Optimization of Radioembolic Effect with Extended-shelf-life Yttrium-90 Microspheres: Results from a Pilot Study

Robert J. Lewandowski, Ahsun Riaz, Robert K. Ryu, Mary F. Mulcahy, Kent T. Sato, Laura M. Kulik, Vanessa L. Gates, Talia Baker, Reed Omary, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Purpose: To evaluate the safety and efficacy of yttrium-90 (90Y) radioembolization with extended-shelf-life glass microspheres. We postulated that this approach, for the same planned tissue dose of 120 Gy, would increase the embolic load, improve distribution, and result in enhanced tumor response without causing additional adverse events. Materials and Methods: Between June 2007 and September 2008, 50 patients with extensive tumor burden and/or markedly hypervascular tumors (13 hepatocellular carcinomas, and 37 liver metastases) underwent radioembolization with extended-shelf-life microspheres at a planned dose of 120 Gy. Baseline and follow-up imaging and laboratory data were obtained. Response in the target lesion was assessed with cross-sectional imaging by using World Health Organization (WHO) and European Association for the Study of the Liver (EASL) guidelines. Results: The mean delivered radiation dose was 126 Gy. The mean increase in embolic load with this approach was 111%, corresponding to an increase from 3.6 to 7.3 million microspheres. Clinical toxicities included fatigue (28 patients, 56%), abdominal pain (19 patients, 38%), and nausea/vomiting (six patients, 12%). Grade 3-4 bilirubin toxicity was seen in one patient. Two gastroduodenal ulcers were observed. With cross-sectional imaging, response rates according to WHO and EASL guidelines were 51% and 69%, respectively. Conclusions: The results demonstrate the safety and efficacy of extended-shelf-life 90Y glass microspheres. The increased embolic load and lowered activity per microsphere theoretically resulted in better tumor coverage and, hence, improved response rates. This standardizable treatment paradigm provides a minimally embolic therapy for liver tumors.

Original languageEnglish (US)
Pages (from-to)1557-1563
Number of pages7
JournalJournal of Vascular and Interventional Radiology
Volume20
Issue number12
DOIs
StatePublished - Dec 1 2009

Fingerprint

Yttrium
Microspheres
Glass
Liver
Neoplasms
Guidelines
Safety
Tumor Burden
Peptic Ulcer
Bilirubin
Nausea
Vomiting
Fatigue
Hepatocellular Carcinoma
Radiation
Neoplasm Metastasis
Therapeutics

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{097489d8fb0c4e90bec146ffeb3bbeb3,
title = "Optimization of Radioembolic Effect with Extended-shelf-life Yttrium-90 Microspheres: Results from a Pilot Study",
abstract = "Purpose: To evaluate the safety and efficacy of yttrium-90 (90Y) radioembolization with extended-shelf-life glass microspheres. We postulated that this approach, for the same planned tissue dose of 120 Gy, would increase the embolic load, improve distribution, and result in enhanced tumor response without causing additional adverse events. Materials and Methods: Between June 2007 and September 2008, 50 patients with extensive tumor burden and/or markedly hypervascular tumors (13 hepatocellular carcinomas, and 37 liver metastases) underwent radioembolization with extended-shelf-life microspheres at a planned dose of 120 Gy. Baseline and follow-up imaging and laboratory data were obtained. Response in the target lesion was assessed with cross-sectional imaging by using World Health Organization (WHO) and European Association for the Study of the Liver (EASL) guidelines. Results: The mean delivered radiation dose was 126 Gy. The mean increase in embolic load with this approach was 111{\%}, corresponding to an increase from 3.6 to 7.3 million microspheres. Clinical toxicities included fatigue (28 patients, 56{\%}), abdominal pain (19 patients, 38{\%}), and nausea/vomiting (six patients, 12{\%}). Grade 3-4 bilirubin toxicity was seen in one patient. Two gastroduodenal ulcers were observed. With cross-sectional imaging, response rates according to WHO and EASL guidelines were 51{\%} and 69{\%}, respectively. Conclusions: The results demonstrate the safety and efficacy of extended-shelf-life 90Y glass microspheres. The increased embolic load and lowered activity per microsphere theoretically resulted in better tumor coverage and, hence, improved response rates. This standardizable treatment paradigm provides a minimally embolic therapy for liver tumors.",
author = "Lewandowski, {Robert J.} and Ahsun Riaz and Ryu, {Robert K.} and Mulcahy, {Mary F.} and Sato, {Kent T.} and Kulik, {Laura M.} and Gates, {Vanessa L.} and Talia Baker and Reed Omary and Riad Salem",
year = "2009",
month = "12",
day = "1",
doi = "10.1016/j.jvir.2009.08.021",
language = "English (US)",
volume = "20",
pages = "1557--1563",
journal = "Journal of Vascular and Interventional Radiology",
issn = "1051-0443",
publisher = "Elsevier Inc.",
number = "12",

}

TY - JOUR

T1 - Optimization of Radioembolic Effect with Extended-shelf-life Yttrium-90 Microspheres

T2 - Results from a Pilot Study

AU - Lewandowski, Robert J.

