Treatment Parameters and Outcome in 680 Treatments of Internal Radiation With Resin 90Y-Microspheres for Unresectable Hepatic Tumors

Andrew S. Kennedy*, Patrick McNeillie, William A. Dezarn, Charles Nutting, Bruno Sangro, Dan Wertman, Michael Garafalo, David Liu, Douglas Coldwell, Michael Savin, Tobias Jakobs, Steven Rose, Richard Warner, Dennis Carter, Stephen Sapareto, Subir Nag, Seza Gulec, Allison Calkins, Vanessa L. Gates, Riad Salem

*Corresponding author for this work

Research output: Contribution to journalArticle

166 Citations (Scopus)

Abstract

Purpose: Radioembolization (RE) using 90Y-microspheres is an effective and safe treatment for patients with unresectable liver malignancies. Radiation-induced liver disease (RILD) is rare after RE; however, greater understanding of radiation-related factors leading to serious liver toxicity is needed. Methods and Materials: Retrospective review of radiation parameters was performed. All data pertaining to demographics, tumor, radiation, and outcomes were analyzed for significance and dependencies to develop a predictive model for RILD. Toxicity was scored using the National Cancer Institute Common Toxicity Criteria Adverse Events Version 3.0 scale. Results: A total of 515 patients (287 men; 228 women) from 14 US and 2 EU centers underwent 680 separate RE treatments with resin 90Y-microspheres in 2003-2006. Multifactorial analyses identified factors related to toxicity, including activity (GBq) Selective Internal Radiation Therapy delivered (p < 0.0001), prescribed (GBq) activity (p < 0.0001), percentage of empiric activity (GBq) delivered (p < 0.0001), number of prior liver treatments (p < 0.0008), and medical center (p < 0.0001). The RILD was diagnosed in 28 of 680 treatments (4%), with 21 of 28 cases (75%) from one center, which used the empiric method. Conclusions: There was an association between the empiric method, percentage of calculated activity delivered to the patient, and the most severe toxicity, RILD. A predictive model for RILD is not yet possible given the large variance in these data.

Original languageEnglish (US)
Pages (from-to)1494-1500
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume74
Issue number5
DOIs
StatePublished - Aug 1 2009

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Microspheres
liver
resins
tumors
Radiation
toxicity
Liver
Liver Diseases
radiation
Neoplasms
Therapeutics
National Cancer Institute (U.S.)
Statistical Factor Analysis
radiation therapy
Radiotherapy
cancer
Demography

Keywords

  • Dosimetry
  • Liver
  • Microsphere
  • Radioembolization
  • Selective Internal Radiation Therapy
  • Y

ASJC Scopus subject areas

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

Cite this

Kennedy, Andrew S. ; McNeillie, Patrick ; Dezarn, William A. ; Nutting, Charles ; Sangro, Bruno ; Wertman, Dan ; Garafalo, Michael ; Liu, David ; Coldwell, Douglas ; Savin, Michael ; Jakobs, Tobias ; Rose, Steven ; Warner, Richard ; Carter, Dennis ; Sapareto, Stephen ; Nag, Subir ; Gulec, Seza ; Calkins, Allison ; Gates, Vanessa L. ; Salem, Riad. / Treatment Parameters and Outcome in 680 Treatments of Internal Radiation With Resin 90Y-Microspheres for Unresectable Hepatic Tumors. In: International Journal of Radiation Oncology Biology Physics. 2009 ; Vol. 74, No. 5. pp. 1494-1500.
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title = "Treatment Parameters and Outcome in 680 Treatments of Internal Radiation With Resin 90Y-Microspheres for Unresectable Hepatic Tumors",
abstract = "Purpose: Radioembolization (RE) using 90Y-microspheres is an effective and safe treatment for patients with unresectable liver malignancies. Radiation-induced liver disease (RILD) is rare after RE; however, greater understanding of radiation-related factors leading to serious liver toxicity is needed. Methods and Materials: Retrospective review of radiation parameters was performed. All data pertaining to demographics, tumor, radiation, and outcomes were analyzed for significance and dependencies to develop a predictive model for RILD. Toxicity was scored using the National Cancer Institute Common Toxicity Criteria Adverse Events Version 3.0 scale. Results: A total of 515 patients (287 men; 228 women) from 14 US and 2 EU centers underwent 680 separate RE treatments with resin 90Y-microspheres in 2003-2006. Multifactorial analyses identified factors related to toxicity, including activity (GBq) Selective Internal Radiation Therapy delivered (p < 0.0001), prescribed (GBq) activity (p < 0.0001), percentage of empiric activity (GBq) delivered (p < 0.0001), number of prior liver treatments (p < 0.0008), and medical center (p < 0.0001). The RILD was diagnosed in 28 of 680 treatments (4{\%}), with 21 of 28 cases (75{\%}) from one center, which used the empiric method. Conclusions: There was an association between the empiric method, percentage of calculated activity delivered to the patient, and the most severe toxicity, RILD. A predictive model for RILD is not yet possible given the large variance in these data.",
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author = "Kennedy, {Andrew S.} and Patrick McNeillie and Dezarn, {William A.} and Charles Nutting and Bruno Sangro and Dan Wertman and Michael Garafalo and David Liu and Douglas Coldwell and Michael Savin and Tobias Jakobs and Steven Rose and Richard Warner and Dennis Carter and Stephen Sapareto and Subir Nag and Seza Gulec and Allison Calkins and Gates, {Vanessa L.} and Riad Salem",
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Kennedy, AS, McNeillie, P, Dezarn, WA, Nutting, C, Sangro, B, Wertman, D, Garafalo, M, Liu, D, Coldwell, D, Savin, M, Jakobs, T, Rose, S, Warner, R, Carter, D, Sapareto, S, Nag, S, Gulec, S, Calkins, A, Gates, VL & Salem, R 2009, 'Treatment Parameters and Outcome in 680 Treatments of Internal Radiation With Resin 90Y-Microspheres for Unresectable Hepatic Tumors', International Journal of Radiation Oncology Biology Physics, vol. 74, no. 5, pp. 1494-1500. https://doi.org/10.1016/j.ijrobp.2008.10.005

