Radioembolization of colorectal hepatic metastases using Yttrium-90 microspheres

Mary Frances Mulcahy, Robert J Lewandowski, Saad M. Ibrahim, Kent T Sato, Robert K. Ryu, Bassel Atassi, Steven Newman, Mark Talamonti, Reed A. Omary, Al B Benson III, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

128 Citations (Scopus)

Abstract

Background: The objective of the current study was to determine the safety and efficacy of Yttrium-90 (Y90) microsphere treatment in patients with liver-dominant colorectal metastases. METHODS: Seventytwo patients with unresectable hepatic colorectal metastases were treated at a targeted absorbed dose of 120 Gray (Gy). Safety and toxicity were assessed using version 3 of the National Cancer Institute Common Terminology Criteria. Response was assessed by anatomic imaging and positron emission tomography (PET). Survival from the diagnosis of hepatic metastases and first treatment were estimated using the Kaplan-Meier method. Substratification analyses were performed. RESULTS: The median dose delivered was 118 Gy. Treatment-related toxicities included fatigue (61%), nausea (21%), and abdominal pain (25%). Grade 3 and 4 bilirubin toxicities were observed in 9 of 72 patients (12.6%). The tumor response rate was 40.3%. The median time to hepatic progression was 15.4 months, and the median response duration was 15 months. The PET response rate was 77%. Overall survival from the first Y90 treatment was 14.5 months. Tumor replacement (≤25% vs >25%) was associated with significantly greater median survival (18.7 months vs 5.2 months). The presence of extrahepatic disease was associated negatively with overall survival (7.9 months vs 21 months). Overall survival from the date of initial hepatic metastases was 34.6 months. A subset analysis of patients who had an Eastern Cooperative Oncology Group performance status of 0 demonstrated a median survival of 42.8 months and 23.5 months from the time of hepatic metastases and Y90 treatment, respectively. CONCLUSIONS: Y90 liver therapy appears to provide sustained disease stabilization with acceptable toxicity. Asymptomatic patients with preserved liver function at the time of Y90 appeared to benefit most from treatment.

Original languageEnglish (US)
Pages (from-to)1849-1858
Number of pages10
JournalCancer
Volume115
Issue number9
DOIs
StatePublished - May 1 2009

Fingerprint

Yttrium
Microspheres
Neoplasm Metastasis
Liver
Survival
Positron-Emission Tomography
Therapeutics
Safety
National Cancer Institute (U.S.)
Bilirubin
Terminology
Nausea
Abdominal Pain
Fatigue
Neoplasms

Keywords

  • Fluorodeoxyglucose-positron emission tomography
  • Hepatic arterial infusion chemotherapy
  • Radiofrequency ablation
  • Systemic agents
  • TheraSphere
  • Time to hepatic progression
  • Transarterial chemoembolization
  • Yttrium-90
  • radioembolization

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Mulcahy, Mary Frances ; Lewandowski, Robert J ; Ibrahim, Saad M. ; Sato, Kent T ; Ryu, Robert K. ; Atassi, Bassel ; Newman, Steven ; Talamonti, Mark ; Omary, Reed A. ; Benson III, Al B ; Salem, Riad. / Radioembolization of colorectal hepatic metastases using Yttrium-90 microspheres. In: Cancer. 2009 ; Vol. 115, No. 9. pp. 1849-1858.
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title = "Radioembolization of colorectal hepatic metastases using Yttrium-90 microspheres",
abstract = "Background: The objective of the current study was to determine the safety and efficacy of Yttrium-90 (Y90) microsphere treatment in patients with liver-dominant colorectal metastases. METHODS: Seventytwo patients with unresectable hepatic colorectal metastases were treated at a targeted absorbed dose of 120 Gray (Gy). Safety and toxicity were assessed using version 3 of the National Cancer Institute Common Terminology Criteria. Response was assessed by anatomic imaging and positron emission tomography (PET). Survival from the diagnosis of hepatic metastases and first treatment were estimated using the Kaplan-Meier method. Substratification analyses were performed. RESULTS: The median dose delivered was 118 Gy. Treatment-related toxicities included fatigue (61{\%}), nausea (21{\%}), and abdominal pain (25{\%}). Grade 3 and 4 bilirubin toxicities were observed in 9 of 72 patients (12.6{\%}). The tumor response rate was 40.3{\%}. The median time to hepatic progression was 15.4 months, and the median response duration was 15 months. The PET response rate was 77{\%}. Overall survival from the first Y90 treatment was 14.5 months. Tumor replacement (≤25{\%} vs >25{\%}) was associated with significantly greater median survival (18.7 months vs 5.2 months). The presence of extrahepatic disease was associated negatively with overall survival (7.9 months vs 21 months). Overall survival from the date of initial hepatic metastases was 34.6 months. A subset analysis of patients who had an Eastern Cooperative Oncology Group performance status of 0 demonstrated a median survival of 42.8 months and 23.5 months from the time of hepatic metastases and Y90 treatment, respectively. CONCLUSIONS: Y90 liver therapy appears to provide sustained disease stabilization with acceptable toxicity. Asymptomatic patients with preserved liver function at the time of Y90 appeared to benefit most from treatment.",
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Radioembolization of colorectal hepatic metastases using Yttrium-90 microspheres. / Mulcahy, Mary Frances; Lewandowski, Robert J; Ibrahim, Saad M.; Sato, Kent T; Ryu, Robert K.; Atassi, Bassel; Newman, Steven; Talamonti, Mark; Omary, Reed A.; Benson III, Al B; Salem, Riad.

