cianni R, Urigo C, Notarianni E, et al. Radioembolisation using yttrium 90 (Y-90) in patients affected by unresectable hepatic metastases. Radiol med 2010;115:619-633.