Treatment Parameters and Outcome in 680 Treatments of Internal Radiation With Resin 90Y-Microspheres for Unresectable Hepatic Tumors. / Kennedy, Andrew S.; McNeillie, Patrick; Dezarn, William A.; Nutting, Charles; Sangro, Bruno; Wertman, Dan; Garafalo, Michael; Liu, David; Coldwell, Douglas; Savin, Michael; Jakobs, Tobias; Rose, Steven; Warner, Richard; Carter, Dennis; Sapareto, Stephen; Nag, Subir; Gulec, Seza; Calkins, Allison; Gates, Vanessa L.; Salem, Riad.

In: International Journal of Radiation Oncology Biology Physics, Vol. 74, No. 5, 01.08.2009, p. 1494-1500.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Treatment Parameters and Outcome in 680 Treatments of Internal Radiation With Resin 90Y-Microspheres for Unresectable Hepatic Tumors

AU - Kennedy, Andrew S.

AU - McNeillie, Patrick

AU - Dezarn, William A.

AU - Nutting, Charles

AU - Sangro, Bruno

AU - Wertman, Dan

AU - Garafalo, Michael

AU - Liu, David

AU - Coldwell, Douglas

AU - Savin, Michael

AU - Jakobs, Tobias

AU - Rose, Steven

AU - Warner, Richard

AU - Carter, Dennis

AU - Sapareto, Stephen

AU - Nag, Subir

AU - Gulec, Seza

AU - Calkins, Allison

AU - Gates, Vanessa L.

AU - Salem, Riad

PY - 2009/8/1

Y1 - 2009/8/1

N2 - Purpose: Radioembolization (RE) using 90Y-microspheres is an effective and safe treatment for patients with unresectable liver malignancies. Radiation-induced liver disease (RILD) is rare after RE; however, greater understanding of radiation-related factors leading to serious liver toxicity is needed. Methods and Materials: Retrospective review of radiation parameters was performed. All data pertaining to demographics, tumor, radiation, and outcomes were analyzed for significance and dependencies to develop a predictive model for RILD. Toxicity was scored using the National Cancer Institute Common Toxicity Criteria Adverse Events Version 3.0 scale. Results: A total of 515 patients (287 men; 228 women) from 14 US and 2 EU centers underwent 680 separate RE treatments with resin 90Y-microspheres in 2003-2006. Multifactorial analyses identified factors related to toxicity, including activity (GBq) Selective Internal Radiation Therapy delivered (p < 0.0001), prescribed (GBq) activity (p < 0.0001), percentage of empiric activity (GBq) delivered (p < 0.0001), number of prior liver treatments (p < 0.0008), and medical center (p < 0.0001). The RILD was diagnosed in 28 of 680 treatments (4%), with 21 of 28 cases (75%) from one center, which used the empiric method. Conclusions: There was an association between the empiric method, percentage of calculated activity delivered to the patient, and the most severe toxicity, RILD. A predictive model for RILD is not yet possible given the large variance in these data.

AB - Purpose: Radioembolization (RE) using 90Y-microspheres is an effective and safe treatment for patients with unresectable liver malignancies. Radiation-induced liver disease (RILD) is rare after RE; however, greater understanding of radiation-related factors leading to serious liver toxicity is needed. Methods and Materials: Retrospective review of radiation parameters was performed. All data pertaining to demographics, tumor, radiation, and outcomes were analyzed for significance and dependencies to develop a predictive model for RILD. Toxicity was scored using the National Cancer Institute Common Toxicity Criteria Adverse Events Version 3.0 scale. Results: A total of 515 patients (287 men; 228 women) from 14 US and 2 EU centers underwent 680 separate RE treatments with resin 90Y-microspheres in 2003-2006. Multifactorial analyses identified factors related to toxicity, including activity (GBq) Selective Internal Radiation Therapy delivered (p < 0.0001), prescribed (GBq) activity (p < 0.0001), percentage of empiric activity (GBq) delivered (p < 0.0001), number of prior liver treatments (p < 0.0008), and medical center (p < 0.0001). The RILD was diagnosed in 28 of 680 treatments (4%), with 21 of 28 cases (75%) from one center, which used the empiric method. Conclusions: There was an association between the empiric method, percentage of calculated activity delivered to the patient, and the most severe toxicity, RILD. A predictive model for RILD is not yet possible given the large variance in these data.

KW - Dosimetry

KW - Liver

KW - Microsphere

KW - Radioembolization

KW - Selective Internal Radiation Therapy

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