Regional yttrium-90 microsphere treatment of surgically unresectable and chemotherapy-refractory metastatic liver carcinoma.
OBJECTIVE
The aim of this prospective study was to assess the safety and tumor response of intra-arterial Y-90 microspheres for the treatment of surgically unresectable and chemotherapy-refractory liver metastases.


METHODS
Forty-six (46) patients with metastatic cancer to the liver from various solid tumors, with tumor progression despite polychemotherapy, were included. All patients had baseline computed tomography (CT), 18-Fluoro-2-deoxy-D-glucose-positron emission tomography (F-18 FDG-PET), hepatic angiography, and intra-arterial Tc-99m macroaggregated albumin (MAA) scan for the assessment of extrahepatic aberrant perfusion and lung shunting fraction. Twenty-seven (27) and 19 patients were treated with Y-90 glass- or resin-based microspheres (but not both), respectively, on a lobar basis and were monitored over 3 months after last treatment using dedicated attenuation corrected PET. For each patient, regions of interest (ROIs) were drawn along the liver edge to measure total liver standard uptake value (SUV) on axial images covering the entire liver for comparing pre- and post-treatment total liver SUV change.


RESULTS
There was a significant decrement in total liver SUV after treatment by either glass- or resin-based microspheres (p = 0.0013 and 0.028, respectively). There was no significant difference in the amplitudes of the mean percentage reduction of tumor metabolism between these two agents (20% +/- 25% vs. 10% +/- 30% for glass- vs. resin-based microspheres; p = 0.38). None of the patients in the glass-based group developed complications, whereas 3 patients had complications related to hyperbilirubinemia (1 transient and 2 permanent) in the resin-based group.


CONCLUSIONS
Results suggest that there is significant mean reduction of hepatic metastatic tumor load (metabolism), as evaluated objectively by PET after Y-90 microsphere, for the treatment of unresectable metastatic disease to the liver. The Y-90 therapy provides encouraging and safe results by arresting the progression of metastatic cancer to the liver with decreasing tumor metabolism.
Wong
Ching-Yee Oliver
CY
Positron Diagnostic Center and Medical Cyclotron, Department of Nuclear Medicine, William Beaumont Hospital, Royal Oak, MI 48073-6769, USA. owong@beaumont.edu
Savin
Michael
M
Sherpa
Kanchi M
KM
Qing
Feng
F
Campbell
Janice
J
Gates
Vanessa L
VL
Lewandowski
Robert J
RJ
Cheng
Vincent
V
Thie
Joseph
J
Fink-Bennett
Darlene
D
Nagle
Conrad
C
Salem
Riad
R
D000368:Aged; D000369:Aged, 80 and over; D002951:Citrates / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000556:secondary*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D009369:Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy; D009942:Organometallic Compounds / Q000008:administration & dosage* / Q000009:adverse effects; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals / Q000008:administration & dosage* / Q000009:adverse effects; D015021:Yttrium Radioisotopes / Q000008:administration & dosage* / Q000009:adverse effects
D002951:Citrates; D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes; C045937:yttrium citrate