Unresectable chemorefractory liver metastases: Radioembolization with 90Y microspheres - Safety, efficacy, and survival

Kent T Sato, Robert J Lewandowski, Mary Frances Mulcahy, Bassel Atassi, Robert K. Ryu, Vanessa L. Gates, Albert A Nemcek Jr, Omar Barakat, Al B Benson III, Robert Mandal, Mark Talamonti, Ching Yee O. Wong, Frank H Miller, Steven B. Newman, John M. Shaw, Kenneth G. Thurston, Reed A. Omary, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

170 Citations (Scopus)

Abstract

Purpose: To prospectively evaluate the safety, efficacy, and survival of patients with chemorefractory liver metastases who have been treated with yttrium 90 (90Y) glass microspheres. Materials and Methods: Institutional review boards from two institutions approved the HIPAA-compliant study; all patients provided informed consent. One hundred thirty-seven patients underwent 225 administrations of 90Y microspheres by using intraarterial infusion. Primary sites (origins) included colon, breast, neuroendocrine, pancreas, lung, cholangiocarcinoma, melanoma, renal, esophageal, ovary, adenocarcinoma of unknown primary, lymphoma, gastric, duodenal, bladder, angiosarcoma, squamous cell carcinoma, thyroid, adrenal, and parotid. Patients underwent evaluation of baseline and follow-up liver function and tumor markers and computed tomographic or magnetic resonance imaging. Patients were observed for survival from first treatment. Median survival (in days) and corresponding 95% confidence intervals were computed by using the Kaplan-Meier method. The log-rank statistic was used for statistical significance testing of survival distributions between various subgroups of patients. Results: There were 66 men and 71 women. All patients were treated on an outpatient basis. Median age was 61 years. The mean number of treatments was 1.6. The median activity and dose infused were 1.83 GBq and 112.8 Gy, respectively. Clinical toxicities included fatigue (56%), vague abdominal pain (26%), and nausea (23%). At follow-up imaging, according to World Health Organization criteria, there was a 42.8% response rate (2.1% complete response, 40.7% partial response). There was a biologic tumor response (any decrease in tumor size) of 87%. Overall median survival was 300 days. One-year survival was 47.8%, and 2-year survival was 30.9%. Median survival was 457 days for patients with colorectal tumors, 776 days for those with neuroendocrine tumors, and 207 days for those with noncolorectal, nonneuroendocrine tumors. Conclusion: 90Y hepatic treatments are well tolerated with acceptable toxicities; tumor response and median survival are promising.

Original languageEnglish (US)
Pages (from-to)507-515
Number of pages9
JournalRadiology
Volume247
Issue number2
DOIs
StatePublished - May 1 2008

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Microspheres
Neoplasm Metastasis
Safety
Survival
Liver
Neoplasms
Health Insurance Portability and Accountability Act
Yttrium
Intra Arterial Infusions
Hemangiosarcoma
Neuroendocrine Tumors
Cholangiocarcinoma
Research Ethics Committees
Tumor Biomarkers
Informed Consent
Nausea
Abdominal Pain
Fatigue
Glass
Pancreas

