Radioembolization for unresectable neuroendocrine hepatic metastases using resin 90Y-microspheres: Early results in 148 patients

Andrew S. Kennedy, William A. Dezarn, Patrick McNeillie, Doug Coldwell, Charles Nutting, Dennis Carter, Ravi Murthy, Steven Rose, Richard R P Warner, David Liu, Holger Palmedo, Carroll Overton, Bonita Jones, Riad Salem

Research output: Contribution to journalArticle

288 Citations (Scopus)

Abstract

PURPOSE:: The use of Y-microspheres to treat unresectable liver metastases originating from a variety of neuroendocrine tumors was reviewed. MATERIALS AND METHODS:: This is a retrospective review from 10 institutions of patients given Y-microsphere therapy for neuroendocrine hepatic metastases. Physical, radiographic, biochemical, and clinical factors associated with treatment and response were examined. All patients were followed with laboratory and imaging studies at regular intervals until death, or censured whether other therapy was given after brachytherapy. Toxicities (acute and late) were recorded, and survival of the group determined. RESULTS:: A total of 148 patients were treated with 185 separate procedures. The median age was 58 years (26-95 years) at treatment with median performance status of Eastern Cooperative Oncology Group (0). The median activity delivered was 1.14 GBq (0.33-3.30 GBq) with a median of 99% of the planned activity able to be given (38.1%-147.4%). There were no acute or delayed toxicity of Common Terminology Criteria for Adverse Events v3.0 grade 3 in 67% of patients, with fatigue (6.5%) the most common side effect. Imaging response was stable in 22.7%, partial response in 60.5%, complete in 2.7% and progressive disease in 4.9%. No radiation liver failure occurred. The median survival is 70 months. CONCLUSION:: Radioembolization with Y-microspheres to the whole liver, or lobe with single or multiple fractions are safe and produce high response rates, even with extensive tumor replacement of normal liver and/or heavy pretreatment. The acute and delayed toxicity was very low without a treatment related grade 4 acute event or radiation induced liver disease in this modest-sized cohort. The significant objective response suggests that further investigation of this approach is warranted.

Original languageEnglish (US)
Pages (from-to)271-279
Number of pages9
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Volume31
Issue number3
DOIs
StatePublished - Jun 1 2008

Fingerprint

Microspheres
Neoplasm Metastasis
Liver
Radiation
Therapeutics
Survival
Neuroendocrine Tumors
Brachytherapy
Liver Failure
Terminology
Fatigue
Liver Diseases
Neoplasms

Keywords

  • Carcinoid
  • Liver
  • Microsphere
  • Neuroendocrine-related liver metastases
  • Yttrium-90

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Kennedy, Andrew S. ; Dezarn, William A. ; McNeillie, Patrick ; Coldwell, Doug ; Nutting, Charles ; Carter, Dennis ; Murthy, Ravi ; Rose, Steven ; Warner, Richard R P ; Liu, David ; Palmedo, Holger ; Overton, Carroll ; Jones, Bonita ; Salem, Riad. / Radioembolization for unresectable neuroendocrine hepatic metastases using resin 90Y-microspheres : Early results in 148 patients. In: American Journal of Clinical Oncology: Cancer Clinical Trials. 2008 ; Vol. 31, No. 3. pp. 271-279.
@article{b2944c20600f411083ce0e0d6c5346c1,
title = "Radioembolization for unresectable neuroendocrine hepatic metastases using resin 90Y-microspheres: Early results in 148 patients",
abstract = "PURPOSE:: The use of Y-microspheres to treat unresectable liver metastases originating from a variety of neuroendocrine tumors was reviewed. MATERIALS AND METHODS:: This is a retrospective review from 10 institutions of patients given Y-microsphere therapy for neuroendocrine hepatic metastases. Physical, radiographic, biochemical, and clinical factors associated with treatment and response were examined. All patients were followed with laboratory and imaging studies at regular intervals until death, or censured whether other therapy was given after brachytherapy. Toxicities (acute and late) were recorded, and survival of the group determined. RESULTS:: A total of 148 patients were treated with 185 separate procedures. The median age was 58 years (26-95 years) at treatment with median performance status of Eastern Cooperative Oncology Group (0). The median activity delivered was 1.14 GBq (0.33-3.30 GBq) with a median of 99{\%} of the planned activity able to be given (38.1{\%}-147.4{\%}). There were no acute or delayed toxicity of Common Terminology Criteria for Adverse Events v3.0 grade 3 in 67{\%} of patients, with fatigue (6.5{\%}) the most common side effect. Imaging response was stable in 22.7{\%}, partial response in 60.5{\%}, complete in 2.7{\%} and progressive disease in 4.9{\%}. No radiation liver failure occurred. The median survival is 70 months. CONCLUSION:: Radioembolization with Y-microspheres to the whole liver, or lobe with single or multiple fractions are safe and produce high response rates, even with extensive tumor replacement of normal liver and/or heavy pretreatment. The acute and delayed toxicity was very low without a treatment related grade 4 acute event or radiation induced liver disease in this modest-sized cohort. The significant objective response suggests that further investigation of this approach is warranted.",
keywords = "Carcinoid, Liver, Microsphere, Neuroendocrine-related liver metastases, Yttrium-90",
author = "Kennedy, {Andrew S.} and Dezarn, {William A.} and Patrick McNeillie and Doug Coldwell and Charles Nutting and Dennis Carter and Ravi Murthy and Steven Rose and Warner, {Richard R P} and David Liu and Holger Palmedo and Carroll Overton and Bonita Jones and Riad Salem",
year = "2008",
month = "6",
day = "1",
doi = "10.1097/COC.0b013e31815e4557",
language = "English (US)",
volume = "31",
pages = "271--279",
journal = "American Journal of Clinical Oncology",
issn = "0277-3732",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

