Radiofrequency ablation after selective internal radiation therapy with Yttrium90 microspheres in metastatic liver disease-Is it feasible?
This retrospective study analyzes, whether patients suffering from extensive hepatic metastatic disease treated with SIRT can become suitable candidates for RFA.Within 38 months 46 patients (26 female, 20 male; age 32-75 years) bearing an extensive hepatic metastatic disease were treated with SIRT. Patients suffered from metastases of breast cancer (16/46), colorectal cancer (CRC) (21/46), neuroendocrine (3/46), and other primary carcinomas (6/46). The indication for SIRT was otherwise untreatable metastases confined to the liver. Forty-three patients received single-session whole-liver radioembolization treatment using Yttrium90 resin microspheres with a mean activity of 2.13GBq. In 1 patient SIRT was confined to the left and in 2 patients to the right liver lobe. In 3 patients major complications (2/3 gastric ulceration and 1/3 oedematous pancreatitis) and in 24 patients minor complications occurred (acute abdominal/epigastric pain and/or nausea). Follow-up CT and/or MRI were obtained in 44 of 46 patients. In 5 of 44 patients tumor load decreased substantially (3/5 breast cancer, 1/5 CRC and 1/5 pancreatic cancer) making RFA feasible. The patients were referred for RFA after the first 3-month follow-up. RFA of the liver was successful in all cases in terms of complete ablation. In selected patients radioembolization is able to downstage liver metastases to an extent making a subsequent RFA suitable and therefore allows increasing the number of patients with a "complete response" after a minimally invasive therapy.
Hoffmann
R T
RT
Institute of Clinical Radiology, Ludwig Maximilians-University - Campus Grosshadern, Marchioninstr. 15, 81377 Munich, Germany. rthoffma@med.uni-muenchen.de
Jakobs
T F
TF
Kubisch
C H
CH
Stemmler
H J
HJ
Trumm
C
C
Tatsch
K
K
Helmberger
T K
TK
Reiser
M F
MF
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000503:physiopathology*; D018278:Carcinoma, Neuroendocrine / Q000503:physiopathology*; D017115:Catheter Ablation; D015179:Colorectal Neoplasms / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D012189:Retrospective Studies; D015021:Yttrium Radioisotopes
D015021:Yttrium Radioisotopes