Yttrium-90 Radioembolization Research Articles

Long-term outcome analysis of Y90 radioembolization in hepatocellular carcinoma.

e16633 Background: Yttrium-90 (Y90) radioembolization is a catheter-based therapy utilized in the treatment of hepatic tumors such as hepatocellular carcinoma (HCC). Multiple trials have evaluated the efficacy of Y90 in HCC; few have assessed long term hepatic function. These studies reported PFS ranging from 7.9 to 18 months (m), and median OS of 17.2 to 18 m for Child-Pugh (CP) Class A and 6.0 to 7.7 m for CP Class B. This study aimed to evaluate a clinical real-world experience of Y90 therapeutic effectiveness and long-term impact on hepatic function. Methods: A single-center retrospective chart review was performed for patients with a CP score of A or B who received Y90 for primary HCC between 2008 and 2016. Model for end stage liver disease (MELD) and CP scores were calculated for the day of treatment and at 1, 3, 6, 12, and 24 m post procedure. OS and PFS were characterized using a Kaplan-Meier survival analysis and a multivariate model. Results: 134 patients were included. Mean age was 60 years old, ranging from 44-90. Underlying liver disease included HCV – 66%, ETOH cirrhosis – 23%, NAFLD – 19%, HBV – 5%. CP Class A patients (79%) had a median OS of 16.59 m (95% CI: 8.90 to 23.10m) from date of Y90 treatment compared to a median of 7.90 m (95% CI: 4.60 to 15.64 m) for CP Class B. CP Class A patients had a median PFS of 3.45 m (95% CI: 2.99 to 5.55 m) from date of Y90 treatment compared to a median of 3.71 m (95% CI: 2.07 to 8.28 m) for CP Class B patients. These differences were not statistically significant. Median OS from date of diagnosis for the entire study population was 29.37 m (95% CI: 23.00 to 38.77 m). MELD scores were statistically significantly higher at 1, 3, 6 and 12 m post-treatment than on Day 0, with significant recovery at 24 vs 3 m. Older age, higher T stage, higher MELD and CP scores, and patients with a history of portal vein thrombosis (PVT) had significantly lower OS. PFS was significantly shorter in those with advanced stage at diagnosis and higher CP score. Conclusions: While our study supports the literature for OS in Y90 patients, we found a shorter PFS in this population. This may reflect the utilization of RECIST in clinical trials vs clinical radiology practice in determining progression. Over time, the most significant factors associated with OS were age, MELD and CP scores and PVT. For PFS, CP score and stage at diagnosis were significant. The increasing MELD and CP scores over time reflect a possible mix of radio embolization‐induced liver disease and progression of HCC. The downtrend at 24 m is likely due to durable survivors with significant benefit from therapy and no long-term complications from Y90.

Yttrium-90 radioembolization for breast cancer with liver metastases: A focus on mortality, adverse reactions, and radiological response.

e13065 Background: Breast cancer associated with liver metastases (BCLM) occurs later in the progression of metastatic breast cancer and carries a poorer prognosis than bone or soft tissue metastases (Pagani). As systemic therapy begins to prolong progression, there is an inherent necessity for localized therapy directed at distant metastases. Further, there is some evidence to suggest that interventional techniques can prolong survival and palliate symptoms although data is lacking in this area (Hoe). Here we present findings describing the mortality benefit, adverse effects, and radiological response to Yttrium-90 (Y-90) radioembolization in BCLM patients. Methods: All patients with BCLM who received Y-90 radioembolization at St. Vincent Hospital from 2013-2018 were included in data collection. Digital chart review was utilized for data collection. To be eligible for the study, patients must have image or biopsy proven metastatic breast cancer to the liver, active unresectable disease not appropriate for ablation, ECOG performance status of 0-2, Bilirubin < 2.0 mg/dL, and no other evidence of liver disease. Patients with a life expectancy less than 2 months were excluded. Results: Twenty-five patients with BCLM underwent Y-90 radioembolization of hepatic metastases. Median survival after therapy was 495 days, or 16 months compared to the median survival rate of 4 months for BCLM patients reported by previous studies (Hoe). At 3 month follow up CT, 48% of patients experienced significant reduction in hepatic tumor burden, only 20% had worsening disease. 16% of patients reported abdominal pain. Median increase in bilirubin was 0.1. Median post procedural AST was 47, and ALT 40. Six patients experienced ascites requiring paracentesis, which occurred on average 14.3 months after Y-90 therapy. There were zero cases of pancreatitis and Radioembolization Induced Liver Disease (REILD). Conclusions: In patients with BCLM who undergo Y-90 radioembolization there seems to be a mortality benefit compared to traditional therapies. Further, there is a radiological reduction in tumor burden, and only minimal adverse effects.

Impact of Genomic Mutation and Timing of Y90 Radioembolization in Colorectal Liver Metastases.

