Yttrium-90 microsphere radioembolization for the treatment of liver malignancies: a structured meta-analysis.
Radioembolization with yttrium-90 microspheres ((90)Y-RE), either glass- or resin-based, is increasingly applied in patients with unresectable liver malignancies. Clinical results are promising but overall response and survival are not yet known. Therefore a meta-analysis on tumor response and survival in patients who underwent (90)Y-RE was conducted. Based on an extensive literature search, six groups were formed. Determinants were cancer type, microsphere type, chemotherapy protocol used, and stage (deployment in first-line or as salvage therapy). For colorectal liver metastases (mCRC), in a salvage setting, response was 79% for (90)Y-RE combined with 5-fluorouracil/leucovorin (5-FU/LV), and 79% when combined with 5-FU/LV/oxaliplatin or 5-FU/LV/irinotecan, and in a first-line setting 91% and 91%, respectively. For hepatocellular carcinoma (HCC), response was 89% for resin microspheres and 78% for glass microspheres. No statistical method is available to assess median survival based on data presented in the literature. In mCRC, (90)Y-RE delivers high response rates, especially if used neoadjuvant to chemotherapy. In HCC, (90)Y-RE with resin microspheres is significantly more effective than (90)Y-RE with glass microspheres. The impact on survival will become known only when the results of phase III studies are published.
Vente
M A D
MA
Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands. m.vente@umcutrecht.nl
Wondergem
M
M
van der Tweel
I
I
van den Bosch
M A A J
MA
Zonnenberg
B A
BA
Lam
M G E H
MG
van Het Schip
A D
AD
Nijsen
J F W
JF
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D016461:Chemoembolization, Therapeutic / Q000379:methods; D015179:Colorectal Neoplasms / Q000473:pathology / Q000532:radiotherapy; D003131:Combined Modality Therapy / Q000379:methods; D005472:Fluorouracil / Q000008:administration & dosage; D005898:Glass; D006801:Humans; D000077146:Irinotecan; D002955:Leucovorin / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D008863:Microspheres; D009362:Neoplasm Metastasis; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000494:pharmacology*
D009944:Organoplatinum Compounds; D015021:Yttrium Radioisotopes; D000077150:Oxaliplatin; D000077146:Irinotecan; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin