Abstract No. 537 Transarterial yttrium-90 radioembolization treatment of pancreatic cancer patients with liver-dominant metastatic disease

Abstract

The presence of liver metastasis in pancreatic cancer patients portends a very poor prognosis; the reported median overall survival (OS) is 2.8 months without treatment1 and 5.7 months with systemic therapy.2 The purpose of this study is to evaluate the safety and efficacy of transarterial hepatic radioembolization in pancreatic cancer patients with liver-dominant metastatic disease. From April 2010 to September 2017, 26 patients (10 male, 14 female, average age of 65.5, range: 44 – 83) with metastatic pancreatic adenocarcinoma to the liver were treated with yttrium-90 (Y90) glass microsphere radioembolization. 19 had extrahepatic disease at the time of radioembolization. Prior to radioembolization 8 patients had a pancreatectomy. All patients received systemic chemotherapy prior to Y90 embolization and 19 received systemic therapy after embolization. 2 patients had other liver-directed therapy prior to embolization and none had liver-directed therapy after. Retrospective review of medical records and imaging studies was performed to evaluate toxicities, treatment response, and overall survival. The median follow-up period from Y90 embolization was 13 months (range, 1 - 85 months). Median OS from Pancreatic adenocarcinoma diagnosis was 30.7 months (95% CI, 20.3- 41.1 months), from diagnosis of liver metastasis was 21.8 months (95% CI, 17.2 - 26.3 months), and from radioembolization treatment was 7.0 months (95% CI, 2.0 - 12.0 months). After treatment, 21 patients reported grade 1 and 2 clinical toxicities, and 24 patients had grade 1 and 2 biochemical toxicities. 7 patients experienced grade 3 toxicities, with 4 patients having grade 3 clinical toxicities and 6 patients having grade 3 biochemical toxicities. Imaging at 3 months after treatment demonstrates partial response in 1 patient, stable disease in 9 patients, and progression of disease in 12 patients by RECIST criteria. 4 patients had no follow-up imaging. Radioembolization is safe and led to promising overall survival in pancreatic cancer patients with liver-dominant metastatic disease.