To investigate timing of Yttrium-90 radioembolization (Y90) during treatment course, genomics, and other clinical factors as predictors of overall survival (OS) in colorectal liver metastasis (CRLM) that have progressed on at least one line of chemotherapy. This was a retrospective study from 2013 to 2018 of patients with CRLM and genomic analysis prior to Y90 at a multihospital tertiary referral center. OS from liver metastasis diagnosis and predictors of OS were analyzed using Kaplan-Meier estimation with log-rank and Cox regression analyses. Overall, 58 patients with CRLM who progressed on at least one line of chemotherapy who had genomic analysis prior to Y90 were identified. Median OS after hepatic metastasis was 29.9months. Of these, 16 (28%) patients received Y90 after failure of the first-line systemic chemotherapy. There was significantly prolonged OS in patients receiving Y90 immediately following failure of the first-line chemotherapy folinic acid, fluorouracil, oxaliplatin ((FOLFOX) ± bevacizumab) versus following multiple lines of chemotherapy (median OS of 46.3 vs. 26.6months, P = 0.005). The presence of genetic mutation in tumor, MAPK pathway wild type, left-sided primary tumor, low MELD score, and non-diffuse unilobar disease were also found to be predictors prolonged survival on log-rank analysis (P's < 0.05). On multivariate analysis, receiving Y90 after failure of the first line of chemotherapy, low baseline MELD score, and baseline ECOG performance score of 0 were all found to be independent predictors of prolonged OS from the time of metastatic disease diagnosis (P's < 0.05). In patients with CRLM, receiving Y90 after failing the first line of chemotherapy, lack of genetic mutation, low MELD score, and lower tumor burden appear to be independent predictors of prolonged OS. Level 4, case-control study.

Predictors of Survival after Yttrium-90 Radioembolization of Chemotherapy-Refractory Hepatic Metastases from Breast Cancer

PurposeTo determine predictors of survival after transarterial radioembolization of hepatic metastases from breast cancer. Materials and MethodsTwenty-four patients with chemotherapy-refractory hepatic metastases from breast cancer who underwent radioembolization from 2013 to 2018 were evaluated based on various demographic and clinical factors before and after treatment. Overall survival (OS) was estimated by Kaplan–Meier method. Log-rank analysis was performed to determine predictors of prolonged OS from the time of first radioembolization and first hepatic metastasis diagnosis. ResultsMedian OS times were 35.4 and 48.6 months from first radioembolization and time of hepatic metastasis diagnosis, respectively. Radioembolization within 6 months of hepatic metastasis diagnosis was a positive predictor of survival from first radioembolization, with median OS of 38.9 months vs 22.1 months for others (P = .033). Estrogen receptor (ER)–positive status predicted prolonged survival (38.6 months for ER+ vs 5.4 months for ER−; P = .005). The presence of abdominal pain predicted poor median OS: 12.8 months vs 38.6 months for others (P < .001). The presence of ascites was also a negative predictor of OS (1.7 months vs 35.4 months for others; P = .037), as was treatment-related grade ≥ 2 toxicity at 3 months (5.4 months vs 38.6 months for others; P = .017). ConclusionsIn patients with metastatic breast cancer, radioembolization within 6 months of hepatic metastasis diagnosis and ER+ status appear to be positive predictors of prolonged survival. Conversely, baseline abdominal pain, baseline ascites, and treatment-related grade ≥ 2 toxicity at 3 months after treatment appear to be negative predictors of OS.

Outcomes of Yttrium-90 Radioembolization for Unresectable Combined Biphenotypic Hepatocellular-Cholangiocarcinoma

PurposeTo evaluate outcomes of yttrium-90 radioembolization in patients with combined biphenotypic hepatocellular-cholangiocarcinoma (cHCC-CC). Materials and MethodsA retrospective review of patients with biopsy-confirmed cHCC-CC treated with yttrium-90 radioembolization between 2012 and 2018 was performed. Twenty-two patients with cHCC-CC (mean age 65.6 y, 17 men, 5 women) underwent 29 radioembolization treatments (5 resin, 24 glass microspheres). Survival data were available in 21 patients, and hepatic imaging response data were available in 20 patients. Hepatic imaging response to radioembolization was assessed on follow-up CT or MR imaging using modified Response Evaluation Criteria In Solid Tumours criteria. Univariate stepwise Cox regression analysis was used to evaluate the association between demographic and clinical factors and survival. Logistic regression evaluated associations between clinical factors and response to treatment, overall response, and disease control. ResultsHepatic imaging response was as follows: 15% complete response, 40% partial response, 10% stable disease, and 35% progressive disease (55% response rate, 65% disease control rate). Two patients were downstaged or bridged to transplant, and 1 patient was downstaged to resection. Median overall survival was 9.3 mo (range, 2.5–31.0 mo) from time of radioembolization. Nonreponse to treatment, bilobar disease, presence of multiple tumors, and elevated carbohydrate antigen 19-9 before treatment were associated with reduced survival after radioembolization. ConclusionsRadioembolization is a viable option for locoregional control of cHCC-CC with good response and disease control rates.