Kennedy, AS, Dezarn, WA, McNeillie, P, Coldwell, D, Nutting, C, Carter, D, Murthy, R, Rose, S, Warner, RRP, Liu, D, Palmedo, H, Overton, C, Jones, B & Salem, R 2008, 'Radioembolization for unresectable neuroendocrine hepatic metastases using resin 90Y-microspheres: Early results in 148 patients', American Journal of Clinical Oncology: Cancer Clinical Trials, vol. 31, no. 3, pp. 271-279. https://doi.org/10.1097/COC.0b013e31815e4557

Radioembolization for unresectable neuroendocrine hepatic metastases using resin 90Y-microspheres : Early results in 148 patients. / Kennedy, Andrew S.; Dezarn, William A.; McNeillie, Patrick; Coldwell, Doug; Nutting, Charles; Carter, Dennis; Murthy, Ravi; Rose, Steven; Warner, Richard R P; Liu, David; Palmedo, Holger; Overton, Carroll; Jones, Bonita; Salem, Riad.

In: American Journal of Clinical Oncology: Cancer Clinical Trials, Vol. 31, No. 3, 01.06.2008, p. 271-279.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Radioembolization for unresectable neuroendocrine hepatic metastases using resin 90Y-microspheres

T2 - Early results in 148 patients

AU - Kennedy, Andrew S.

AU - Dezarn, William A.

AU - McNeillie, Patrick

AU - Coldwell, Doug

AU - Nutting, Charles

AU - Carter, Dennis

AU - Murthy, Ravi

AU - Rose, Steven

AU - Warner, Richard R P

AU - Liu, David

AU - Palmedo, Holger

AU - Overton, Carroll

AU - Jones, Bonita

AU - Salem, Riad

PY - 2008/6/1

Y1 - 2008/6/1

N2 - PURPOSE:: The use of Y-microspheres to treat unresectable liver metastases originating from a variety of neuroendocrine tumors was reviewed. MATERIALS AND METHODS:: This is a retrospective review from 10 institutions of patients given Y-microsphere therapy for neuroendocrine hepatic metastases. Physical, radiographic, biochemical, and clinical factors associated with treatment and response were examined. All patients were followed with laboratory and imaging studies at regular intervals until death, or censured whether other therapy was given after brachytherapy. Toxicities (acute and late) were recorded, and survival of the group determined. RESULTS:: A total of 148 patients were treated with 185 separate procedures. The median age was 58 years (26-95 years) at treatment with median performance status of Eastern Cooperative Oncology Group (0). The median activity delivered was 1.14 GBq (0.33-3.30 GBq) with a median of 99% of the planned activity able to be given (38.1%-147.4%). There were no acute or delayed toxicity of Common Terminology Criteria for Adverse Events v3.0 grade 3 in 67% of patients, with fatigue (6.5%) the most common side effect. Imaging response was stable in 22.7%, partial response in 60.5%, complete in 2.7% and progressive disease in 4.9%. No radiation liver failure occurred. The median survival is 70 months. CONCLUSION:: Radioembolization with Y-microspheres to the whole liver, or lobe with single or multiple fractions are safe and produce high response rates, even with extensive tumor replacement of normal liver and/or heavy pretreatment. The acute and delayed toxicity was very low without a treatment related grade 4 acute event or radiation induced liver disease in this modest-sized cohort. The significant objective response suggests that further investigation of this approach is warranted.

AB - PURPOSE:: The use of Y-microspheres to treat unresectable liver metastases originating from a variety of neuroendocrine tumors was reviewed. MATERIALS AND METHODS:: This is a retrospective review from 10 institutions of patients given Y-microsphere therapy for neuroendocrine hepatic metastases. Physical, radiographic, biochemical, and clinical factors associated with treatment and response were examined. All patients were followed with laboratory and imaging studies at regular intervals until death, or censured whether other therapy was given after brachytherapy. Toxicities (acute and late) were recorded, and survival of the group determined. RESULTS:: A total of 148 patients were treated with 185 separate procedures. The median age was 58 years (26-95 years) at treatment with median performance status of Eastern Cooperative Oncology Group (0). The median activity delivered was 1.14 GBq (0.33-3.30 GBq) with a median of 99% of the planned activity able to be given (38.1%-147.4%). There were no acute or delayed toxicity of Common Terminology Criteria for Adverse Events v3.0 grade 3 in 67% of patients, with fatigue (6.5%) the most common side effect. Imaging response was stable in 22.7%, partial response in 60.5%, complete in 2.7% and progressive disease in 4.9%. No radiation liver failure occurred. The median survival is 70 months. CONCLUSION:: Radioembolization with Y-microspheres to the whole liver, or lobe with single or multiple fractions are safe and produce high response rates, even with extensive tumor replacement of normal liver and/or heavy pretreatment. The acute and delayed toxicity was very low without a treatment related grade 4 acute event or radiation induced liver disease in this modest-sized cohort. The significant objective response suggests that further investigation of this approach is warranted.

KW - Carcinoid

KW - Liver

KW - Microsphere

KW - Neuroendocrine-related liver metastases

KW - Yttrium-90

UR - http://www.scopus.com/inward/record.url?scp=44949120870&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=44949120870&partnerID=8YFLogxK

U2 - 10.1097/COC.0b013e31815e4557

DO - 10.1097/COC.0b013e31815e4557

M3 - Article

C2 - 18525307

AN - SCOPUS:44949120870

VL - 31

SP - 271

EP - 279

JO - American Journal of Clinical Oncology

JF - American Journal of Clinical Oncology

SN - 0277-3732

IS - 3

ER -