Yttrium-90 Microsphere Radioembolization Research Articles

Survival and pattern of tumor progression with yttrium-90 microsphere radioembolization in predominantly hepatitis B Asian patients with hepatocellular carcinoma.

Intra-arterial yttrium-90 ((90)Y) microsphere radioembolization (RE) is an emerging treatment option with good outcomes reported predominantly in hepatitis C Western populations with hepatocellular carcinoma (HCC). We report outcomes in predominantly hepatitis B Asian patients treated with (90)Y-RE focusing on overall survival (OS), time to progression (TTP), tumor response, pattern of tumor recurrence and adverse events. Prognostic factors for survival were also identified. A retrospective cohort study was conducted in a single tertiary institution. All non-trial patients treated with (90)Y-RE at our institution from 1 January 2008 to 30 June 2012 were included. Data from 103 consecutive patients were analyzed. The majority of patients were Child-Pugh class A (59.2%) and Barcelona Clinic Liver Cancer (BCLC) stage C (68.9%). Median OS was 14.4months (95% CI 11.0-22.2), which varied by disease stage: Child-Pugh A, 21.7months; Child-Pugh B, 7.1months; BCLC B, 23.8months; BCLC C, 11.8months. Response and disease control rates by RECIST 1.1 were 21.2 and 59.6%, respectively, while disease control for index lesions treated with (90)Y-RE was 100%. Development of new intrahepatic lesions was the main reason for eventual disease progression. Median overall TTP was 5.3months (95% CI 4.1-10.0). Pretreatment vascular invasion, low serum albumin and elevated total bilirubin levels predicted poorer survival. Survival outcomes in hepatitis B Asian patients treated with (90)Y-RE for HCC are comparable to hepatitis C Western populations. While disease control for lesions treated with (90)Y-RE is excellent, the development of new lesions suggests a role for concomitant systemic therapy.

A Robust Workflow of a Multidisciplinary Team-Involved Radiation Therapy Procedure -- A Case in Yttrium-90 Microsphere Radioembolization

A Robust Workflow of a Multidisciplinary Team-Involved Radiation Therapy Procedure -- A Case in Yttrium-90 Microsphere Radioembolization

Abstract No. 471 - Superselective radioembolization: results of Yttrium 90 radiation segmentectomy for hepatocellular carcinoma

Yttrium-90 (Y90) microsphere radioembolization is a well-accepted treatment strategy for unresectable hepatocellular carcinoma (HCC). It is usually performed in patients with extensive tumors, necessitating lobar infusions. This study assessed the safety and efficacy of Y90 radioembolization when performed in a superselective fashion.

Radiographic Parameters in Predicting Outcome of Patients with Hepatocellular Carcinoma Treated with Yttrium-90 Microsphere Radioembolization

Background. In patients with hepatocellular carcinoma, selection criteria for transarterial hepatic selective internal radiotherapy are imprecise. Additionally, radiographic parameters to predict outcome of transarterial hepatic selective internal radiotherapy have not been fully characterized. Patients and methods. Computed tomography (CT) scans of 23 patients with unresectable primary hepatocellular carcinoma before and after transarterial hepatic selective internal radiotherapy with yttrium-90 microspheres were retrospectively reviewed. Selected radiographic parameters were evaluated and correlated with progression-free survival and overall survival. Response to treatment was assessed with Response RECIST 1.1 and Morphology, Attenuation, Size, and Structure (MASS) criteria. Results. On the post-SIRT CT, 68% of tumors demonstrated decreased size (median decrease of 0.8 cm, P = 0.3); 64% had decreased attenuation (median decrease 5.7 HU, P = 0.06), and 48% demonstrated increased tumor necrosis (P < 0.001). RECIST-defined partial response was seen in 10% patients, stable disease in 80%, and 10% had disease progression. Median progression-free survival was 3.9 months (range, 3.3 to 7.3), and median overall survival was 11.2 months (7.1 to 31.1). Pretreatment lower hepatopulmonary shunt fraction, central hypervascularity, and well-defined tumor margins were associated with improved progression-free survival. Conclusion. In patients with unresectable hepatocellular carcinoma, pretreatment CT parameters may predict favorable response to SIRT and improve patient selection.