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Sato, Kent T ; Lewandowski, Robert J ; Mulcahy, Mary Frances ; Atassi, Bassel ; Ryu, Robert K. ; Gates, Vanessa L. ; Nemcek Jr, Albert A ; Barakat, Omar ; Benson III, Al B ; Mandal, Robert ; Talamonti, Mark ; Wong, Ching Yee O. ; Miller, Frank H ; Newman, Steven B. ; Shaw, John M. ; Thurston, Kenneth G. ; Omary, Reed A. ; Salem, Riad. / Unresectable chemorefractory liver metastases : Radioembolization with 90Y microspheres - Safety, efficacy, and survival. In: Radiology. 2008 ; Vol. 247, No. 2. pp. 507-515.
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title = "Unresectable chemorefractory liver metastases: Radioembolization with 90Y microspheres - Safety, efficacy, and survival",
abstract = "Purpose: To prospectively evaluate the safety, efficacy, and survival of patients with chemorefractory liver metastases who have been treated with yttrium 90 (90Y) glass microspheres. Materials and Methods: Institutional review boards from two institutions approved the HIPAA-compliant study; all patients provided informed consent. One hundred thirty-seven patients underwent 225 administrations of 90Y microspheres by using intraarterial infusion. Primary sites (origins) included colon, breast, neuroendocrine, pancreas, lung, cholangiocarcinoma, melanoma, renal, esophageal, ovary, adenocarcinoma of unknown primary, lymphoma, gastric, duodenal, bladder, angiosarcoma, squamous cell carcinoma, thyroid, adrenal, and parotid. Patients underwent evaluation of baseline and follow-up liver function and tumor markers and computed tomographic or magnetic resonance imaging. Patients were observed for survival from first treatment. Median survival (in days) and corresponding 95{\%} confidence intervals were computed by using the Kaplan-Meier method. The log-rank statistic was used for statistical significance testing of survival distributions between various subgroups of patients. Results: There were 66 men and 71 women. All patients were treated on an outpatient basis. Median age was 61 years. The mean number of treatments was 1.6. The median activity and dose infused were 1.83 GBq and 112.8 Gy, respectively. Clinical toxicities included fatigue (56{\%}), vague abdominal pain (26{\%}), and nausea (23{\%}). At follow-up imaging, according to World Health Organization criteria, there was a 42.8{\%} response rate (2.1{\%} complete response, 40.7{\%} partial response). There was a biologic tumor response (any decrease in tumor size) of 87{\%}. Overall median survival was 300 days. One-year survival was 47.8{\%}, and 2-year survival was 30.9{\%}. Median survival was 457 days for patients with colorectal tumors, 776 days for those with neuroendocrine tumors, and 207 days for those with noncolorectal, nonneuroendocrine tumors. Conclusion: 90Y hepatic treatments are well tolerated with acceptable toxicities; tumor response and median survival are promising.",
author = "Sato, {Kent T} and Lewandowski, {Robert J} and Mulcahy, {Mary Frances} and Bassel Atassi and Ryu, {Robert K.} and Gates, {Vanessa L.} and {Nemcek Jr}, {Albert A} and Omar Barakat and {Benson III}, {Al B} and Robert Mandal and Mark Talamonti and Wong, {Ching Yee O.} and Miller, {Frank H} and Newman, {Steven B.} and Shaw, {John M.} and Thurston, {Kenneth G.} and Omary, {Reed A.} and Riad Salem",
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Unresectable chemorefractory liver metastases : Radioembolization with 90Y microspheres - Safety, efficacy, and survival. / Sato, Kent T; Lewandowski, Robert J; Mulcahy, Mary Frances; Atassi, Bassel; Ryu, Robert K.; Gates, Vanessa L.; Nemcek Jr, Albert A; Barakat, Omar; Benson III, Al B; Mandal, Robert; Talamonti, Mark; Wong, Ching Yee O.; Miller, Frank H; Newman, Steven B.; Shaw, John M.; Thurston, Kenneth G.; Omary, Reed A.; Salem, Riad.

In: Radiology, Vol. 247, No. 2, 01.05.2008, p. 507-515.

Research output: Contribution to journalArticle

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T1 - Unresectable chemorefractory liver metastases

T2 - Radioembolization with 90Y microspheres - Safety, efficacy, and survival

AU - Sato, Kent T

AU - Lewandowski, Robert J

AU - Mulcahy, Mary Frances

AU - Atassi, Bassel

AU - Ryu, Robert K.

AU - Gates, Vanessa L.

AU - Nemcek Jr, Albert A

AU - Barakat, Omar

AU - Benson III, Al B

AU - Mandal, Robert

AU - Talamonti, Mark

AU - Wong, Ching Yee O.

AU - Miller, Frank H

AU - Newman, Steven B.

AU - Shaw, John M.

AU - Thurston, Kenneth G.

