title: Safety of repeated radioembolizations in patients with advanced primary and secondary liver tumors and progressive disease after first selective internal radiotherapy.
abstract: The purpose of this study was to assess the safety of repeated (90)Y radioembolization with resin microspheres in patients with extensive primary and secondary liver tumors after failure of first radioembolization.
  
  
  METHODS
  Between 2007 and 2011, 21 patients (12 women, 9 men; mean age, 61.0 y) with nonresectable advanced liver tumors (breast cancer liver metastases, n = 7; colorectal liver metastases, n = 5; hepatocellular carcinoma, n = 8; cholangiocellular carcinoma, n = 1) were repeatedly treated by radioembolization. Safety was the primary endpoint. Whole-liver treatment was achieved with sequential treatment sessions in most patients, with selective embolization of the left and right liver lobes within 6 wk. Toxicity was documented prospectively and according to Common Terminology Criteria for Adverse Events 4.0 criteria based on laboratory parameters; magnetic-resonance tomography; and clinical examinations 3 d, 6 wk, and every 3 mo after selective internal radiotherapy (SIRT). Metric variables were evaluated using the Student t test. Overall survival was assessed by Kaplan-Meier statistics.
  
  
  RESULTS
  Patients received an average of 1.6 whole-liver treatments performed in 3.0 unilobar radioembolizations (liver lobes sequentially). The mean total activity administered was 2.57 GBq. No radioembolization-induced liver disease was observed in any of the patients. Three patients showed reversible grade III to IV toxicities according to laboratory values, which returned to pretreatment levels after 6 wk. In 1 patient, a treatment-related duodenal ulcer occurred. Median overall survival was 18 mo after first radioembolization.
  
  
  CONCLUSIONS
  In advanced liver tumors, repeated whole-liver treatments with (90)Y radioembolization can be performed with an acceptable toxicity profile.
authors: Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Magdeburg, Germany.
authors: Alina
authors: A
authors: Zarva
authors: Konrad
authors: K
authors: Mohnike
authors: Robert
authors: R
authors: Damm
authors: Juri
authors: J
authors: Ruf
authors: Ricarda
authors: R
authors: Seidensticker
authors: Gerhard
authors: G
authors: Ulrich
authors: Max
authors: M
authors: Seidensticker
authors: Maciej
authors: M
authors: Pech
authors: Jens
authors: J
authors: Ricke
authors: Holger
authors: H
authors: Amthauer
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000473:pathology / Q000532:radiotherapy*; D012189:Retrospective Studies; D012449:Safety; D016019:Survival Analysis
keywords: 90Y microspheres; liver malignancies; repeated radioembolization; sequential approach; toxicity