title: Yttrium-90 radioembolization stops progression of targeted breast cancer liver metastases after failed chemotherapy.
abstract: OBJECTIVE
  To determine, in an open-label, retrospective report, the safety and effectiveness of locoregional therapy with yttrium-90 ((90)Y) radioembolization for patients with progressing breast cancer liver metastases (BCLMs) despite multi-agent chemotherapy.
  
  
  METHODS
  Seventy-five patients with progressing BCLMs and stable extrahepatic disease were treated with radioembolization at a single institution. Retrospective review of a prospectively collected database was performed to evaluate clinical and biochemical toxicities, tumor response, overall survival (OS), and time to progression. Radiologic response assessments included Response Evaluation Criteria In Solid Tumors in primary index lesions and metabolic activity on positron emission tomography (PET). Univariate and multivariate analyses were performed.
  
  
  RESULTS
  The mortality rate at 30 days was 4% (n = 3). Clinical toxicity and hyperbilirubinemia of grade 3 or worse occurred in 7.6% (n = 5) and 5.9% of patients (n = 4), respectively. Partial response (PR) was seen in 35.3% of patients (n = 24), stable disease (SD) in 63.2% (n = 43), and progressive disease in 1.5% (n = 1). PET imaging was available in 25 patients, and 21 (84%) had a complete response, PR, or SD. The median OS was 6.6 months (95% confidence interval [CI], 5.0-9.2 mo). The hazard ratio (HR) for OS on multivariate analysis was 0.39 (95% CI, 0.23-0.66) for tumor burden less than 25% compared with greater burden. Elevated bilirubin levels were shown to reduce OS. The HR for hepatic progression was 0.22 (95% CI, 0.05-0.98) for solitary versus multifocal disease.
  
  
  CONCLUSIONS
  Locoregional therapy with (90)Y radioembolization is safe and stops or delays the progression of targeted chemorefractory BCLMs. Adverse prognosticators were identified.
authors.affiliation: Department of Radiology and Section of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago; Department of Biomedical Engineering, Northwestern University, Evanston, Illinois.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Gordon
authors.affiliation: Department of Medicine-Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago.
authors.forename: William J
authors.initials: WJ
authors.lastname: Gradishar
authors.affiliation: Department of Medicine-Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago.
authors.forename: Virginia G
authors.initials: VG
authors.lastname: Kaklamani
authors.affiliation: Department of Radiology and Section of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago.
authors.forename: Avesh J
authors.initials: AJ
authors.lastname: Thuluvath
authors.affiliation: Department of Radiology and Section of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Ryu
authors.affiliation: Department of Radiology and Section of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago.
authors.forename: Kent T
authors.initials: KT
authors.lastname: Sato
authors.affiliation: Department of Radiology and Section of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago.
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Gates
authors.affiliation: Department of Radiology and Section of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago; Department of Medicine-Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago; Department of Surgery-Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago.
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
authors.affiliation: Department of Radiology and Section of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago. Electronic address: r-lewandowski@northwestern.edu.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology*; D018450:Disease Progression; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D019275:Radiopharmaceuticals / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D015021:Yttrium Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes