Response of liver metastases after treatment with yttrium-90 microspheres: Role of size, necrosis, and PET

Frank H Miller*, Ana L. Keppke, Denise Reddy, Jie Huang, Jianhua Jin, Mary Frances Mulcahy, Riad Salem

*Corresponding author for this work

Research output: Contribution to journalReview article

86 Citations (Scopus)

Abstract

OBJECTIVE. Yttrium-90 radioembolization is an emerging treatment for liver malignancies. The purpose of this study was to evaluate the imaging response of liver metastases to 90Y microspheres based on size and necrosis criteria using CT and comparing the results to PET and to describe imaging features related to 90Y therapy. MATERIALS AND METHODS. We reviewed the imaging studies of 42 patients with unresectable liver metastases treated with lobar radioembolization with 90Y. CT response was determined using traditional size criteria (World Health Organization [WHO] and Response Evaluation Criteria in Solid Tumors [RECIST]), necrosis criteria, and combined criteria (RECIST and necrosis). We compared the response on CT with the response on PET. Complications of treatment were assessed. RESULTS. The response rate was 19% (8/42) by WHO criteria, 24% (10/42) by RECIST, 45% (19/42) by necrosis criteria, and 50% (21/42) by combined criteria. Stabilization of lesion size occurred in 50% of patients. Necrosis and combined criteria identified responders earlier than RECIST and WHO criteria. Seven responders by combined criteria had an increase in lesion size on initial follow-up and would have been considered nonresponders. PET scans were obtained in 23 patients (33 treated lobes). PET detected significantly more responses to treatment (21/33, 63%) than CT using RECIST (2/33, 6%) or combined criteria (8/33, 24%) (p < 0.05, McNemar test). Complications of treatment included radiation cholecystitis (10 patients, 23%) and liver edema (18 patients, 42%). CONCLUSION. The use of necrosis and size criteria on CT and correlation with PET may improve the accuracy of assessment of response to 90Y treatment in patients with liver metastases and detect response earlier than standard size criteria.

Original languageEnglish (US)
Pages (from-to)776-783
Number of pages8
JournalAmerican Journal of Roentgenology
Volume188
Issue number3
DOIs
StatePublished - Mar 1 2007

Fingerprint

Yttrium
Microspheres
Necrosis
Neoplasm Metastasis
Liver
Therapeutics
Cholecystitis
Positron-Emission Tomography
Edema
Response Evaluation Criteria in Solid Tumors
Radiation
Neoplasms

Keywords

  • CT imaging
  • Interventional radiology
  • Liver
  • Oncologic imaging
  • PET
  • Radioembolization

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{62e5ab9271a2452bace0cd069f5b9867,
title = "Response of liver metastases after treatment with yttrium-90 microspheres: Role of size, necrosis, and PET",
abstract = "OBJECTIVE. Yttrium-90 radioembolization is an emerging treatment for liver malignancies. The purpose of this study was to evaluate the imaging response of liver metastases to 90Y microspheres based on size and necrosis criteria using CT and comparing the results to PET and to describe imaging features related to 90Y therapy. MATERIALS AND METHODS. We reviewed the imaging studies of 42 patients with unresectable liver metastases treated with lobar radioembolization with 90Y. CT response was determined using traditional size criteria (World Health Organization [WHO] and Response Evaluation Criteria in Solid Tumors [RECIST]), necrosis criteria, and combined criteria (RECIST and necrosis). We compared the response on CT with the response on PET. Complications of treatment were assessed. RESULTS. The response rate was 19{\%} (8/42) by WHO criteria, 24{\%} (10/42) by RECIST, 45{\%} (19/42) by necrosis criteria, and 50{\%} (21/42) by combined criteria. Stabilization of lesion size occurred in 50{\%} of patients. Necrosis and combined criteria identified responders earlier than RECIST and WHO criteria. Seven responders by combined criteria had an increase in lesion size on initial follow-up and would have been considered nonresponders. PET scans were obtained in 23 patients (33 treated lobes). PET detected significantly more responses to treatment (21/33, 63{\%}) than CT using RECIST (2/33, 6{\%}) or combined criteria (8/33, 24{\%}) (p < 0.05, McNemar test). Complications of treatment included radiation cholecystitis (10 patients, 23{\%}) and liver edema (18 patients, 42{\%}). CONCLUSION. The use of necrosis and size criteria on CT and correlation with PET may improve the accuracy of assessment of response to 90Y treatment in patients with liver metastases and detect response earlier than standard size criteria.",
keywords = "CT imaging, Interventional radiology, Liver, Oncologic imaging, PET, Radioembolization",
author = "Miller, {Frank H} and Keppke, {Ana L.} and Denise Reddy and Jie Huang and Jianhua Jin and Mulcahy, {Mary Frances} and Riad Salem",
year = "2007",
month = "3",
day = "1",
doi = "10.2214/AJR.06.0707",
language = "English (US)",
volume = "188",
pages = "776--783",
journal = "American Journal of Roentgenology",
issn = "0361-803X",
publisher = "American Roentgen Ray Society",
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}

Response of liver metastases after treatment with yttrium-90 microspheres : Role of size, necrosis, and PET. / Miller, Frank H; Keppke, Ana L.; Reddy, Denise; Huang, Jie; Jin, Jianhua; Mulcahy, Mary Frances; Salem, Riad.