AU - Riaz, Ahsun

AU - Ryu, Robert K.

AU - Mulcahy, Mary F.

AU - Sato, Kent T.

AU - Kulik, Laura M.

AU - Gates, Vanessa L.

AU - Baker, Talia

AU - Omary, Reed

AU - Salem, Riad

PY - 2009/12/1

Y1 - 2009/12/1

N2 - Purpose: To evaluate the safety and efficacy of yttrium-90 (90Y) radioembolization with extended-shelf-life glass microspheres. We postulated that this approach, for the same planned tissue dose of 120 Gy, would increase the embolic load, improve distribution, and result in enhanced tumor response without causing additional adverse events. Materials and Methods: Between June 2007 and September 2008, 50 patients with extensive tumor burden and/or markedly hypervascular tumors (13 hepatocellular carcinomas, and 37 liver metastases) underwent radioembolization with extended-shelf-life microspheres at a planned dose of 120 Gy. Baseline and follow-up imaging and laboratory data were obtained. Response in the target lesion was assessed with cross-sectional imaging by using World Health Organization (WHO) and European Association for the Study of the Liver (EASL) guidelines. Results: The mean delivered radiation dose was 126 Gy. The mean increase in embolic load with this approach was 111%, corresponding to an increase from 3.6 to 7.3 million microspheres. Clinical toxicities included fatigue (28 patients, 56%), abdominal pain (19 patients, 38%), and nausea/vomiting (six patients, 12%). Grade 3-4 bilirubin toxicity was seen in one patient. Two gastroduodenal ulcers were observed. With cross-sectional imaging, response rates according to WHO and EASL guidelines were 51% and 69%, respectively. Conclusions: The results demonstrate the safety and efficacy of extended-shelf-life 90Y glass microspheres. The increased embolic load and lowered activity per microsphere theoretically resulted in better tumor coverage and, hence, improved response rates. This standardizable treatment paradigm provides a minimally embolic therapy for liver tumors.

AB - Purpose: To evaluate the safety and efficacy of yttrium-90 (90Y) radioembolization with extended-shelf-life glass microspheres. We postulated that this approach, for the same planned tissue dose of 120 Gy, would increase the embolic load, improve distribution, and result in enhanced tumor response without causing additional adverse events. Materials and Methods: Between June 2007 and September 2008, 50 patients with extensive tumor burden and/or markedly hypervascular tumors (13 hepatocellular carcinomas, and 37 liver metastases) underwent radioembolization with extended-shelf-life microspheres at a planned dose of 120 Gy. Baseline and follow-up imaging and laboratory data were obtained. Response in the target lesion was assessed with cross-sectional imaging by using World Health Organization (WHO) and European Association for the Study of the Liver (EASL) guidelines. Results: The mean delivered radiation dose was 126 Gy. The mean increase in embolic load with this approach was 111%, corresponding to an increase from 3.6 to 7.3 million microspheres. Clinical toxicities included fatigue (28 patients, 56%), abdominal pain (19 patients, 38%), and nausea/vomiting (six patients, 12%). Grade 3-4 bilirubin toxicity was seen in one patient. Two gastroduodenal ulcers were observed. With cross-sectional imaging, response rates according to WHO and EASL guidelines were 51% and 69%, respectively. Conclusions: The results demonstrate the safety and efficacy of extended-shelf-life 90Y glass microspheres. The increased embolic load and lowered activity per microsphere theoretically resulted in better tumor coverage and, hence, improved response rates. This standardizable treatment paradigm provides a minimally embolic therapy for liver tumors.

UR - http://www.scopus.com/inward/record.url?scp=70450284438&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=70450284438&partnerID=8YFLogxK

U2 - 10.1016/j.jvir.2009.08.021

DO - 10.1016/j.jvir.2009.08.021

M3 - Article

C2 - 19854068

AN - SCOPUS:70450284438

VL - 20

SP - 1557

EP - 1563

JO - Journal of Vascular and Interventional Radiology

JF - Journal of Vascular and Interventional Radiology

SN - 1051-0443

IS - 12

ER -