title: Lung Shunt Fraction prior to Yttrium-90 Radioembolization Predicts Survival in Patients with Neuroendocrine Liver Metastases: Single-Center Prospective Analysis.
abstract: OBJECTIVE
  To investigate survival outcomes following radioembolization with Yttrium-90 (Y90) for neuroendocrine tumor liver metastases (NETLMs). This study was designed to assess the efficacy of Y90 radioembolization and to evaluate lung shunt fraction (LSF) as a predictor for survival.
  
  
  METHODS
  A single-center, prospective study of 44 consecutive patients (median age: 58.5 years, 29.5 % male) diagnosed with pancreatic (52.3 %) or carcinoid (47.7 %) NETLMs from 2006 to 2012 who underwent Y90 radioembolization was performed. Patients' baseline characteristics, including LSF and median overall survival (OS) from first Y90 radioembolization, were recorded and compared between patients with high (≥10 %) and low (<10 %) LSF. Baseline comparisons were performed using Fisher's exact tests for categorical and Mann-Whitney U test for continuous variables. Survival was calculated using the Kaplan-Meier method. Univariate (Wilcoxon rank-sum test) and multivariate analyses (Cox Proportional Hazard Model) for risk factor analysis were performed.
  
  
  RESULTS
  There was no statistically significant difference in age, gender, race, tumor properties, or previous treatments between patients with high (n = 15) and low (n = 29) LSF. The median OS was 27.4 months (95 %CI 12.73-55.23), with 4.77 months (95 %CI 2.87-26.73) for high and 42.77 months (95 %CI 18.47-59.73) for low LSF (p = 0.003). Multivariate analysis identified high LSF (p = 0.001), total serum bilirubin >1.2 mg (p = 0.016), and lack of pretreatment with octreotide (p = 0.01) as independent prognostic factors for poorer survival. Tumor type and total radiation dose did not predict survival.
  
  
  CONCLUSIONS
  LSF ≥10 %, elevated bilirubin levels, and lack of pretreatment with octreotide were found to be independent prognostic factors for poorer survival in patients with NETLMs.
authors.affiliation: Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University, 330 Cedar Street, TE 2-224, New Haven, CT, 06510, USA.
authors.forename: Johannes M
authors.initials: JM
authors.lastname: Ludwig
authors.affiliation: Department of Diagnostic Radiology, John Hopkins University School of Medicine, 601 N Caroline Street, Baltimore, MD, 21287, USA.
authors.forename: Emily McIntosh
authors.initials: EM
authors.lastname: Ambinder
authors.affiliation: Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
authors.forename: Anish
authors.initials: A
authors.lastname: Ghodadra
authors.affiliation: Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University, 330 Cedar Street, TE 2-224, New Haven, CT, 06510, USA.
authors.forename: Minzhi
authors.initials: M
authors.lastname: Xing
authors.affiliation: Division of Interventional Radiology, Department of Radiology, The University of Tennessee Health Science Center, 865 Jefferson Ave, Memphis, TN, 38103, USA.
authors.forename: Hasmukh J
authors.initials: HJ
authors.lastname: Prajapati
authors.affiliation: Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University, 330 Cedar Street, TE 2-224, New Haven, CT, 06510, USA. kevin.kim@yale.edu.|Yale Cancer Center, 333 Cedar Street, New Haven, CT, 06510, USA. kevin.kim@yale.edu.
authors.forename: Hyun S
authors.initials: HS
authors.lastname: Kim
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000473:pathology*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D015021:Yttrium Radioisotopes
keywords: Hepatopulmonary Shunt Fraction; Liver Metastases; Neuroendocrine Tumors; Survival Biomarker; Yttrium-90 Radioembolization