Selective Internal Radioembolization Research Articles

Image-guided percutaneous locoregional therapies for hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the 3rd leading cause of cancer death worldwide. Treatment options include surgical resection, liver transplantation, imageguided percutaneous locoregional options, external beam radiation therapy (EBRT) and systemic therapies. Treatment choice depends on the stage of the disease and patient's characteristics including performance status and liver function. Barcelona Clinic Liver Cancer (BCLC) staging system, with its recent 2022 update, is one of the most widely endorsed staging system. Locoregional therapies (LRT) are recommended for very early stage (BCLC-0), early stage (BCLC-A), and the two first subgroups of intermediate stage (BCLC-B). Image-guided percutaneous locoregional therapies include ablation, mainly thermal ablation with radiofrequency (RFA), microwave ablations (MWA) and cryoablation, transarterial embolization (TAE, also known as bland embolization), transarterial chemoembolization (TACE), drug-eluding beadstransarterial chemoembolization (DEB-TACE), combination of ablation with embolization, transarterial radioembolization (TARE) also known as selective internal radioembolization therapy, and hepatic artery infusion (HAI). While ablation is recognized as a curative therapy, all intra-arterial therapies are considered non-curative options. There is growing evidence that TARE, through radiation segmentectomy, can be considered a curative intent treatment in appropriate selective patients. In this article, we will review indications, complications, and outcomes of locoregional therapies for HCC.

Intraarterial Therapies for the Management of Hepatocellular Carcinoma.

Simple SummaryHepatocellular carcinoma is the most common liver cancer, leading to approximately 700,000 deaths worldwide and 30,000 deaths in the United States every year. Transarterial therapies play a crucial role in the management of these patients, with significant development in techniques over the last couple of decades. The aim of this review is to discuss the different types of transarterial therapies with regards to the pre-procedure, procedural, and post-procedural patient management, along with giving a review of evidence from the literature.Image-guided locoregional therapies play a crucial role in the management of patients with hepatocellular carcinoma (HCC). Transarterial therapies consist of a group of catheter-based treatments where embolic agents are delivered directly into the tumor via their supplying arteries. Some of the transarterial therapies available include bland embolization (TAE), transarterial chemoembolization (TACE), drug-eluting beads–transarterial chemoembolization (DEB–TACE), selective internal radioembolization therapy (SIRT), and hepatic artery infusion (HAI). This article provides a review of pre-procedural, intra-procedural, and post-procedural aspects of each therapy, along with a review of the literature. Newer embolotherapy options and future directions are also briefly discussed.

Long-term results of selective internal radioembolization (SIRT) to control progressive liver metastases of gastro-intestinal stromal tumors (GIST) beyond treatment with tyrosine kinase inhibitors (TKI).

11538 Background: Liver and peritoneum are the main area of metastatic spread in GIST. Liver resection does not play a role for hepatic metastases in comparison to f.e. colorectal cancer. If hepatic metastases are the only or major area of tumor progression and are resistant to available TKIs due to a missing mutation in KIT/PDGFRA/SDH ( ‘wildtype’) or after treatment with 1st/2nd/3rd/4th line therapy, interventional radioembolization with yttrium-90 (90Y) microspheres are promising treatment options, as radiation doses as high as 200Gy can be applied locally. We analyzed the long-term results of SIRT with respect to hepatic-progression-free survival (HEP-PFS) in a consecutive cohort of patients.. Methods: From 1/2008 to 1/2018, 25 pts (12f, 13m) with biopsy proven liver metastases of GIST which were the only (n = 13) or the dominant site of progression (n = 12) were treated by SIRT. Median age at GIST diagnosis had been 51.8 yrs and when receiving SIRT was 57.6yrs (range, 18–75yrs). The mutational status was ‘wildtype’ (n = 7, 2 NF-1), exon 11 (n = 7), exon 11+2nd mutation (n = 6), exon 9 (n = 3), exon 9+2ndmut (n = 1), and, exon 13 (n = 1). All patients except of two had prior TKI therapy: 1 line n = 3, 2 lines n = 11, 3-4 lines n = 9. Follow-up after SIRT was done via dynamic MRI and contrast-enhanced (CE)-CT, the median follow-up is 30.6 mos (range, 12-100mos) and all patients were followed until death. Results: The median hepatic-progression free survival (HEP-PFS) after SIRT was 17 months (range, 5-53+, 95%CI 11.8-22.1 mos). Of the patients with concomitant extrahepatic disease, the extraHEP-PFS was median 10 months. Twelve patients received next-line TKI therapy for progressive extrahepatic disease, whereas six patients required this for progressive liver metastases. When comparing the results according to the mutational status, patients with a ‘wildtype’ tumor showed a better median HEP-PFS of 19 mos (range, 12-53+, 95%CI 16.7-21.2 mos.) in comparison to KIT exon 9/11/13 mutated patients with only 14 months (range, 4-34 mos., 95%CI 6.5-21.4 mos), p < 0.11 (Wilcoxon). Conclusions: 90Y radioembolization (SIRT) offers a safe and effective treatment for patients with liver metastases of GISTs being the dominant site of tumor progression and with no drug treatment options available. In patients known to have no mutation in KIT/PDGFRA (wt, also NF-1 associated) it looks whether the results might be even more promising and SIRT could be used in early treatment lines.

