Yttrium-90 Radioembolization for Liver Malignancies: Prognostic Factors Associated with Survival

Brian L. Dunfee, Ahsun Riaz, Robert J Lewandowski, Saad Ibrahim, Mary Frances Mulcahy, Robert K. Ryu, Bassel Atassi, Kent T Sato, Steven Newman, Reed A. Omary, Al B Benson III, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Purpose: To identify key prognostic clinical and imaging variables in patients undergoing yttrium-90 radioembolization (90Y) for liver malignancies. Materials and Methods: Patients with liver malignancies that progressed despite standard-of-care therapy were treated with 90Y from 2002 to 2006. Baseline functional status, laboratory values, and diagnostic imaging were assessed before therapy. Imaging follow-up was performed 1 month after treatment and subsequently at 3-month intervals. Patients were followed for survival from the time of their first 90Y treatment. Results: Patients with follow-up imaging after radioembolization (N = 130) were included in this analysis. Primary malignancies included colon, neuroendocrine, and others. The following clinical variables had a significant effect on survival on multivariate analysis: Eastern Cooperative Oncology Group (ECOG) performance status (PS) greater than 0 (hazard ratio [HR], 7.98; 95% CI, 3.98-16), hepatic tumor burden of 51%-75% (HR, 2.46; 95% CI, 1.01-6.02), bilirubin level greater than 1.3 mg/dL (HR, 2.60; 95% CI, 1.27-5.34), hepatic metastases from breast cancer (HR, 2.51; 95% CI, 1.13-5.61), response on imaging based on World Health Organization (WHO) criteria (HR, 0.48; 95% CI, 0.24-0.94), and lymphocyte depression (HR, 0.56; 95% CI, 0.31-0.96). Among patients with colorectal cancer metastases to the liver, the HR for survival on univariate analysis for responders compared with nonresponders (per WHO criteria) was 0.26 (95% CI, 0.10-0.69). Conclusions: Cancer-related symptoms (ie, ECOG PS > 0), hepatic tumor burden greater than 50%, increased bilirubin levels, and hepatic metastases from breast cancer were found to be negative prognostic factors. Tumor response to therapy and lymphocyte depression were associated with favorable prognosis. Additionally, WHO response was identified to be a favorable prognostic factor in patients with colorectal cancer metastases. These findings may be useful when counseling patients regarding prognosis of their hepatic disease.

Original languageEnglish (US)
Pages (from-to)90-95
Number of pages6
JournalJournal of Vascular and Interventional Radiology
Volume21
Issue number1
DOIs
StatePublished - Jan 1 2010

Fingerprint

Yttrium
Survival
Liver
Neoplasms
Neoplasm Metastasis
Tumor Burden
Bilirubin
Colorectal Neoplasms
Lymphocytes
Depression
Breast Neoplasms
Therapeutics
Diagnostic Imaging
Standard of Care
Counseling
Colon
Multivariate Analysis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{6ff2ddc958cf472e9f4f53a7739e761d,
title = "Yttrium-90 Radioembolization for Liver Malignancies: Prognostic Factors Associated with Survival",
abstract = "Purpose: To identify key prognostic clinical and imaging variables in patients undergoing yttrium-90 radioembolization (90Y) for liver malignancies. Materials and Methods: Patients with liver malignancies that progressed despite standard-of-care therapy were treated with 90Y from 2002 to 2006. Baseline functional status, laboratory values, and diagnostic imaging were assessed before therapy. Imaging follow-up was performed 1 month after treatment and subsequently at 3-month intervals. Patients were followed for survival from the time of their first 90Y treatment. Results: Patients with follow-up imaging after radioembolization (N = 130) were included in this analysis. Primary malignancies included colon, neuroendocrine, and others. The following clinical variables had a significant effect on survival on multivariate analysis: Eastern Cooperative Oncology Group (ECOG) performance status (PS) greater than 0 (hazard ratio [HR], 7.98; 95{\%} CI, 3.98-16), hepatic tumor burden of 51{\%}-75{\%} (HR, 2.46; 95{\%} CI, 1.01-6.02), bilirubin level greater than 1.3 mg/dL (HR, 2.60; 95{\%} CI, 1.27-5.34), hepatic metastases from breast cancer (HR, 2.51; 95{\%} CI, 1.13-5.61), response on imaging based on World Health Organization (WHO) criteria (HR, 0.48; 95{\%} CI, 0.24-0.94), and lymphocyte depression (HR, 0.56; 95{\%} CI, 0.31-0.96). Among patients with colorectal cancer metastases to the liver, the HR for survival on univariate analysis for responders compared with nonresponders (per WHO criteria) was 0.26 (95{\%} CI, 0.10-0.69). Conclusions: Cancer-related symptoms (ie, ECOG PS > 0), hepatic tumor burden greater than 50{\%}, increased bilirubin levels, and hepatic metastases from breast cancer were found to be negative prognostic factors. Tumor response to therapy and lymphocyte depression were associated with favorable prognosis. Additionally, WHO response was identified to be a favorable prognostic factor in patients with colorectal cancer metastases. These findings may be useful when counseling patients regarding prognosis of their hepatic disease.",
author = "Dunfee, {Brian L.} and Ahsun Riaz and Lewandowski, {Robert J} and Saad Ibrahim and Mulcahy, {Mary Frances} and Ryu, {Robert K.} and Bassel Atassi and Sato, {Kent T} and Steven Newman and Omary, {Reed A.} and {Benson III}, {Al B} and Riad Salem",
year = "2010",
month = "1",
day = "1",
doi = "10.1016/j.jvir.2009.09.011",
language = "English (US)",
volume = "21",
pages = "90--95",
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issn = "1051-0443",
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}

Yttrium-90 Radioembolization for Liver Malignancies : Prognostic Factors Associated with Survival. / Dunfee, Brian L.; Riaz, Ahsun; Lewandowski, Robert J; Ibrahim, Saad; Mulcahy, Mary Frances; Ryu, Robert K.; Atassi, Bassel; Sato, Kent T; Newman, Steven; Omary, Reed A.; Benson III, Al B; Salem, Riad.