AU - Omary, Reed A.

AU - Salem, Riad

PY - 2008/5/1

Y1 - 2008/5/1

N2 - Purpose: To prospectively evaluate the safety, efficacy, and survival of patients with chemorefractory liver metastases who have been treated with yttrium 90 (90Y) glass microspheres. Materials and Methods: Institutional review boards from two institutions approved the HIPAA-compliant study; all patients provided informed consent. One hundred thirty-seven patients underwent 225 administrations of 90Y microspheres by using intraarterial infusion. Primary sites (origins) included colon, breast, neuroendocrine, pancreas, lung, cholangiocarcinoma, melanoma, renal, esophageal, ovary, adenocarcinoma of unknown primary, lymphoma, gastric, duodenal, bladder, angiosarcoma, squamous cell carcinoma, thyroid, adrenal, and parotid. Patients underwent evaluation of baseline and follow-up liver function and tumor markers and computed tomographic or magnetic resonance imaging. Patients were observed for survival from first treatment. Median survival (in days) and corresponding 95% confidence intervals were computed by using the Kaplan-Meier method. The log-rank statistic was used for statistical significance testing of survival distributions between various subgroups of patients. Results: There were 66 men and 71 women. All patients were treated on an outpatient basis. Median age was 61 years. The mean number of treatments was 1.6. The median activity and dose infused were 1.83 GBq and 112.8 Gy, respectively. Clinical toxicities included fatigue (56%), vague abdominal pain (26%), and nausea (23%). At follow-up imaging, according to World Health Organization criteria, there was a 42.8% response rate (2.1% complete response, 40.7% partial response). There was a biologic tumor response (any decrease in tumor size) of 87%. Overall median survival was 300 days. One-year survival was 47.8%, and 2-year survival was 30.9%. Median survival was 457 days for patients with colorectal tumors, 776 days for those with neuroendocrine tumors, and 207 days for those with noncolorectal, nonneuroendocrine tumors. Conclusion: 90Y hepatic treatments are well tolerated with acceptable toxicities; tumor response and median survival are promising.

AB - Purpose: To prospectively evaluate the safety, efficacy, and survival of patients with chemorefractory liver metastases who have been treated with yttrium 90 (90Y) glass microspheres. Materials and Methods: Institutional review boards from two institutions approved the HIPAA-compliant study; all patients provided informed consent. One hundred thirty-seven patients underwent 225 administrations of 90Y microspheres by using intraarterial infusion. Primary sites (origins) included colon, breast, neuroendocrine, pancreas, lung, cholangiocarcinoma, melanoma, renal, esophageal, ovary, adenocarcinoma of unknown primary, lymphoma, gastric, duodenal, bladder, angiosarcoma, squamous cell carcinoma, thyroid, adrenal, and parotid. Patients underwent evaluation of baseline and follow-up liver function and tumor markers and computed tomographic or magnetic resonance imaging. Patients were observed for survival from first treatment. Median survival (in days) and corresponding 95% confidence intervals were computed by using the Kaplan-Meier method. The log-rank statistic was used for statistical significance testing of survival distributions between various subgroups of patients. Results: There were 66 men and 71 women. All patients were treated on an outpatient basis. Median age was 61 years. The mean number of treatments was 1.6. The median activity and dose infused were 1.83 GBq and 112.8 Gy, respectively. Clinical toxicities included fatigue (56%), vague abdominal pain (26%), and nausea (23%). At follow-up imaging, according to World Health Organization criteria, there was a 42.8% response rate (2.1% complete response, 40.7% partial response). There was a biologic tumor response (any decrease in tumor size) of 87%. Overall median survival was 300 days. One-year survival was 47.8%, and 2-year survival was 30.9%. Median survival was 457 days for patients with colorectal tumors, 776 days for those with neuroendocrine tumors, and 207 days for those with noncolorectal, nonneuroendocrine tumors. Conclusion: 90Y hepatic treatments are well tolerated with acceptable toxicities; tumor response and median survival are promising.

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