Comparison of Positron Emission Tomography and Bremsstrahlung Imaging to Detect Particle Distribution in Patients Undergoing Yttrium-90 Radioembolization for Large Hepatocellular Carcinomas or Associated Portal Vein Thrombosis

PurposeTo compare positron emission tomography/computed tomography (PET/CT) imaging with bremsstrahlung single photon emission computed tomography (SPECT) in patients after yttrium-90 (90Y) microsphere radioembolization to assess particle uptake. Materials and MethodsThis prospective study comprised patients with large (> 5 cm) hepatocellular carcinoma (HCC) or tumor-associated portal vein thrombus (PVT), or both. After radioembolization for HCC, patients underwent bremsstrahlung SPECT/CT and time-of-flight PET/CT imaging of 90Y without additional tracer administration. Follow-up imaging and toxicity was analyzed. Imaging analyses of PET/CT and bremsstrahlung SPECT/CT were independently performed. ResultsThere were 13 patients enrolled in the study, including 7 with PVT. Median tumor diameter was 7 cm. PET/CT demonstrated precise localization of 90Y particles in the liver, with specific patterns of uptake in large tumors. In cases of PVT, PET/CT showed activity within the PVT. When correlated to short-term follow-up imaging, areas of necrosis correlated with regions of uptake seen on PET/CT. Compared with bremsstrahlung imaging, PET/CT demonstrated at least comparable spatial resolution with less scatter. Quantitative uptake in nontreated regions of interest showed significantly reduced scatter with PET/CT versus SPECT/CT (1% vs 14%, P < .001). ConclusionsEvaluation of 90Y particle uptake with PET/CT potentially demonstrates high spatial resolution and low scatter compared with bremsstrahlung SPECT/CT. Confirmation of particles within PVT on PET/CT correlates with response on follow-up imaging and may account for the efficacy of radioembolization in patients with PVT.

Clinical outcomes with yttrium-90 resin microsphere radioembolization for hepatocellular carcinoma in a multiethnic southeast Asian population.

e15137 Background: Treatment options for unresectable hepatocellular carcinoma (HCC) are limited. Intra-arterial yttrium-90 (90Y) microsphere radioembolization is an emerging treatment option with good outcomes among Caucasian patients. We report clinical outcomes in a multi-ethnic south-east Asian population treated with 90Y microspheres. Methods: A single-centre, retrospective, observational cohort study was conducted on patients who received 90Y microsphere radioembolization at Singapore General Hospital between January 2008 and June 2012. Patients were followed from the date of treatment until January 30, 2013, or until the date of death. Disease was staged by Barcelona Clinic Liver Cancer (BCLC) and Child-Pugh class. Patient survival was estimated using the Kaplan-Meier method. Response rate was determined by RECIST criteria. Prognostic factors for survival were identified using Cox proportional hazards regression. Results: 103 patients comprising 40.8% Chinese, 30.1% Myanmar, 14.6% Indonesian, 6.8% Indochinese and 7.7% others were treated with 90Y microspheres. Hepatitis B or C was recorded as the etiology in 47.6% and 23.3% of patients, respectively. The median overall survival (OS) was 14.4 months [95% CI 11.3-22.2 months] (BCLC B, 23.8 months ; BCLC C, 13.6 months; P = 0.048); (Child-Pugh A, 21.7 months; Child-Pugh B, 10.1 months; P &lt; 0.0001). Median OS in patients with portal vein thrombosis (PVT) was poorer than those without PVT (PVT, 11.0 months; No PVT, 18.1 months; P = 0.024). Overall disease control rate by RECIST was 64.7%, while target lesions response rate was 98.3%. Progression of disease was mainly due to new lesions (69.2%). Significant prognostic factors for survival were serum albumin levels, presence of ascites and PVT. Conclusions: Survival outcomes in south-east Asian patients treated with 90Y microsphere radioembolization for HCC are comparable to Western populations in spite of the different etiologies. While target lesions response was good, new lesions are common and suggest that concomitant systemic therapy may have a role in disease control.

