title: Factors associated with increased incidence of severe toxicities following yttrium-90 resin microspheres in the treatment of hepatic malignancies.
abstract: OBJECTIVE
  To further define variables associated with increased incidences of severe toxicities following administration of yttrium-90 ((90)Y) microspheres.
  
  
  METHODS
  Fifty-eight patients undergoing 79 treatments were retrospectively assessed for development of clinical and laboratory toxicity incidence following (90)Y administration. Severe toxicity events were defined using Common Terminology Criteria for Adverse Events version 4.03 and defined as grade ≥ 3. Univariate logistic regression analyses were used to evaluate the effect of different factors on the incidence of severe toxicity events. Multicollinearity was assessed for all factors with P < 0.1 using Pearson correlation matrices. All factors not excluded due to multicollinearity were included in a multivariate logistic regression model for each measurement of severe toxicity.
  
  
  RESULTS
  Severe (grade ≥ 3) toxicities occurred following 21.5% of the 79 treatments included in our analysis. The most common severe laboratory toxicities were severe alkaline phosphatase (17.7%), albumin (12.7%), and total bilirubin (10.1%) toxicities. Decreased pre-treatment albumin (OR = 26.2, P = 0.010) and increased pre-treatment international normalized ratio (INR) (OR = 17.7, P = 0.048) were associated with development of severe hepatic toxicity. Increased pre-treatment aspartate aminotransferase (AST; OR = 7.4, P = 0.025) and decreased pre-treatment hemoglobin (OR = 12.5, P = 0.025) were associated with severe albumin toxicity. Increasing pre-treatment model for end-stage liver disease (MELD) score (OR = 1.8, P = 0.033) was associated with severe total bilirubin toxicity. Colorectal adenocarcinoma histology was associated with severe alkaline phosphatase toxicity (OR = 5.4, P = 0.043).
  
  
  CONCLUSIONS
  Clinicians should carefully consider pre-treatment albumin, INR, AST, hemoglobin, MELD, and colorectal histology when choosing appropriate candidates for (90)Y microsphere therapy.
authors.affiliation: John D Roberson II, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-3412, United States.
authors.forename: John D
authors.initials: JD
authors.lastname: Roberson Ii
authors.affiliation: John D Roberson II, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-3412, United States.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: McDonald
authors.affiliation: John D Roberson II, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-3412, United States.
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Baden
authors.affiliation: John D Roberson II, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-3412, United States.
authors.forename: Chee Paul
authors.initials: CP
authors.lastname: Lin
authors.affiliation: John D Roberson II, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-3412, United States.
authors.forename: Rojymon
authors.initials: R
authors.lastname: Jacob
authors.affiliation: John D Roberson II, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-3412, United States.
authors.forename: Omer L
authors.initials: OL
authors.lastname: Burnett Iii
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001918:Brachytherapy / Q000009:adverse effects*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D019934:International Normalized Ratio; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D016015:Logistic Models; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D011832:Radiation Injuries / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D019275:Radiopharmaceuticals / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D000075462:Serum Albumin, Human; D012720:Severity of Illness Index; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: C422455:ALB protein, human; D015415:Biomarkers; D006454:Hemoglobins; D019275:Radiopharmaceuticals; D012709:Serum Albumin; D015021:Yttrium Radioisotopes; D001219:Aspartate Aminotransferases; D000075462:Serum Albumin, Human
keywords: Colorectal adenocarcinoma; Liver metastases; Multivariate analysis; Toxicity incidence; Yttrium-90 microspheres