In: Journal of Vascular and Interventional Radiology, Vol. 21, No. 1, 01.01.2010, p. 90-95.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Yttrium-90 Radioembolization for Liver Malignancies

T2 - Prognostic Factors Associated with Survival

AU - Dunfee, Brian L.

AU - Riaz, Ahsun

AU - Lewandowski, Robert J

AU - Ibrahim, Saad

AU - Mulcahy, Mary Frances

AU - Ryu, Robert K.

AU - Atassi, Bassel

AU - Sato, Kent T

AU - Newman, Steven

AU - Omary, Reed A.

AU - Benson III, Al B

AU - Salem, Riad

PY - 2010/1/1

Y1 - 2010/1/1

N2 - Purpose: To identify key prognostic clinical and imaging variables in patients undergoing yttrium-90 radioembolization (90Y) for liver malignancies. Materials and Methods: Patients with liver malignancies that progressed despite standard-of-care therapy were treated with 90Y from 2002 to 2006. Baseline functional status, laboratory values, and diagnostic imaging were assessed before therapy. Imaging follow-up was performed 1 month after treatment and subsequently at 3-month intervals. Patients were followed for survival from the time of their first 90Y treatment. Results: Patients with follow-up imaging after radioembolization (N = 130) were included in this analysis. Primary malignancies included colon, neuroendocrine, and others. The following clinical variables had a significant effect on survival on multivariate analysis: Eastern Cooperative Oncology Group (ECOG) performance status (PS) greater than 0 (hazard ratio [HR], 7.98; 95% CI, 3.98-16), hepatic tumor burden of 51%-75% (HR, 2.46; 95% CI, 1.01-6.02), bilirubin level greater than 1.3 mg/dL (HR, 2.60; 95% CI, 1.27-5.34), hepatic metastases from breast cancer (HR, 2.51; 95% CI, 1.13-5.61), response on imaging based on World Health Organization (WHO) criteria (HR, 0.48; 95% CI, 0.24-0.94), and lymphocyte depression (HR, 0.56; 95% CI, 0.31-0.96). Among patients with colorectal cancer metastases to the liver, the HR for survival on univariate analysis for responders compared with nonresponders (per WHO criteria) was 0.26 (95% CI, 0.10-0.69). Conclusions: Cancer-related symptoms (ie, ECOG PS > 0), hepatic tumor burden greater than 50%, increased bilirubin levels, and hepatic metastases from breast cancer were found to be negative prognostic factors. Tumor response to therapy and lymphocyte depression were associated with favorable prognosis. Additionally, WHO response was identified to be a favorable prognostic factor in patients with colorectal cancer metastases. These findings may be useful when counseling patients regarding prognosis of their hepatic disease.

AB - Purpose: To identify key prognostic clinical and imaging variables in patients undergoing yttrium-90 radioembolization (90Y) for liver malignancies. Materials and Methods: Patients with liver malignancies that progressed despite standard-of-care therapy were treated with 90Y from 2002 to 2006. Baseline functional status, laboratory values, and diagnostic imaging were assessed before therapy. Imaging follow-up was performed 1 month after treatment and subsequently at 3-month intervals. Patients were followed for survival from the time of their first 90Y treatment. Results: Patients with follow-up imaging after radioembolization (N = 130) were included in this analysis. Primary malignancies included colon, neuroendocrine, and others. The following clinical variables had a significant effect on survival on multivariate analysis: Eastern Cooperative Oncology Group (ECOG) performance status (PS) greater than 0 (hazard ratio [HR], 7.98; 95% CI, 3.98-16), hepatic tumor burden of 51%-75% (HR, 2.46; 95% CI, 1.01-6.02), bilirubin level greater than 1.3 mg/dL (HR, 2.60; 95% CI, 1.27-5.34), hepatic metastases from breast cancer (HR, 2.51; 95% CI, 1.13-5.61), response on imaging based on World Health Organization (WHO) criteria (HR, 0.48; 95% CI, 0.24-0.94), and lymphocyte depression (HR, 0.56; 95% CI, 0.31-0.96). Among patients with colorectal cancer metastases to the liver, the HR for survival on univariate analysis for responders compared with nonresponders (per WHO criteria) was 0.26 (95% CI, 0.10-0.69). Conclusions: Cancer-related symptoms (ie, ECOG PS > 0), hepatic tumor burden greater than 50%, increased bilirubin levels, and hepatic metastases from breast cancer were found to be negative prognostic factors. Tumor response to therapy and lymphocyte depression were associated with favorable prognosis. Additionally, WHO response was identified to be a favorable prognostic factor in patients with colorectal cancer metastases. These findings may be useful when counseling patients regarding prognosis of their hepatic disease.

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