Nonobstructing Gastric Antral Ulcer Following Selective Internal Radiation Therapy with Yttrium-90: A Case Report

Radio beads have been increasingly utilized in the US to treat liver cancers. Either resin- (90 Yttrium beads) or glass-based (Theraspheres) microspheres are utilized for selective internal radioembolization (SIR) of tumors. Approximately 120 centers in the US utilize resin-based and about 60 centers utilize glass-based microspheres for treating liver tumors. As experience builds, SIR procedures will continue to …

Phase Ib study of pasireotide (P), everolimus (E), and selective internal radioembolization therapy (SIRT) for unresectable neuroendocrine hepatic metastases.

4092 Background: Pasireotide (P) is a somatostatin (SST) analogue active against receptors 1, 2, 3, and 5. Everolimus (E) is an mTOR inhibitor. mTOR and SST pathways activate angiogensis, survival ...

4:24 PM, Abstract No. 292 - Radioembolization for unresectable intrahepatic cholangiocarcinoma: single center review of imaging response and survival

Purpose: Intrahepatic cholangiocarcinoma (ICC) is often locally advanced at diagnosis, precluding surgical resection. While several chemotherapy and locoregional approaches have been investigated for treatment of unresectable ICC, there exists no widely accepted standard. We report our experience with selective internal radioembolization therapy (SIRT) with yttrium-90 for locally advanced ICC. Materials and Methods: Patients with unresectable ICC who were selected for SIRT were retrospectively reviewed. Patient demographics, performance, and survival data were acquired from patient medical records and the Social Security Death Index. Tumor response and time to progression (TTP) were assessed on CT/MRI using RECIST criteria. Statistical analysis was performed using Kaplan-Meier survival estimator and log-rank tests. Major and minor adverse events (AEs) were assessed up to 30 days. Results: From 6/2008 to 7/2014, 26 patients (mean age 67 12 y) that had previously received chemotherapy (n1⁄413), resection (n1⁄46) or no treatment (n1⁄49) for ICC were selected for SIRT. Tumor lobe included left (n1⁄45), right (n1⁄47) and bilobar (n1⁄414), with average max tumor dimension 6.8 4.4 cm. Disease burden included intrahepatic-only (n1⁄413) and extrahepatic (n1⁄412). All treatments were administered successfully (mean dose 1.58 0.85 GBq) using SIR-Spheres (n1⁄418; Sirtex, N. Sydney, Australia) or Theraspheres (n1⁄48; BTG, London, UK). Seven patients were lost to follow up. Objective response rate was 21% (CR:3, PR:1; SD:7, PD:8). Disease control rate was 58%. Median TTP was 113 (94-169) days. Median TTP in patients with baseline ECOG 0 (n1⁄49) and ECOG Z 1 (n1⁄410) was 169 and 113 days, respectively (p 1⁄4 0.045, log-rank). Median survival from SIRT was 225 (95% CI 153-609) days. Post-treatment survival was significantly prolonged in patients with objective response via RECIST (p1⁄40.021, log-rank). AEs included stroke within 30 days (n1⁄41). Conclusion: SIRT for ICC is feasible and represents a treatment option for unresectable disease. Time to progression is significantly longer in ECOG 0 patients. Post-treatment survival is significantly prolonged in patients with objective response via RECIST.

SIR-Spheres ® radioembolization in the management of metastatic colorectal cancer: a medical oncology perspective

SUMMARY Despite of the recent advances in personalized medicine, the majority of patients with metastatic colorectal cancer still succumb to disease progression, with liver failure constituting one of the most common causes of death. Recently, selective internal radioembolization has emerged as a new treatment option in patients with liver predominant disease. The concurrent administration of yttrium-90 (Y-90) SIR-Spheres® (SIRTEX, Sydney, Australia) microspheres and chemotherapy has been linked to significant improvements in response rate, time to intrahepatic tumor progression and overall survival. In this manuscript, the author provides his personal perspective on the current clinical evidence in support of SIR-Spheres liver embolization and reflects on the potential of this treatment in various stages of treatment of metastatic colorectal cancer.

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Is Selective Internal Radioembolization Safe and Effective for Patients with Inoperable Hepatocellular Carcinoma and Venous Thrombosis?

The goal of this study was to examine the safety and efficacy of selective internal radioembolization (SIR) for hepatocellular carcinoma (HCC) with portal vein or caval thrombosis (VT), or both. Recent reports have demonstrated that SIR is safe for patients with HCC, but the impact on efficacy of venous thrombosis is unknown. Prospective single-arm study of the use of Therasphere in patients with unresectable HCC enrolled from January 2004 to June 2007. Patients were categorized into three groups based on VT status and therapy. Fifty-two patients were enrolled: 20 patients without VT who received SIR, 15 patients with VT who were treated, and 17 patients (10 with VT) who were not treated because of preprocedure screening failure. Fifty-eight treatments were administered, with a median of two treatments per patient (range of one to three treatments). Child's score was different between groups. Of the VT patients treated, 67% had portal VT, 7% had cava VT, and 26% had both. There were no treatment-related deaths. There was no difference in complications among groups (p = 0.34). Treated patients without thrombosis had a median overall survival of 13.9 months versus 2.7 months for those treated with thrombosis and 5.2 months for the untreated group given best supportive care only (p = 0.01). SIR is safe in patients with HCC. Although SIR can be delivered with minimal morbidity, there might be no benefit for patients with VT. Continued emphasis on multimodality therapy in this population is needed to improve survival.