Radioembolization of unresectable primary and secondary hepatic malignancies using yttrium-90: The University of Texas at Houston experience.

Abstract

311 Background: Few effective treatments exist for unresectable hepatic malignant lesions. The objective of this study was to analyze the patient outcomes and toxicities of yttrium-90 (Y90) radioembolization in patients with unresectable primary and secondary hepatic malignancies. Methods: A retrospective review from 3/03 to11/09 of pts with liver malignancies who received Y-90 (TheraSphere and SIR-Spheres) was conducted. Pretreatment CT scans characterized the liver lesions. Hepatic arterial Tc-99m MAA scans showed % lung shunt and liver flow. Postprocedure toxicities (including pt symptoms, lab values) were recorded. CT/MRI scans at 1-, 3-, and 6-month intervals measured tumor response as per RECIST 1.0. The Kaplan-Meier method was used for survival analyses. Results: 50 pts were initially screened, of which 44 pts received 63 Y90 treatments. Mean age was 62y (24 male, 20 female). Of the 44 pts, 15 had hepatocellular cancer (HCC), 2 had intrahepatic cholangiocarcinoma and 27 had liver metastases (10 colorectal, 8 breast, 4 carcinoid, 1 esophagus, 1 lung, 1 gallbladder, 1 pancreas, 1 gastric). Mean tumor size was 10.6 cm (range 2.2-23.5cm), mean tumor absorbed dose was 30.8 mCi (range 7.1-63.5 mCi). Post-procedure symptoms included fatigue (n=21, 47.7%), abdominal pain (n=35, 79.5%), nausea/vomiting (n=12, 27.2%). At 1 month, 20 pts (45.5%) had SD, 14 (31.8%) had PR, and 10 (22.7%) had PD. At 3 months, 25 patients had SD, 10 had PD and 9 pts were in hospice or were deceased. At 6 months, 11 pts had SD. Per RECIST, PD at 1, 3, 6- months were significant predictors of mortality (OR 25, p<0.0002) as was the preprocedure MELD (OR 1.208, p=0.0160). Caucasian pts had a lower overall mortality (OR 1.238, p=0.0363). Survival analyses will be updated. One pt with HCC was successfully downstaged after Y90 and listed for liver transplant; 26 patients were alive at 6-month follow-up. Conclusions: Y90 radioembolization represents a pragmatic option for hepatic lesions malignancies not amenable to resection. With an acceptable safety profile and the promising response on imaging, Y90 warrants further trials into its ideal use in the therapeutic algorithm for unresectable liver lesions. No significant financial relationships to disclose.