Unresectable chemorefractory liver metastases: radioembolization with 90Y microspheres--safety, efficacy, and survival.
OBJECTIVE
To prospectively evaluate the safety, efficacy, and survival of patients with chemorefractory liver metastases who have been treated with yttrium 90 ((90)Y) glass microspheres.


METHODS
Institutional review boards from two institutions approved the HIPAA-compliant study; all patients provided informed consent. One hundred thirty-seven patients underwent 225 administrations of (90)Y microspheres by using intraarterial infusion. Primary sites (origins) included colon, breast, neuroendocrine, pancreas, lung, cholangiocarcinoma, melanoma, renal, esophageal, ovary, adenocarcinoma of unknown primary, lymphoma, gastric, duodenal, bladder, angiosarcoma, squamous cell carcinoma, thyroid, adrenal, and parotid. Patients underwent evaluation of baseline and follow-up liver function and tumor markers and computed tomographic or magnetic resonance imaging. Patients were observed for survival from first treatment. Median survival (in days) and corresponding 95% confidence intervals were computed by using the Kaplan-Meier method. The log-rank statistic was used for statistical significance testing of survival distributions between various subgroups of patients.


RESULTS
There were 66 men and 71 women. All patients were treated on an outpatient basis. Median age was 61 years. The mean number of treatments was 1.6. The median activity and dose infused were 1.83 GBq and 112.8 Gy, respectively. Clinical toxicities included fatigue (56%), vague abdominal pain (26%), and nausea (23%). At follow-up imaging, according to World Health Organization criteria, there was a 42.8% response rate (2.1% complete response, 40.7% partial response). There was a biologic tumor response (any decrease in tumor size) of 87%. Overall median survival was 300 days. One-year survival was 47.8%, and 2-year survival was 30.9%. Median survival was 457 days for patients with colorectal tumors, 776 days for those with neuroendocrine tumors, and 207 days for those with noncolorectal, nonneuroendocrine tumors.


CONCLUSIONS
(90)Y hepatic treatments are well tolerated with acceptable toxicities; tumor response and median survival are promising.
Sato
Kent T
KT
Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 N Saint Clair St, Suite 800, Chicago, IL 60611, USA.
Lewandowski
Robert J
RJ
Mulcahy
Mary F
MF
Atassi
Bassel
B
Ryu
Robert K
RK
Gates
Vanessa L
VL
Nemcek
Albert A
AA
Barakat
Omar
O
Benson
Al
A
Mandal
Robert
R
Talamonti
Mark
M
Wong
Ching-Yee O
CY
Miller
Frank H
FH
Newman
Steven B
SB
Shaw
John M
JM
Thurston
Kenneth G
KG
Omary
Reed A
RA
Salem
Riad
R
D018450:Disease Progression; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D008279:Magnetic Resonance Imaging; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D011446:Prospective Studies; D016019:Survival Analysis; D014055:Tomography, Emission-Computed; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000008:administration & dosage / Q000627:therapeutic use*
D015021:Yttrium Radioisotopes