title: Clinical and laboratory toxicity after intra-arterial radioembolization with (90)y-microspheres for unresectable liver metastases.
abstract: OBJECTIVE
  To investigate clinical and laboratory toxicity in patients with unresectable liver metastases, treated with yttrium-90 radioembolization ((90)Y-RE).
  
  
  METHODS
  Patients with liver metastases treated with (90)Y-RE, between February 1(st) 2009 and March 31(st) 2012, were included in this study. Clinical toxicity assessment was based on the reporting in patient's charts. Laboratory investigations at baseline and during a four-month follow-up were used to assess laboratory toxicity according to the Common Terminology Criteria for Adverse Events version 4.02. The occurrence of grade 3-4 laboratory toxicity was stratified according to treatment strategy (whole liver treatment in one session versus sequential sessions). Response assessment was performed at the level of target lesions, whole liver and overall response in accordance with RECIST 1.1 at 3- and 6 months post-treatment. Median time to progression (TTP) and overall survival were calculated by Kaplan-Meier analysis.
  
  
  RESULTS
  A total of 59 patients, with liver metastases from colorectal cancer (n = 30), neuroendocrine tumors (NET) (n = 6) and other primary tumors (n = 23) were included. Clinical toxicity after (90)Y-RE treatment was confined to grade 1-2 events, predominantly post-embolization symptoms. No grade 3-4 clinical toxicity was observed, whereas laboratory toxicity grade 3-4 was observed in 38% of patients. Whole liver treatment in one session was not associated with increased laboratory toxicity. Three-months disease control rates for target lesions, whole liver and overall response were 35%, 21% and 19% respectively. Median TTP was 6.2 months for target lesions, 3.3 months for the whole liver and 3.0 months for overall response. Median overall survival was 8.9 months.
  
  
  CONCLUSIONS
  The risk of severe complications or grade 3-4 clinical toxicity in patients with liver metastases of various primary tumors undergoing (90)Y-RE is low. In contrast, laboratory toxicity grade 3-4 can be expected to occur in more than one-third of patients without any clinical signs of radiation induced liver disease.
authors.affiliation: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Maarten L J
authors.initials: ML
authors.lastname: Smits
authors.forename: Andor F
authors.initials: AF
authors.lastname: van den Hoven
authors.forename: Charlotte E N M
authors.initials: CE
authors.lastname: Rosenbaum
authors.forename: Bernard A
authors.initials: BA
authors.lastname: Zonnenberg
authors.forename: Marnix G E H
authors.initials: MG
authors.lastname: Lam
authors.forename: Johannes F W
authors.initials: JF
authors.lastname: Nijsen
authors.forename: Miriam
authors.initials: M
authors.lastname: Koopman
authors.forename: Maurice A A J
authors.initials: MA
authors.lastname: van den Bosch
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000150:complications / Q000401:mortality / Q000532:radiotherapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000150:complications / Q000401:mortality / Q000532:radiotherapy; D012189:Retrospective Studies; D015021:Yttrium Radioisotopes / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D015021:Yttrium Radioisotopes
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