Abstract
Simple SummarySarcomas of the liver are a rare and aggressive group of malignancies for which surgery is the preferred treatment modality even though most patients are not surgical candidates and receive chemotherapy with poor outcomes. In these cases, trans-arterial liver-directed therapies are emerging as a new treatment option. Among these, radioembolization is a promising but understudied treatment option. In radioembolization, microbeads conjugated to a radioactive drug are injected into the blood vessels, nourishing the cancers and leading to cell death and tumor shrinkage. In this study, we retrospectively analyzed 35 patients with liver sarcomas receiving radioembolization at our institution. We found that those with disease control in the liver 6 months after the procedure had longer overall survival as well as patients with a liver progression-free interval post-procedure equal to or greater than 9 months. Patients with good performance status and normal liver function at baseline also had longer survival. The most common adverse reactions were nausea, fatigue, abdominal pain, and mild reversible abnormalities in liver function tests. Overall, our results suggest that radioembolization might be a safe and effective treatment option for patients with unresectable liver sarcomas.Patients with liver-dominant metastatic or primary hepatic soft tissue sarcomas (STS) have poor prognosis. Surgery can prolong survival, but most patients are not surgical candidates, and treatment response is limited with systemic chemotherapy. Liver-directed therapies have been increasingly employed in this setting, and Yttrium-90 trans-arterial radioembolization (TARE) is an understudied yet promising treatment option. This is a retrospective analysis of 35 patients with metastatic or primary hepatic STS who underwent TARE at a single institution between 2006 and 2020. The primary outcomes that were measured were overall survival (OS), liver progression-free survival (LPFS), and radiologic tumor response. Clinical and biochemical toxicities were assessed 3 months after the procedure. Median OS was 20 months (95% CI: 13.9–26.1 months), while median LPFS was 9 months (95% CI: 6.2–11.8 months). The objective response rate was 56.7%, and the disease control rate was 80.0% by mRECIST at 3 months. The following correlated with better OS post-TARE: liver disease control (DC) at 6 months (median OS: 40 vs. 17 months, p = 0.007); LPFS ≥ 9 months (median OS: 50 vs. 8 months, p < 0.0001); ECOG status 0–1 vs. 2 (median OS: 22 vs. 6 months, p = 0.042); CTP class A vs. B (median OS: 22 vs. 6 months, p = 0.018); and TACE post-progression (median OS: 99 vs. 16 months, p = 0.003). The absence of metastases at diagnosis was correlated with higher median LPFS (7 vs. 1 months, p = 0.036). Two grade 4 (5.7%) and ten grade 3 (28.6%) laboratory toxicities were identified at 3 months. There was one case of radioembolization-induced liver disease and two cases of radiation-induced peptic ulcer disease. We concluded that TARE could be an effective and safe treatment option for patients with metastatic or primary hepatic STS with good tumor response rates, low incidence of severe toxicity, and longer survival in patients with liver disease control post-TARE.
Highlights
Soft tissue sarcomas (STS) represent an uncommon and heterogenous group of malignancies of mesenchymal origin [1,2]
Most patients had tumors involving both lobes of the liver at the time of trans-arterial radioembolization (TARE) (n = 29, 82.9%) with large hepatic tumor burden and conglomerated masses or infiltrative disease that precluded the accurate measurement of the tumor volumes
We found that patients with disease control (DC) at 6 months, either by the RECIST or modified RECIST (mRECIST) criteria, had longer survival compared to patients with PD, similar to prior retrospective studies where a favorable radiologic response to liver-directed therapies (LDTs) in patients with liver-dominant metastatic soft tissue sarcomas (STS) and HCC was associated with better survival [19,39,40]
Summary
Soft tissue sarcomas (STS) represent an uncommon and heterogenous group of malignancies of mesenchymal origin [1,2]. STS most commonly spreads to the lungs (80%), with the rate of spread to the liver varying by the site of the primary tumor and approaching up to 60% in patients with visceral sarcomas [4,5,6,7]. Patients with primary and metastatic hepatic STS have a poor prognosis, with a 2-year overall survival (OS) rate of 22% for the former and 21.7% for the latter [8,9,10]. Many patients have unresectable disease or are not surgical candidates due to poor performance status or comorbidities. For these patients, systemic chemotherapy is employed treatment response rates are low [15,16,17]. Compared to other LDTs, TARE is associated with a lower incidence of side effects, lower rates of hospitalization, and the opportunity to treat patients with extensive liver tumor burden in fewer treatment sessions [18]
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