Quantitative Comparison of PET and Bremsstrahlung SPECT for Imaging the In Vivo Yttrium-90 Microsphere Distribution after Liver Radioembolization

BackgroundAfter yttrium-90 (90Y) microsphere radioembolization (RE), evaluation of extrahepatic activity and liver dosimetry is typically performed on 90Y Bremsstrahlung SPECT images. Since these images demonstrate a low quantitative accuracy, 90Y PET has been suggested as an alternative. The aim of this study is to quantitatively compare SPECT and state-of-the-art PET on the ability to detect small accumulations of 90Y and on the accuracy of liver dosimetry.Methodology/Principal FindingsSPECT/CT and PET/CT phantom data were acquired using several acquisition and reconstruction protocols, including resolution recovery and Time-Of-Flight (TOF) PET. Image contrast and noise were compared using a torso-shaped phantom containing six hot spheres of various sizes. The ability to detect extra- and intrahepatic accumulations of activity was tested by quantitative evaluation of the visibility and unique detectability of the phantom hot spheres. Image-based dose estimates of the phantom were compared to the true dose. For clinical illustration, the SPECT and PET-based estimated liver dose distributions of five RE patients were compared. At equal noise level, PET showed higher contrast recovery coefficients than SPECT. The highest contrast recovery coefficients were obtained with TOF PET reconstruction including resolution recovery. All six spheres were consistently visible on SPECT and PET images, but PET was able to uniquely detect smaller spheres than SPECT. TOF PET-based estimates of the dose in the phantom spheres were more accurate than SPECT-based dose estimates, with underestimations ranging from 45% (10-mm sphere) to 11% (37-mm sphere) for PET, and 75% to 58% for SPECT, respectively. The differences between TOF PET and SPECT dose-estimates were supported by the patient data.Conclusions/SignificanceIn this study we quantitatively demonstrated that the image quality of state-of-the-art PET is superior over Bremsstrahlung SPECT for the assessment of the 90Y microsphere distribution after radioembolization.

735P - Radiographic Parameters in Predicting Outcome of Patients with Hepatocellular Carcinoma (HCC) Treated with YTTRIUM-90 Microsphere Radioembolization (SIRT)

ABSTRACT Background The predictive role of radiographic parameters in HCC pts undergoing transarterial hepatic selective internal radiotherapy (SIRT) is not fully characterized. The objective of this retrospective study was to determine whether radiographic parameters at baseline and/or radiographic changes following SIRT predict outcome in HCC pts treated with Yttrium-90 glass microsphere radioembolization. Methods Baseline and post-SIRT CT images (median of 6 weeks) were analyzed. Various features such as tumor size; attenuation; margins; enhancement; and amount of tumor necrosis were examined. Selected radiographic parameters were evaluated & correlated with PFS & OS. Objective response was assessed by RECIST 1.1 and Morphology, Attenuation, Size, and Structure (MASS) criteria (favorable (FR) vs. non favorable). Differences were analyzed using Wilcoxon Signed Rank Test and Fisher's Exact Test. Kaplan-Meier methods were used to estimate survival curves. Cox regression was used in uni- and multi- variable survival analyses Results Twenty-four pts (79% M; median age 63 y) received a median radiation dose of 1.965 GBq. On post-SIRT CT, 65% of tumors had decreased longest diameter (median decrease 8%, p = 0.27); 64% had decreased attenuation (median decrease 18 HU, p = 0.067), and 45% demonstrated increased tumor necrosis (p Conclusions In pts with HCC, pre-treatment tumor margins and shunt fraction may be developed as biomarkers to identify pts who are unlikely to benefit from SIRT. In addition, response evaluation by MASS criteria may provide better and earlier determination of lack of benefit from SIRT and the need for further therapy. Disclosure All authors have declared no conflicts of interest.

