Radioembolization for neuroendocrine liver metastases: Safety, imaging, and long-term outcomes

Khairuddin Memon, Robert J Lewandowski, Mary Frances Mulcahy, Ahsun Riaz, Robert K. Ryu, Kent T Sato, Ramona Gupta, Paul Nikolaidis, Frank H Miller, Vahid Yaghmai, Vanessa L. Gates, Bassel Atassi, Steven Newman, Reed A. Omary, Al B Benson III, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Purpose: To present long-term outcomes on the safety and efficacy of Yttrium-90 radioembolization in the treatment of unresectable hepatic neuroendocrine metastases refractory to standard-of-care therapy. Methods and Materials: This study was approved by our institutional review board and was compliant with the Health Insurance Portability and Accountability Act. Forty patients with hepatic neuroendocrine metastases were treated with 90Y radioembolization at a single center. Toxicity was assessed using National Cancer Institute Common Terminology Criteria v3.0. Response to therapy was assessed by World Health Organization (WHO) guidelines for size and European Association for the Study of the Liver disease (EASL) guidelines for necrosis. Time to response and overall survival were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed. Results: The median dose was 113 Gy (29-299 Gy). Clinical toxicities included fatigue (63%), nausea/vomiting (40%), abdominal pain (18%), fever (8%), diarrhea and weight loss (5%); Grade 3 and 4 bilirubin toxicities were experienced by 2 patients and 1 patient, respectively. Different responses were noted by WHO (complete response, 1.2%; partial response, 62.7%) and EASL (complete response, 20.5%; partial response, 43.4%). Median time to response was 4 and 4.9 months by lesion and patient, respectively. The 1-, 2-, and 3-year overall survival rates were 72.5%, 62.5%, and 45%, respectively. Eastern Cooperative Oncology Group (ECOG) performance score 0 (p < 0.0001), tumor burden ≤25% (p = 0.0019), albumin ≥3.5 g/dL (p = 0.017), and bilirubin ≤1.2 mg/dL (p = 0.002) prognosticated survival on univariate analysis; only ECOG performance score 0 and bilirubin ≤1.2 mg/dL prognosticated better survival outcome on multivariate analysis (p = 0.0001 and p = 0.02). Conclusion: Yttrium-90 therapy for hepatic neuroendocrine metastases leads to satisfactory tumor response and patient survival with low toxicity, in line with published national guidelines recommending radioembolization as a potential option for unresectable hepatic neuroendocrine metastases.

Original languageEnglish (US)
Pages (from-to)887-894
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume83
Issue number3
DOIs
StatePublished - Jul 1 2012

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metastasis
liver
safety
Neoplasm Metastasis
Safety
Bilirubin
Liver
Yttrium
Survival
toxicity
Guidelines
Multivariate Analysis
health
therapy
National Cancer Institute (U.S.)
Research Ethics Committees
yttrium
Social Responsibility
Therapeutics
Health Insurance

Keywords

  • Neuroendocrine metastasis
  • Radioembolization
  • Response
  • Safety
  • Survival

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

@article{82ff2c41b7f24b0ea166928d8f7c752b,
title = "Radioembolization for neuroendocrine liver metastases: Safety, imaging, and long-term outcomes",
abstract = "Purpose: To present long-term outcomes on the safety and efficacy of Yttrium-90 radioembolization in the treatment of unresectable hepatic neuroendocrine metastases refractory to standard-of-care therapy. Methods and Materials: This study was approved by our institutional review board and was compliant with the Health Insurance Portability and Accountability Act. Forty patients with hepatic neuroendocrine metastases were treated with 90Y radioembolization at a single center. Toxicity was assessed using National Cancer Institute Common Terminology Criteria v3.0. Response to therapy was assessed by World Health Organization (WHO) guidelines for size and European Association for the Study of the Liver disease (EASL) guidelines for necrosis. Time to response and overall survival were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed. Results: The median dose was 113 Gy (29-299 Gy). Clinical toxicities included fatigue (63{\%}), nausea/vomiting (40{\%}), abdominal pain (18{\%}), fever (8{\%}), diarrhea and weight loss (5{\%}); Grade 3 and 4 bilirubin toxicities were experienced by 2 patients and 1 patient, respectively. Different responses were noted by WHO (complete response, 1.2{\%}; partial response, 62.7{\%}) and EASL (complete response, 20.5{\%}; partial response, 43.4{\%}). Median time to response was 4 and 4.9 months by lesion and patient, respectively. The 1-, 2-, and 3-year overall survival rates were 72.5{\%}, 62.5{\%}, and 45{\%}, respectively. Eastern Cooperative Oncology Group (ECOG) performance score 0 (p < 0.0001), tumor burden ≤25{\%} (p = 0.0019), albumin ≥3.5 g/dL (p = 0.017), and bilirubin ≤1.2 mg/dL (p = 0.002) prognosticated survival on univariate analysis; only ECOG performance score 0 and bilirubin ≤1.2 mg/dL prognosticated better survival outcome on multivariate analysis (p = 0.0001 and p = 0.02). Conclusion: Yttrium-90 therapy for hepatic neuroendocrine metastases leads to satisfactory tumor response and patient survival with low toxicity, in line with published national guidelines recommending radioembolization as a potential option for unresectable hepatic neuroendocrine metastases.",
keywords = "Neuroendocrine metastasis, Radioembolization, Response, Safety, Survival",
author = "Khairuddin Memon and Lewandowski, {Robert J} and Mulcahy, {Mary Frances} and Ahsun Riaz and Ryu, {Robert K.} and Sato, {Kent T} and Ramona Gupta and Paul Nikolaidis and Miller, {Frank H} and Vahid Yaghmai and Gates, {Vanessa L.} and Bassel Atassi and Steven Newman and Omary, {Reed A.} and {Benson III}, {Al B} and Riad Salem",
year = "2012",
month = "7",
day = "1",
doi = "10.1016/j.ijrobp.2011.07.041",
language = "English (US)",
volume = "83",
pages = "887--894",
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Radioembolization for neuroendocrine liver metastases : Safety, imaging, and long-term outcomes. / Memon, Khairuddin; Lewandowski, Robert J; Mulcahy, Mary Frances; Riaz, Ahsun; Ryu, Robert K.; Sato, Kent T; Gupta, Ramona; Nikolaidis, Paul; Miller, Frank H; Yaghmai, Vahid; Gates, Vanessa L.; Atassi, Bassel; Newman, Steven; Omary, Reed A.; Benson III, Al B; Salem, Riad.

