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Published online before print March 18, 2008, 10.1148/radiol.2472062029

(Radiology 2008;247:507.)

A more recent version of this article appeared on May 1, 2008
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© RSNA, 2008

Nuclear Medicine

Unresectable Chemorefractory Liver Metastases: Radioembolization with 90Y Microspheres—Safety, Efficacy, and Survival1

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

1 From the Department of Radiology, Section of Interventional Radiology (K.T.S., R.J.L., M.F.M., B.A., R.K.R., V.L.G., A.A.N., O.B., F.H.M., R.A.O., R.S.), Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center (M.F.M., A.B., S.B.N., J.M.S., R.S.), Department of Nuclear Medicine (V.L.G.), and Department of Surgery, Robert H. Lurie Comprehensive Cancer Center (M.T.), Northwestern University, 676 N Saint Clair St, Suite 800, Chicago, IL 60611; North Shore Oncology and Hematology Associates, Libertyville, Ill (R.M.); Department of Nuclear Medicine, Beaumont Hospital, Royal Oak, Mich (C.Y.O.W.); and West Grove, Pa (K.G.T.). Received November 28, 2006; revision requested January 24, 2007; revision received June 27; accepted August 1; final version accepted October 15. Address correspondence to R.S. (e-mail: r-salem{at}northwestern.edu)

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.

Clinical trial registration no. NCT00532740 [ClinicalTrials.gov] .

© RSNA, 2008






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