Hepatic Artery Radioembolization Research Articles

A Recanalized Umbilical Vein Hypermetabolic Thrombosis Mimicked an Hepatocellular Carcinoma Recurrence: A New Pitfall?

A transarterial left hepatic artery radioembolization involving 90Y microspheres was performed on a cirrhotic man with hypermetabolic 18F-FDG segment III hepatocellular carcinoma. During the 18F-FDG PET/CT follow-up, the disappearance of the hypermetabolic lesion was initially observed. Then, a focal segment III hypermetabolism reappeared mimicking a recurrence before disappearing without any treatment. Finally, the hepatic MRI demonstrated that the transitory segment III hypermetabolism matched a thrombus of the dilated recanalized umbilical vein.

A phase II trial of y-90 radioembolization in patients with progressive hepatic metastases from neuroendocrine carcinoma at an NCI-designated comprehensive cancer center.

312 Background: Patients with neuroendocrine carcinoma mostly present with symptomatic metastatic disease due to mass effect or release of biologically active polypeptides or amines and have a 5-year survival rate of 22%. The objective of this study was to assess the efficacy of hepatic artery radioembolization with Yttrium (Y)-90 microspheres in patients with unresectable progressive hepatic metastasis from neuroendocrine tumors. Methods: We conducted a prospective, single institutional, one-arm phase II study at an NCI-designated comprehensive cancer center. The primary endpoint was 6-month progression-free survival (PFS). Secondary endpoints included objective overall response rate (ORR), 1-year overall survival (OS) rate and safety and toxicity profile. Results: A total of 22 patients were enrolled between July 2007 and September 2009 with ECOG performance status 0-1, 45% males and median age of 62.5 (28-88) years. Histology included small bowel carcinoid (n=12), pancreatic neuroendocrine (n=7) and neuroendocrine tumors of unknown primary (n=3). Patients received a median of 2 (1-2) treatments with lobar approach in 95% and segmental approach in 5%. The primary endpoint of 6-month PFS rate in patients with one, two or three hepatic lesions was 82%, 82% and 72% respectively. ORR (partial and complete response) as per RECIST v1.0 was 48% in patients with one lesion, 29% with two lesions and 29% with 3 lesions. Median PFS was 9.4 (8.0-14.8) months. One-year OS rate was 86% and at 2-year was 78%. No procedure related complications were reported and grade 3 toxicities included hyperbilirubinemia (n=1) and elevated alkaline phosphatase (n=1). Conclusions: Y-90 radioembolization is a promising treatment option for patients with unresectable progressive hepatic metastases from neuroendocrine carcinoma with acceptable toxicity. Limited prospective data is available and there is a strong unmet need for randomized clinical trials with radioembolization.

Induction of hypertrophy of the left hepatic lobe by unilateral right hepatic arterial radioembolization (RE) using 90Y-labeled resin microspheres in patients with right-sided secondary malignant liver tumors.

e14630 Background: In patients with unilateral liver tumors who are candidates for extended liver resection but demonstrate insufficient future liver remnant (FLR) size, induction of FLR hypertrophy by contralateral portal vein embolization (PVE) is an established approach but concerns exist regarding tumor progression during the interval from PVE to liver surgery. We hypothesized that unilateral hepatic arterial radioembolization (RE) using 90Y-labelled resin microspheres achieves a similar degree of contralateral hypertrophy as PVE. Methods: 32 patients with right-sided secondary liver cancers (metastases from colorectal [n=20], breast [n=7], head and neck [n=2], and other [n=3] cancers) were treated with unilateral right hepatic arterial RE. Before and 44 (22-81) days following RE MRI-based volumetry of the total liver (TLV), the right (RLV, segments 4-8) and left (LLV, segments 2 and 3) hepatic lobes was performed. TLV, RLV, and LLV as well as the LLV/TLV ratio before and after RE were compared using the Mann-Whitney U-test. Results: Median values for TLV, RLV, LLV, and the LLV/TLV ratio are shown in table. Compared to baseline, RLV and TLV showed no significant change after right hepatic arterial RE (-3.7 [min/max, -37.7/+56.5] per cent [p=0.158] and +3.2 [-16.5/+47.4] per cent [p=0.282], respectively). In contrast, LLV as well as the LLV/TLV ratio were significantly increased after RE (+34.9 [-3.1/+146.2] per cent [p<0.001] and +29.4 [-24.3/+155.3] per cent [p<0.001], respectively). Conclusions: Right hepatic arterial RE achieved superior contralateral liver hypertrophy compared to hypertrophy reported after PVE and may be an alternative to PVE since it provides simultaneous treatment to the liver tumors during the interval from treatment to liver surgery, reducing the risk for tumor progression. These two methods should be directly compared within a prospective trial. [Table: see text]

Hepatic artery radioembolization (HARE) in the management of progressive metastatic neuroendocrine tumors (NETs): A survival and biochemical response analysis in geriatric (G) and young (Y) populations.

e19727 Background: HARE with Y-90 SIR-Spheres is a treatment (Rx) option for NET patients (pts); however, survival statistics, biochemical responses (BR) and factors influencing outcomes are lackin...