In: American Journal of Roentgenology, Vol. 188, No. 3, 01.03.2007, p. 776-783.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Response of liver metastases after treatment with yttrium-90 microspheres

T2 - Role of size, necrosis, and PET

AU - Miller, Frank H

AU - Keppke, Ana L.

AU - Reddy, Denise

AU - Huang, Jie

AU - Jin, Jianhua

AU - Mulcahy, Mary Frances

AU - Salem, Riad

PY - 2007/3/1

Y1 - 2007/3/1

N2 - OBJECTIVE. Yttrium-90 radioembolization is an emerging treatment for liver malignancies. The purpose of this study was to evaluate the imaging response of liver metastases to 90Y microspheres based on size and necrosis criteria using CT and comparing the results to PET and to describe imaging features related to 90Y therapy. MATERIALS AND METHODS. We reviewed the imaging studies of 42 patients with unresectable liver metastases treated with lobar radioembolization with 90Y. CT response was determined using traditional size criteria (World Health Organization [WHO] and Response Evaluation Criteria in Solid Tumors [RECIST]), necrosis criteria, and combined criteria (RECIST and necrosis). We compared the response on CT with the response on PET. Complications of treatment were assessed. RESULTS. The response rate was 19% (8/42) by WHO criteria, 24% (10/42) by RECIST, 45% (19/42) by necrosis criteria, and 50% (21/42) by combined criteria. Stabilization of lesion size occurred in 50% of patients. Necrosis and combined criteria identified responders earlier than RECIST and WHO criteria. Seven responders by combined criteria had an increase in lesion size on initial follow-up and would have been considered nonresponders. PET scans were obtained in 23 patients (33 treated lobes). PET detected significantly more responses to treatment (21/33, 63%) than CT using RECIST (2/33, 6%) or combined criteria (8/33, 24%) (p < 0.05, McNemar test). Complications of treatment included radiation cholecystitis (10 patients, 23%) and liver edema (18 patients, 42%). CONCLUSION. The use of necrosis and size criteria on CT and correlation with PET may improve the accuracy of assessment of response to 90Y treatment in patients with liver metastases and detect response earlier than standard size criteria.

AB - OBJECTIVE. Yttrium-90 radioembolization is an emerging treatment for liver malignancies. The purpose of this study was to evaluate the imaging response of liver metastases to 90Y microspheres based on size and necrosis criteria using CT and comparing the results to PET and to describe imaging features related to 90Y therapy. MATERIALS AND METHODS. We reviewed the imaging studies of 42 patients with unresectable liver metastases treated with lobar radioembolization with 90Y. CT response was determined using traditional size criteria (World Health Organization [WHO] and Response Evaluation Criteria in Solid Tumors [RECIST]), necrosis criteria, and combined criteria (RECIST and necrosis). We compared the response on CT with the response on PET. Complications of treatment were assessed. RESULTS. The response rate was 19% (8/42) by WHO criteria, 24% (10/42) by RECIST, 45% (19/42) by necrosis criteria, and 50% (21/42) by combined criteria. Stabilization of lesion size occurred in 50% of patients. Necrosis and combined criteria identified responders earlier than RECIST and WHO criteria. Seven responders by combined criteria had an increase in lesion size on initial follow-up and would have been considered nonresponders. PET scans were obtained in 23 patients (33 treated lobes). PET detected significantly more responses to treatment (21/33, 63%) than CT using RECIST (2/33, 6%) or combined criteria (8/33, 24%) (p < 0.05, McNemar test). Complications of treatment included radiation cholecystitis (10 patients, 23%) and liver edema (18 patients, 42%). CONCLUSION. The use of necrosis and size criteria on CT and correlation with PET may improve the accuracy of assessment of response to 90Y treatment in patients with liver metastases and detect response earlier than standard size criteria.

KW - CT imaging

KW - Interventional radiology

KW - Liver

KW - Oncologic imaging

KW - PET

KW - Radioembolization

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U2 - 10.2214/AJR.06.0707

DO - 10.2214/AJR.06.0707

M3 - Review article

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JO - American Journal of Roentgenology

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