Celiac Artery Stenting to Facilitate Hepatic Yttrium-90 Radioembolization Therapy

Radioembolization offers a novel way to treat the nonresectable, liver predominant hepatic malignancies with better tumor response and overall progression-free survival rates. Transarterial catheter-based radioembolization procedure involves the hepatic arterial administration of glass- or resin-based beta emitting Yttirum-90 microspheres. Safe delivery of the tumoricidal radiation dose requires careful angiogram planning and coil embolization to quantify lung shunting and prevent systemic toxicity, respectively. Diagnostic pretreatment angiogram also serves to identify the hepatic arterial variant anatomy and other coexisting pathologies that might require a different or alternative approach. We describe a complex case of celiac artery stenosis with tortuous pancreaticoduodenal arterial arcade precluding access to the right hepatic artery for performing radioembolization. Celiac artery stenting of the stenosis was performed to facilitate subsequent safe and successful Yttrium-90 microsphere radioembolization.

Calculating Lung Dose Using Volumetric Analysis in Patients Treated with Yttrium-90 Microsphere Radioembolization for Hepatocellular Carcinoma

Calculating Lung Dose Using Volumetric Analysis in Patients Treated with Yttrium-90 Microsphere Radioembolization for Hepatocellular Carcinoma

Hepatocellular carcinoma with portal vein thrombosis treated with yttrium-90 microsphere radioembolization results on 22 consecutive patients.

e14573 Background: Portal vein tumoral thrombosis is a pejorative and a frequent complication of hepatoculluar carcinoma (HCC). PVT shows as the primary tumour, an arterial hypervascularization; his main characteristic is the rationale of this study which aim to assess the safety and the efficacy of a Yttrium-90 microsphere (90Y- microS) treatment with TheraSphere in this advanced situation. Methods: Since 2008 we have treated 22 patients with unresectable HCC and PVT; 24 treatments were done as described by Salem and col (J Vasc Interv Radiol 2006;17:1251-78.). Patients were evaluated at 3, 6 and then every 3 months for response (EASL criterias), survival and toxicity (CTCAEv3.0 criterias). Patients characteristics were as follow : Sex (M/F; n) 17/5; Mean age+/-SD (y) 65.3 +/-7.1. Previous treatment: 19 Etiology of cirrhosis VHC 5–Alcohol 12–Iron overload 3– Dysmetabolic syndrom 2; Child–Pugh grade: A/B/C : 15/7/0, Mean largest diameter +/- SD (cm) 8.3-3.5; Patent portal vein thrombosis: right/left/both: 8/3/11; a-fetoprotein (ng/mL) 849+/-19400- normal in 5 cases. CLIP score (2/3/4): 11/6/3; BCLC score C (n=22). Toxicity, response, and survival analyses were censored at time of last visit or death. Results: Median follow up was 11 months (1-34). Responses were: complete 2 (9%), partial 14 (63%), stable disease 3 (13%), progression 4 (18%), 3 patients were refered to surgery and one to transplantation. Median time to progression and overall survival were respectively 7.2 (95%CI, 3.9-10.5) and 9.0 (95%CI, 5.5-12.5) months. 4 cases of liver disfunction (Child B patients with right and left PVT) were observed, all were grade 2. Conclusions: The safety and efficacy results of in this monocentric cohort of 22 patients challenged those obtained with sorafenib in this indication and are in accordance with previous published data (Gastroenterology, 2010;138: 52-64; J Vasc Interv Radio. 2010; 8:1205-12.). Further clinical trials are waranted to confirm these results and to compare 90Y-microS with or without sorafenib to sorafenib alone, taking into account not only the overall survival but also the possibility of secondary surgery after downstaging.

Hepatic falciform ligament Tc-99m-macroaggregated albumin activity on SPECT/CT prior to Yttrium-90 microsphere radioembolization: prophylactic measures to prevent non-target microsphere localization via patent hepatic falciform arteries

Yttrium-90 (Y-90) selective internal radiation therapy (SIRT) is increasingly used to treat inoperable hepatocellular carcinoma. We describe two patients where hepatic falciform ligament Technetium-99m-macroaggregated albumin (Tc-99m-MAA) activity was identified on single photon emission computed tomography with integrated low-dose CT (SPECT/CT) scan during pre-therapy planning, and the steps taken to prevent radiation dermatitis. The first patient underwent prophylactic coil embolization of the patent hepatic falciform artery; the second patient underwent super-selective infusion of Y-90 resin microspheres to avoid the patent hepatic falciform artery. The incidence of falciform ligament Tc-99m-MAA activity detected on SPECT/CT at our institution is 10%. Tc-99m-MAA SPECT/CT scan provides valuable diagnostic information for treatment planning prior to Y-90 SIRT.