Treatment of Liver Metastases in Patients with Neuroendocrine Tumors: A Comprehensive Review

Patients diagnosed with Neuroendocrine Tumors (NET) often are also diagnosed with Neuroendocrine Liver Metastases (NLM) during the course of their disease. NLM can cause significant morbidity and mortality, oftentimes much more than compared to patients with NET. Treatment options have been limited in the past, focusing on surgical resections, for which only a minority of patients are candidates. However, developments of new treatment modalities have progressed rapidly and patients with NLM now have significantly more options, including surgical-directed therapies; liver-directed therapies; and nonsurgical, non-liver-directed therapies. This review provides information about the roles of hepatic resection, orthotopic liver resection, radiofrequency ablation, hepatic artery embolization and hepatic artery chemoembolization, hepatic artery radioembolization and selective internal radiation therapy, peptide receptor radionuclide therapy, systemic chemotherapy, biotherapies including somatostatin analogs and interferon-α, vascular endothelial growth factor and mTOR targets, and microRNA-regulated pathways. Given these new options, the clinician can tailor therapy specific to the patient diagnosed with NLM, thereby giving the patient the best possible chance of prolonged survival.

State of the art: radiolabeled microspheres treatment for liver malignancies

Importance of the field: Metastatic tumours of the liver are responsible for significant morbidity and mortality, and only a small percentage is resectable with curative intent. Hepatic artery radioembolization (RE) with yttrium-90 (90Y)-loaded microspheres is an alternative treatment for patients with unresectable primary or secondary liver tumours, especially in cases of metastatic colorectal cancer (mCRC) and hepatocellular carcinoma (HCC).Areas covered in this review: Data from recent relevant clinical trials with 90Y-RE are discussed, focusing on response rate assessments and treatment outcome.What the reader will gain: Current data show that 90Y-RE combined with radiosensitizing chemotherapy is a safe and efficient modality that extends the time to progression in liver mCRC and unresectable HCC, although no survival benefits have been demonstrated. The treatment response after 90Y-RE seems to be better assessed using metabolic response assessments with serial fluorodeoxyglucose positron emission tomography (FDG-PET) in cases of FDG-avid tumours than with morphological criteria measured on computed tomography or magnetic resonance imaging (RECIST or WHO trials). Predictive models using multimodality imaging approaches (PET-SPECT-CT image fusion algorithms) have been proposed to better select patients for 90Y-RE. The optimal routine role of radioembolization remains to be defined; the complexity and wide availability of available therapeutic alternatives confuses the role of a locoregional treatment in a generalized disease.Take home message: 90Y-RE is a safe and efficient treatment modality in salvage therapy of colorectal cancer metastatic to the liver and in unresectable HCC. However, it has still to find its place as a first- or second-line treatment of mCRC in combination with or as an alternative to available biological agents. The role of 90Y-RE in other solid tumour types metastatic to the liver is much more uncertain and investigations in clinical situations in which disease is strictly limited to the liver are required. Pretherapeutic work-up, initially developed to explore hepatic vasculature and to assess lung shunting, might be able to predict treatment outcome, allowing a better patient selection.

Yttrium-90 Microsphere Radioembolotherapy of Hepatic Metastatic Neuroendocrine Carcinomas after Hepatic Arterial Embolization

Hepatic artery radioembolization was performed in a cohort of patients with unresectable neuroendocrine hepatic metastases who exhibited hepatic progression or toxicity despite technically adequate embolization procedures without other reasonable therapeutic options. Eight patients (five men) with a median age of 55.5 years met the study criteria. Infusions of yttrium-90 resin microspheres were performed in a lobar fashion. Standard clinical, laboratory, and imaging follow-up was performed. Median hepatic parenchyma replacement by tumor was 55% (range, 25%-60%). Twelve (90)Y resin microsphere infusions were performed, and the median delivered activity was 33.25 mCi (range, 23-55 mCi). One partial response, four cases of disease stabilization, and three cases of progressive disease were noted. No cases of radiation-induced liver disease occurred. Median survival times were 14 months (range, 3-15 months) from the time of (90)Y microsphere treatment and 36.5 months (range, 16-105 months) from the time of diagnosis of hepatic metastases. In this cohort, (90)Y microsphere radioembolization of neuroendocrine hepatic metastases was not precluded by previous nonradioactive embolization procedures, but the effectiveness in this population requires further investigation.