In: International Journal of Radiation Oncology Biology Physics, Vol. 83, No. 3, 01.07.2012, p. 887-894.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Radioembolization for neuroendocrine liver metastases

T2 - Safety, imaging, and long-term outcomes

AU - Memon, Khairuddin

AU - Lewandowski, Robert J

AU - Mulcahy, Mary Frances

AU - Riaz, Ahsun

AU - Ryu, Robert K.

AU - Sato, Kent T

AU - Gupta, Ramona

AU - Nikolaidis, Paul

AU - Miller, Frank H

AU - Yaghmai, Vahid

AU - Gates, Vanessa L.

AU - Atassi, Bassel

AU - Newman, Steven

AU - Omary, Reed A.

AU - Benson III, Al B

AU - Salem, Riad

PY - 2012/7/1

Y1 - 2012/7/1

N2 - Purpose: To present long-term outcomes on the safety and efficacy of Yttrium-90 radioembolization in the treatment of unresectable hepatic neuroendocrine metastases refractory to standard-of-care therapy. Methods and Materials: This study was approved by our institutional review board and was compliant with the Health Insurance Portability and Accountability Act. Forty patients with hepatic neuroendocrine metastases were treated with 90Y radioembolization at a single center. Toxicity was assessed using National Cancer Institute Common Terminology Criteria v3.0. Response to therapy was assessed by World Health Organization (WHO) guidelines for size and European Association for the Study of the Liver disease (EASL) guidelines for necrosis. Time to response and overall survival were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed. Results: The median dose was 113 Gy (29-299 Gy). Clinical toxicities included fatigue (63%), nausea/vomiting (40%), abdominal pain (18%), fever (8%), diarrhea and weight loss (5%); Grade 3 and 4 bilirubin toxicities were experienced by 2 patients and 1 patient, respectively. Different responses were noted by WHO (complete response, 1.2%; partial response, 62.7%) and EASL (complete response, 20.5%; partial response, 43.4%). Median time to response was 4 and 4.9 months by lesion and patient, respectively. The 1-, 2-, and 3-year overall survival rates were 72.5%, 62.5%, and 45%, respectively. Eastern Cooperative Oncology Group (ECOG) performance score 0 (p < 0.0001), tumor burden ≤25% (p = 0.0019), albumin ≥3.5 g/dL (p = 0.017), and bilirubin ≤1.2 mg/dL (p = 0.002) prognosticated survival on univariate analysis; only ECOG performance score 0 and bilirubin ≤1.2 mg/dL prognosticated better survival outcome on multivariate analysis (p = 0.0001 and p = 0.02). Conclusion: Yttrium-90 therapy for hepatic neuroendocrine metastases leads to satisfactory tumor response and patient survival with low toxicity, in line with published national guidelines recommending radioembolization as a potential option for unresectable hepatic neuroendocrine metastases.

AB - Purpose: To present long-term outcomes on the safety and efficacy of Yttrium-90 radioembolization in the treatment of unresectable hepatic neuroendocrine metastases refractory to standard-of-care therapy. Methods and Materials: This study was approved by our institutional review board and was compliant with the Health Insurance Portability and Accountability Act. Forty patients with hepatic neuroendocrine metastases were treated with 90Y radioembolization at a single center. Toxicity was assessed using National Cancer Institute Common Terminology Criteria v3.0. Response to therapy was assessed by World Health Organization (WHO) guidelines for size and European Association for the Study of the Liver disease (EASL) guidelines for necrosis. Time to response and overall survival were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed. Results: The median dose was 113 Gy (29-299 Gy). Clinical toxicities included fatigue (63%), nausea/vomiting (40%), abdominal pain (18%), fever (8%), diarrhea and weight loss (5%); Grade 3 and 4 bilirubin toxicities were experienced by 2 patients and 1 patient, respectively. Different responses were noted by WHO (complete response, 1.2%; partial response, 62.7%) and EASL (complete response, 20.5%; partial response, 43.4%). Median time to response was 4 and 4.9 months by lesion and patient, respectively. The 1-, 2-, and 3-year overall survival rates were 72.5%, 62.5%, and 45%, respectively. Eastern Cooperative Oncology Group (ECOG) performance score 0 (p < 0.0001), tumor burden ≤25% (p = 0.0019), albumin ≥3.5 g/dL (p = 0.017), and bilirubin ≤1.2 mg/dL (p = 0.002) prognosticated survival on univariate analysis; only ECOG performance score 0 and bilirubin ≤1.2 mg/dL prognosticated better survival outcome on multivariate analysis (p = 0.0001 and p = 0.02). Conclusion: Yttrium-90 therapy for hepatic neuroendocrine metastases leads to satisfactory tumor response and patient survival with low toxicity, in line with published national guidelines recommending radioembolization as a potential option for unresectable hepatic neuroendocrine metastases.

KW - Neuroendocrine metastasis

KW - Radioembolization

KW - Response

KW - Safety

KW - Survival

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