In: Cancer, Vol. 115, No. 9, 01.05.2009, p. 1849-1858.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Radioembolization of colorectal hepatic metastases using Yttrium-90 microspheres

AU - Mulcahy, Mary Frances

AU - Lewandowski, Robert J

AU - Ibrahim, Saad M.

AU - Sato, Kent T

AU - Ryu, Robert K.

AU - Atassi, Bassel

AU - Newman, Steven

AU - Talamonti, Mark

AU - Omary, Reed A.

AU - Benson III, Al B

AU - Salem, Riad

PY - 2009/5/1

Y1 - 2009/5/1

N2 - Background: The objective of the current study was to determine the safety and efficacy of Yttrium-90 (Y90) microsphere treatment in patients with liver-dominant colorectal metastases. METHODS: Seventytwo patients with unresectable hepatic colorectal metastases were treated at a targeted absorbed dose of 120 Gray (Gy). Safety and toxicity were assessed using version 3 of the National Cancer Institute Common Terminology Criteria. Response was assessed by anatomic imaging and positron emission tomography (PET). Survival from the diagnosis of hepatic metastases and first treatment were estimated using the Kaplan-Meier method. Substratification analyses were performed. RESULTS: The median dose delivered was 118 Gy. Treatment-related toxicities included fatigue (61%), nausea (21%), and abdominal pain (25%). Grade 3 and 4 bilirubin toxicities were observed in 9 of 72 patients (12.6%). The tumor response rate was 40.3%. The median time to hepatic progression was 15.4 months, and the median response duration was 15 months. The PET response rate was 77%. Overall survival from the first Y90 treatment was 14.5 months. Tumor replacement (≤25% vs >25%) was associated with significantly greater median survival (18.7 months vs 5.2 months). The presence of extrahepatic disease was associated negatively with overall survival (7.9 months vs 21 months). Overall survival from the date of initial hepatic metastases was 34.6 months. A subset analysis of patients who had an Eastern Cooperative Oncology Group performance status of 0 demonstrated a median survival of 42.8 months and 23.5 months from the time of hepatic metastases and Y90 treatment, respectively. CONCLUSIONS: Y90 liver therapy appears to provide sustained disease stabilization with acceptable toxicity. Asymptomatic patients with preserved liver function at the time of Y90 appeared to benefit most from treatment.

AB - Background: The objective of the current study was to determine the safety and efficacy of Yttrium-90 (Y90) microsphere treatment in patients with liver-dominant colorectal metastases. METHODS: Seventytwo patients with unresectable hepatic colorectal metastases were treated at a targeted absorbed dose of 120 Gray (Gy). Safety and toxicity were assessed using version 3 of the National Cancer Institute Common Terminology Criteria. Response was assessed by anatomic imaging and positron emission tomography (PET). Survival from the diagnosis of hepatic metastases and first treatment were estimated using the Kaplan-Meier method. Substratification analyses were performed. RESULTS: The median dose delivered was 118 Gy. Treatment-related toxicities included fatigue (61%), nausea (21%), and abdominal pain (25%). Grade 3 and 4 bilirubin toxicities were observed in 9 of 72 patients (12.6%). The tumor response rate was 40.3%. The median time to hepatic progression was 15.4 months, and the median response duration was 15 months. The PET response rate was 77%. Overall survival from the first Y90 treatment was 14.5 months. Tumor replacement (≤25% vs >25%) was associated with significantly greater median survival (18.7 months vs 5.2 months). The presence of extrahepatic disease was associated negatively with overall survival (7.9 months vs 21 months). Overall survival from the date of initial hepatic metastases was 34.6 months. A subset analysis of patients who had an Eastern Cooperative Oncology Group performance status of 0 demonstrated a median survival of 42.8 months and 23.5 months from the time of hepatic metastases and Y90 treatment, respectively. CONCLUSIONS: Y90 liver therapy appears to provide sustained disease stabilization with acceptable toxicity. Asymptomatic patients with preserved liver function at the time of Y90 appeared to benefit most from treatment.

KW - Fluorodeoxyglucose-positron emission tomography

KW - Hepatic arterial infusion chemotherapy

KW - Radiofrequency ablation

KW - Systemic agents

KW - TheraSphere

KW - Time to hepatic progression

KW - Transarterial chemoembolization

KW - Yttrium-90

KW - radioembolization

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