title: Yttrium-90 radioembolization in patients with unresectable liver metastases: determining the factors that lead to treatment efficacy.
abstract: BACKGROUND
  Locoregional treatments, such as radioembolization, can be used to treat patients with unresectable liver metastases. We aimed to determine the progression-free survival and factors that predict survival of patients with liver metastases whose response to selective internal radiation therapy (SIRT) with Y-90 was assessed by positron emission tomography-computed tomography (PET-CT).
  
  
  METHODS
  Our study included 78 liver cancer patients who were treated with Y-90 radioembolization.
  
  
  RESULTS
  The post-treatment response rates were as follows: 7 patients (9%) had stable disease (SD), 26 patients (33.3%) had a partial response (PR), 4 patients (5.1%) had a complete response (CR). The median hepatic progression-free survival (HPFS) was 4.4 months while median overall survival was 10.1 months. Univariate analysis revealed that HPFS is significantly affected by international normalized ratio (INR) levels and age (Hazard Ratio(HR)=0.54 (95%CI:0.30-096), P=0.034, HR=1.03(95%CI:1.00-1.05), P=0.051). However, only INR levels retained significance with multivariate analysis (HR=0.53 (95%CI:0.30-0.93), P=0.028), while age had limited significance (HR =1.02 (95% CI:1.00-1.05), P=0.051).
  
  
  CONCLUSIONS
  We determined that Y-90 radioembolization is effective as a salvage therapy in patients with predominant liver metastases. For the first time, we showed that age and INR values reflecting the functional hepatic reserve can be used as positive predictive factors for HPFS.
authors.forename: Seyda
authors.initials: S
authors.lastname: Gunduz
authors.forename: Ozhan
authors.initials: O
authors.lastname: Ozgur
authors.forename: Hakan
authors.initials: H
authors.lastname: Bozcuk
authors.forename: Hasan Senol
authors.initials: HS
authors.lastname: Coşkun
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ozdogan
authors.forename: Metin
authors.initials: M
authors.lastname: Erkilic
authors.forename: Timur
authors.initials: T
authors.lastname: Sindel
authors.forename: Akin
authors.initials: A
authors.lastname: Yldlzs
authors.forename: Saim
authors.initials: S
authors.lastname: Ylmaz
authors.forename: Adil
authors.initials: A
authors.lastname: Boz
authors.forename: Funda
authors.initials: F
authors.lastname: Aydin
authors.forename: Binnur
authors.initials: B
authors.lastname: Karayalçin
authors.forename: Burhan
authors.initials: B
authors.lastname: Savas
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D015999:Multivariate Analysis; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D019275:Radiopharmaceuticals / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D016879:Salvage Therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes