Treatment parameters and outcome in 680 treatments of internal radiation with resin 90Y-microspheres for unresectable hepatic tumors.
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.
Kennedy
Andrew S
AS
Wake Radiology Oncology, Cary, NC 27518, USA. akennedy@wakerad.com
McNeillie
Patrick
P
Dezarn
William A
WA
Nutting
Charles
C
Sangro
Bruno
B
Wertman
Dan
D
Garafalo
Michael
M
Liu
David
D
Coldwell
Douglas
D
Savin
Michael
M
Jakobs
Tobias
T
Rose
Steven
S
Warner
Richard
R
Carter
Dennis
D
Sapareto
Stephen
S
Nag
Subir
S
Gulec
Seza
S
Calkins
Allison
A
Gates
Vanessa L
VL
Salem
Riad
R
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
D015021:Yttrium Radioisotopes