title: Treatment parameters and outcome in 680 treatments of internal radiation with resin 90Y-microspheres for unresectable hepatic tumors.
abstract: OBJECTIVE
  Radioembolization (RE) using (90)Y-microspheres is an effective and safe treatment for patients with unresectable liver malignancies. Radiation-induced liver disease (RILD) is rare after RE; however, greater understanding of radiation-related factors leading to serious liver toxicity is needed.
  
  
  METHODS
  Retrospective review of radiation parameters was performed. All data pertaining to demographics, tumor, radiation, and outcomes were analyzed for significance and dependencies to develop a predictive model for RILD. Toxicity was scored using the National Cancer Institute Common Toxicity Criteria Adverse Events Version 3.0 scale.
  
  
  RESULTS
  A total of 515 patients (287 men; 228 women) from 14 US and 2 EU centers underwent 680 separate RE treatments with resin (90)Y-microspheres in 2003-2006. Multifactorial analyses identified factors related to toxicity, including activity (GBq) Selective Internal Radiation Therapy delivered (p < 0.0001), prescribed (GBq) activity (p < 0.0001), percentage of empiric activity (GBq) delivered (p < 0.0001), number of prior liver treatments (p < 0.0008), and medical center (p < 0.0001). The RILD was diagnosed in 28 of 680 treatments (4%), with 21 of 28 cases (75%) from one center, which used the empiric method.
  
  
  CONCLUSIONS
  There was an association between the empiric method, percentage of calculated activity delivered to the patient, and the most severe toxicity, RILD. A predictive model for RILD is not yet possible given the large variance in these data.
authors.affiliation: Wake Radiology Oncology, Cary, NC 27518, USA. akennedy@wakerad.com
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Kennedy
authors.forename: Patrick
authors.initials: P
authors.lastname: McNeillie
authors.forename: William A
authors.initials: WA
authors.lastname: Dezarn
authors.forename: Charles
authors.initials: C
authors.lastname: Nutting
authors.forename: Bruno
authors.initials: B
authors.lastname: Sangro
authors.forename: Dan
authors.initials: D
authors.lastname: Wertman
authors.forename: Michael
authors.initials: M
authors.lastname: Garafalo
authors.forename: David
authors.initials: D
authors.lastname: Liu
authors.forename: Douglas
authors.initials: D
authors.lastname: Coldwell
authors.forename: Michael
authors.initials: M
authors.lastname: Savin
authors.forename: Tobias
authors.initials: T
authors.lastname: Jakobs
authors.forename: Steven
authors.initials: S
authors.lastname: Rose
authors.forename: Richard
authors.initials: R
authors.lastname: Warner
authors.forename: Dennis
authors.initials: D
authors.lastname: Carter
authors.forename: Stephen
authors.initials: S
authors.lastname: Sapareto
authors.forename: Subir
authors.initials: S
authors.lastname: Nag
authors.forename: Seza
authors.initials: S
authors.lastname: Gulec
authors.forename: Allison
authors.initials: A
authors.lastname: Calkins
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Gates
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000532:radiotherapy; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D008099:Liver / Q000528:radiation effects*; D008113:Liver Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008863:Microspheres; D008956:Models, Chemical; D011832:Radiation Injuries / Q000209:etiology* / Q000473:pathology; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D015021:Yttrium Radioisotopes