title: Radioembolization for neuroendocrine liver metastases: safety, imaging, and long-term outcomes.
abstract: OBJECTIVE
  To present long-term outcomes on the safety and efficacy of Yttrium-90 radioembolization in the treatment of unresectable hepatic neuroendocrine metastases refractory to standard-of-care therapy.
  
  
  METHODS
  This study was approved by our institutional review board and was compliant with the Health Insurance Portability and Accountability Act. Forty patients with hepatic neuroendocrine metastases were treated with (90)Y radioembolization at a single center. Toxicity was assessed using National Cancer Institute Common Terminology Criteria v3.0. Response to therapy was assessed by World Health Organization (WHO) guidelines for size and European Association for the Study of the Liver disease (EASL) guidelines for necrosis. Time to response and overall survival were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed.
  
  
  RESULTS
  The median dose was 113 Gy (29-299 Gy). Clinical toxicities included fatigue (63%), nausea/vomiting (40%), abdominal pain (18%), fever (8%), diarrhea and weight loss (5%); Grade 3 and 4 bilirubin toxicities were experienced by 2 patients and 1 patient, respectively. Different responses were noted by WHO (complete response, 1.2%; partial response, 62.7%) and EASL (complete response, 20.5%; partial response, 43.4%). Median time to response was 4 and 4.9 months by lesion and patient, respectively. The 1-, 2-, and 3-year overall survival rates were 72.5%, 62.5%, and 45%, respectively. Eastern Cooperative Oncology Group (ECOG) performance score 0 (p < 0.0001), tumor burden ≤25% (p = 0.0019), albumin ≥3.5 g/dL (p = 0.017), and bilirubin ≤1.2 mg/dL (p = 0.002) prognosticated survival on univariate analysis; only ECOG performance score 0 and bilirubin ≤1.2 mg/dL prognosticated better survival outcome on multivariate analysis (p = 0.0001 and p = 0.02).
  
  
  CONCLUSIONS
  Yttrium-90 therapy for hepatic neuroendocrine metastases leads to satisfactory tumor response and patient survival with low toxicity, in line with published national guidelines recommending radioembolization as a potential option for unresectable hepatic neuroendocrine metastases.
authors.affiliation: Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, USA.
authors.forename: Khairuddin
authors.initials: K
authors.lastname: Memon
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
authors.forename: Mary F
authors.initials: MF
authors.lastname: Mulcahy
authors.forename: Ahsun
authors.initials: A
authors.lastname: Riaz
authors.forename: Robert K
authors.initials: RK
authors.lastname: Ryu
authors.forename: Kent T
authors.initials: KT
authors.lastname: Sato
authors.forename: Ramona
authors.initials: R
authors.lastname: Gupta
authors.forename: Paul
authors.initials: P
authors.lastname: Nikolaidis
authors.forename: Frank H
authors.initials: FH
authors.lastname: Miller
authors.forename: Vahid
authors.initials: V
authors.lastname: Yaghmai
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Gates
authors.forename: Bassel
authors.initials: B
authors.lastname: Atassi
authors.forename: Steven
authors.initials: S
authors.lastname: Newman
authors.forename: Reed A
authors.initials: RA
authors.lastname: Omary
authors.forename: Al B
authors.initials: AB
authors.lastname: Benson
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D000704:Analysis of Variance; D003967:Diarrhea / Q000209:etiology; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology; D015431:Weight Loss; D015021:Yttrium Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D015021:Yttrium Radioisotopes