Experiences in Hepatic Surgery and Transplantation after Radioembolization

Yttrium-90 microspheres radioembolization has shown to be an effective modality of treatment in patients with primary or metastatic liver tumours [1-4]. It is usually offered to patients with advanced liver cancers. However, surgical experience after radioembolization is very limited to anecdotal cases mainly related to hepatocellular carcinoma. We have treated patients with hepatocellular carcinoma or liver metastasis mainly from colon, breast, melanoma and neuroendocrine tumours. In our experience after such treatment we were able to downstage the tumour to surgery only in the case of hepatocellular carcinoma. Five patients had liver transplantation and 1 had right hepatic resection after Yttrium-90 microspheres radioembolization. Of note 2 patients had neoplastic infiltration of a portal vein branch which resolved after treatment with Yttrium-90 microspheres radioembolization. The extra-hepatic spread was ruled out and later they were both transplanted. Here we report our initial single center experience with Yttrium-90 microspheres radioembolization as downstaging and bridging method for hepatocellular carcinoma prior liver surgery, resection or liver transplantation.

Computational Fluid Dynamics Modeling of 90Y Microspheres in Human Hepatic Tumors

The number of patients afflicted with liver tumors continues to rise being a major concern of international healthcare. Yttrium-90 microsphere radioembolization can be an effective and safe treatment of unresectable primary and secondary liver tumors, and has the potential to be a forefront treatment option for tumor-afflicted patients. Computational fluid-particle dynamics is a powerful research tool that can be used to understand the underlying physics of Yttrium-90 microsphere transport and deposition, leading to improved clinical strategies and ultimately to a better treatment of tumor-afflicted patients. Two representative, patient-inspired three-dimensional geometries of the hepatic arterial system with assumed connections to liver tumors have been considered. Experimentallyvalidated computational fluid-particle dynamics modeling results have shown the significant influence of vessel morphology, downstream resistance to flow, catheter radial and axial location associated with microsphere injection time interval, and injection velocity on microsphere transport through the hepatic arterial system. Moreover, the computational investigations have identified the ability to preferentially deliver microspheres to a specific arterial vessel outlet, presumably connected to a tumor, by selecting appropriate temporal and spatial parameters of the microsphere injection. As the computational findings are extended to additional experiments as well as nextgeneration smart micro-catheters, clinicians can implement a refined set of treatment strategies that utilize the aforementioned physical phenomena. Computational fluid-particle dynamics models have thus provided valuable physical insight as well as suggestions for the improvement of current Yttrium-90 microsphere radioembolization treatment. Additional computational investigations are needed to create more encompassing conclusions from a large collection of patient-specific analyses plus the design, prototyping, and testing of a new smart micro-catheter and high-resolution imaging devices that give radiation and interventional oncologists new degrees of control and precision when administering Yttrium-90 microsphere radioembolization.

Radioembolization and systemic chemotherapy improves response and survival for unresectable colorectal liver metastases

To evaluate the role of radioembolization and systemic chemotherapy as a combined modality therapy for unresectable colorectal liver metastases. Prospective database of a major yttrium-90 microsphere radioembolization treatment center in Sydney, Australia, that included 140 patients with unresectable colorectal liver metastases was analyzed. Tumor response, overall survival, treatment-related complications and an evaluation of its role as a combined modality therapy with systemic chemotherapy were performed. One hundred and thirty-three patients (95%) had a single treatment, and seven patients (5%) had repeated treatments. Response following treatment was complete in two patients (1%), partial in 43 patients (31%), stable in 44 patients (31%), and 51 patients (37%) developed progressive disease. Combining chemotherapy with radioembolization was associated with a favorable treatment response (P = 0.007). The median overall survival was 9 (95% CI 6.4-11.3) months with a 1-, 2-, and 3-year survival rate of 42, 22, and 20%, respectively. Primary tumor site (P = 0.019), presence of extrahepatic disease (P = 0.033), and a favorable treatment response (P < 0.001) were identified as independent predictors for survival. Combined modality therapy appears to improve tumor response rates. Survival is influenced by tumor site, presence of extrahepatic disease, and response to therapy. Yttrium-90 microsphere radioembolization is safe and may best be combined with systemic chemotherapy for patients with unresectable colorectal liver metastases.

