Yttrium-90 radioembolization stops progression of targeted breast cancer liver metastases after failed chemotherapy

Andrew C. Gordon, William J. Gradishar, Virginia G. Kaklamani, Avesh J. Thuluvath, Robert K. Ryu, Kent T. Sato, Vanessa L. Gates, Riad Salem, Robert J. Lewandowski*

*Corresponding author for this work

Research output: Contribution to journalArticle

37 Scopus citations

Abstract

Purpose To determine, in an open-label, retrospective report, the safety and effectiveness of locoregional therapy with yttrium-90 (90Y) radioembolization for patients with progressing breast cancer liver metastases (BCLMs) despite multi-agent chemotherapy.

Materials and Methods Seventy-five patients with progressing BCLMs and stable extrahepatic disease were treated with radioembolization at a single institution. Retrospective review of a prospectively collected database was performed to evaluate clinical and biochemical toxicities, tumor response, overall survival (OS), and time to progression. Radiologic response assessments included Response Evaluation Criteria In Solid Tumors in primary index lesions and metabolic activity on positron emission tomography (PET). Univariate and multivariate analyses were performed.

Results The mortality rate at 30 days was 4% (n = 3). Clinical toxicity and hyperbilirubinemia of grade 3 or worse occurred in 7.6% (n = 5) and 5.9% of patients (n = 4), respectively. Partial response (PR) was seen in 35.3% of patients (n = 24), stable disease (SD) in 63.2% (n = 43), and progressive disease in 1.5% (n = 1). PET imaging was available in 25 patients, and 21 (84%) had a complete response, PR, or SD. The median OS was 6.6 months (95% confidence interval [CI], 5.0-9.2 mo). The hazard ratio (HR) for OS on multivariate analysis was 0.39 (95% CI, 0.23-0.66) for tumor burden less than 25% compared with greater burden. Elevated bilirubin levels were shown to reduce OS. The HR for hepatic progression was 0.22 (95% CI, 0.05-0.98) for solitary versus multifocal disease.

Conclusions Locoregional therapy with 90Y radioembolization is safe and stops or delays the progression of targeted chemorefractory BCLMs. Adverse prognosticators were identified.

Original languageEnglish (US)
Pages (from-to)1523-1532.e2
JournalJournal of Vascular and Interventional Radiology
Volume25
Issue number10
DOIs
StatePublished - Oct 1 2014

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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