Safety of Yttrium-90 Microsphere Radioembolization in Patients with Biliary Obstruction

There are few data on radioembolization in the setting of biliary obstruction. The present study was performed to assess the safety of yttrium-90 ((90)Y) radioembolization in the setting of tumor-related biliary obstruction and total bilirubin levels of 2 mg/dL or lower. Twelve patients with liver tumors underwent 19 treatment sessions with (90)Y to the obstructed liver lobe or segment. Initial bilirubin level was 2 mg/dL or lower in all cases. Measured outcomes included pre- and posttreatment white blood cell (WBC) count, total bilirubin level, and alkaline phosphatase (ALP) level. Bilirubin toxicities and biliary complications were assessed according to Common Toxicity Criteria, version 3.0. Lobar or segmental (90)Y was successful in all cases. Pre- and posttreatment median WBC counts (5.3 vs 5.3; P = .490), bilirubin levels (1.0 vs 1.1; P = .460), and ALP levels (195 vs 146; P = .712) showed no differences. One case of grade 3 bilirubin toxicity was noted in a patient with liver hilar nodal progression and subsequent biliary obstruction requiring external drainage. Complete resolution of biliary obstruction was seen after (90)Y treatment in one case of metastatic colorectal carcinoma at 1 month follow-up. No biliary complications (infection, sepsis, biliary necrosis, biloma formation, abscess development, or biliary stricture) were encountered in this cohort during an overall median follow-up time of 22.9 months. The use of (90)Y glass microspheres demonstrated a good safety profile in the setting of tumor-related biliary obstruction in patients with normal or near-normal bilirubin levels in this series, without evidence of therapy-related progressive leukocytosis, bilirubin increase, or infectious or biliary complications after treatment.

Use of Yttrium-90 Microsphere Radioembolization of Hepatocellular Carcinoma as Downstaging and Bridge Before Liver Transplantation: A Case Report

Background and objectiveYttrium-90 microspheres radioembolization (Y90-RE) has been recently introduced as promising modality of treatment in patients with hepatocellular carcinoma (HCC) who are not otherwise candidates for local ablation, surgical resection, or liver transplantation (OLT). However, its use in downstaging HCC or as a bridge for OLT is still unclear. Herein, we have presented a case where Y90-RE was used to both downstage and to serve as a bridge for OLT. Case ReportWe report a 54-year-old lady who was known to have hepatitis B virus cirrhosis in addition to two focal hepatic lesions in segments 5 and 8, measuring 1.5 and 7.5 cm, respectfully. Extrahepatic spread was thoroughly ruled out. This tumor was clearly beyond both the Milans and University of California San Francisco criteria for OLT in HCC patients; therefore, we offered the patient Y90-RE in an attempt to downstage the tumor and as a bridge for OLT. Y90-RE was performed targeting the large lesion; the patient underwent cadaveric OLT 2 months thereafter. Gross examination of the explant showed necrotic tumor with obvious signs of irradiation-induced damage. Microscopic examination of the explant showed Y90 microspheres trapped in the large tumor with near-complete tumor necrosis. This patient completed 1-year post-OLT follow-up with no signs of tumor recurrence. ConclusionsThe use Y90-RE in HCC may be useful for downstaging or as a bridge to liver transplantation.

Yttrium-90 Microsphere Radioembolization of the Spleen: A New Approach for the Treatment of Malignant Lymphomatous Splenomegaly

Brief Abstract To our knowledge, radioembolization with 90Y-labeled microspheres has never been reported for lymphomatous diseases. A 77-year-old man with marginal zone lymphoma with symptomatic splenomegaly (SM) was treated with 3700 MBb. This procedure is safe and effective and deserves further investigation in lymphomatous or other malignant SM. Full Abstract Introduction 90Y-labeled microsphere (90YRE) is used for the locoregional treatment of hepatic neoplasia. To the best of our knowledge, it has never been reported as a therapeutic approach for lymphomatous diseases. Patients and Methods A 77-year-old man with marginal zone lymphoma CD20+ and CD5, CD10, CD23− developed a lymphomatous leukemia with symptomatic splenomegaly (SM). After several lines of chemotherapies, he progressed into an aggressive clinical disease with a major enlargement of his spleen responsible for hyperleukocytosis above 200000/μL, anemia requiring regular transfusions, abdominal pain, and anorexia. Palliative irradiation of the spleen with 16 Gy allowed an ephemeral hematologic stabilization. In order to reduce the splenic volume, we performed 90YRE. 3700 MBb of 90Y-labelled microspheres (SIRTEX®) was selectively administered via the splenic artery, which corresponds to a total dose of 36 Gy (calculated from treatment simulation/dosimetry with Technetium-99m—labeled macro-aggregates of albumin). This unusual procedure was safe and led to complete normalization of the blood cell counts. Discussion Radioembolization is a well-known safe procedure for hepatic neoplasia. A similar procedure has been previously reported years ago with a successful outcome for congestive hypersplenism due to idiopathic cirrhosis. Radioembolization by classical approach and splenectomy is usually complicated by severe morbidity. Irradiation could injure adjacent organs. In our patient, 90YRE was well tolerated with reduction of splenic volume. Despite major medullar infiltration with circulating leukemic cells, the complete normalization of the BCC suggests a major role of the irradiation of lymphomatous cells stored or circulating through the spleen. The response duration was 3 months, and the treatment has recently been repeated. Conclusion This case report suggests that 90YRE is a safe and effective procedure that deserves further investigation in lymphomatous or other malignant SM. Indeed, this procedure was better tolerated than classical embolization, with impressive results in this highly refractory patient.

A First Report of Radioembolization for Hepatic Metastases From Ocular Melanoma

Background: Ocular melanoma (OM) metastasizes to the liver and is rapidly fatal despite aggressive therapy. Yttrium-90 microspheres (radioembolization) delivered via the hepatic artery is an established and effective approach for primary and metastatic hepatic tumors, although 90Y use in OM has not been reported previously. Methods: A retrospective review was performed for all patients with OM who received radioembolization at 5 centers. Results: 11 patients received 12 treatments with a median activity of 1.55 GBq delivered per treatment. Toxicity was minimal, with PET/CT at 3 months posttreatment showing a response in all patients; 1 patient had a complete response. Conclusions: Radioembolization can control hepatic metastases of OM with very few side effects.

Yttrium-90 microsphere radioembolization for the treatment of liver malignancies: a structured meta-analysis

Radioembolization with yttrium-90 microspheres ((90)Y-RE), either glass- or resin-based, is increasingly applied in patients with unresectable liver malignancies. Clinical results are promising but overall response and survival are not yet known. Therefore a meta-analysis on tumor response and survival in patients who underwent (90)Y-RE was conducted. Based on an extensive literature search, six groups were formed. Determinants were cancer type, microsphere type, chemotherapy protocol used, and stage (deployment in first-line or as salvage therapy). For colorectal liver metastases (mCRC), in a salvage setting, response was 79% for (90)Y-RE combined with 5-fluorouracil/leucovorin (5-FU/LV), and 79% when combined with 5-FU/LV/oxaliplatin or 5-FU/LV/irinotecan, and in a first-line setting 91% and 91%, respectively. For hepatocellular carcinoma (HCC), response was 89% for resin microspheres and 78% for glass microspheres. No statistical method is available to assess median survival based on data presented in the literature. In mCRC, (90)Y-RE delivers high response rates, especially if used neoadjuvant to chemotherapy. In HCC, (90)Y-RE with resin microspheres is significantly more effective than (90)Y-RE with glass microspheres. The impact on survival will become known only when the results of phase III studies are published.