3:54 PM Abstract No. 28 Predictors of survival in patients with advanced (Barcelona Clinic Liver Cancer C) hepatocellular carcinoma undergoing Yttrium-90 radioembolization therapy

To identify key clinical and imaging predictors of survival in patients undergoing Yttrium-90 radioembolization (Y90-RE) for advanced, Barcelona Clinic Liver Cancer (BCLC) C, hepatocellular carcinoma (HCC). In an IRB-approved study, patients with BCLC C HCC who underwent Y90-RE were retrospectively identified. Reason for BCLC C Status (i.e., Eastern Cooperative Oncology Group performance status (ECOG-PS), macrovascular invasion, and/or extrahepatic metastasis) and additional pre and post Y90-RE prognostic factors were recorded and analyzed. Median overall survival (OS) from first Y90-RE was calculated using Kaplan-Meier estimation and potential prognostic factors were tested for significance (p ≤0.05) using log-rank analysis. Between 2013 and 2018, 97 BCLC C HCC patients (79% male; 65 years mean age) underwent Y90-RE with a median OS (95% CI) of 13.7 months (10.8-16.9). Median OS for the 40 (41%) ECOG-PS driven BCLC C patients versus the 57 (59%) macrovascular invasion and/or extrahepatic metastasis driven BCLC C patients was 14.5 (10.8-20.5) versus 13.2 (6.9-16.9) months, respectively (p = 0.9). Prognostic factors associated with a prolonged median OS were absence of hepatic vein invasion (14.9 vs. 5.3; p = 0.0002), single hepatic lobe burden (15.4 vs. 7.2; p = 0.04), absence of anorexia (14.6 vs. 6.1; p = 0.004), normal baseline alkaline phosphatase (19.1 vs. 9.0; P <0.0001), normal baseline serum sodium (14.9 vs. 5.2; p = 0.01), greater post Y90-RS tumor shrinkage (14.9 vs. 5.2; p = 0.01), attainment of Milan eligibility status (20.8 vs. 9.6; p = 0.001), and complete/partial tumor response per mRECIST (17.5 vs. 7.3; p = 0.01). Y90-RE is an effective therapy for the treatment of BCLC C hepatocellular carcinoma patients, resulting in an overall survival that is equivalent, if not favorable, to currently allocated therapies per BCLC guidelines. Certain pre Y90-RE clinical and imaging characteristics are associated with an improved overall survival.Tabled 1Prognostic Factors, in median OS (95% CI) monthsPresentAbsentPHepatic vein invasion5.314.90.0002Single hepatic lobe burden15.47.20.04Anorexia6.114.60.004Normal baseline alkaline phosphatase19.19.00.0001Normal baseline sodium blood levels18.07.10.014Greater tumor shrinkage14.95.20.01Attained Milan eligibility status20.89.60.001Attained complete or partial tumor response, per mRECIST17.57.30.01 Open table in a new tab

Abstract No. 566 Yttrium-90 radioembolization for unresectable neuroendocrine liver metastases: report in an Asian population

Yttrium-90 radioembolization is one of the intra-arterial therapies for unresectable neuroendocrine liver metastases (NELM). However, the data regarding Asian population is lacking. The aim of this study is to present the efficacy of Yttrium-90 radioembolization (Y90-RE) in the treatment of NELM and identify prognostic factors for survival in pure Asian population. This retrospective study was approved by the institutional review board and requirement for informed consent was waived. Between May 2008 and December 2016, twenty-three patients (13 men, 10 women; age range, 33 – 77 years) with NELM treated with Y90-RE at our institute were enrolled. Response to therapy was assessed by RECIST criteria by using periprocedural MR imaging. Posttreatment three-month radiologic response and survival were measured as the clinical end points. Of the 23 patients, 31 Y90-RE sessions were performed with a mean delivered dose 1.5 ± 0.6 GBq (range, 0.5 – 3.0 GBq) of first treatment and 2.6 ± 1.6 GBq (range, 0.7 – 5.0 GBq) of second treatment. In 3 and 6 months imaging follow-up, 8 (34.8%) and 8 (34.8%) patients had radiographic partial response to treatment, 9 (39.1%) and 12 (52.2%) had stable disease, 3 (13.0%) and 1 (4.3%) developed progressive disease. Median survival was 37.4 months, with 1-, 2-, and 3-year overall survival rates of 78.3%, 56.5%, and 30.4%, respectively. In univariate analysis, resection of primary tumor (P = 0.023), post Y90 local regional treat (LRT) (P = 0.019) and 3 months disease control (P = 0.0) were associated with good survival. On the contrary, high-grade (grade 3) histopathology of tumor (P = 0.008), tumor burden > 50% (P = 0.013), estimated absorbed tumor dose 103Gy (P = 0.030) and progressive radiographic response at 3 months (P = 0.005) were related to worse survival. Multivariate analysis revealed that disease control at 3 months (HR 0.002, P = 0.031), primary tumor resection (HR 0.035, P = 0.023), Post Y90 LRTs(HR 0.031, P = 0.001)were a predictor for better survival outcome. In Asian NELM population who underwent Y90-RE, primary tumor resection, 3 month tumor response, and post Y90 LRTs can predict survival outcome.

3:00 PM Abstract No. 237 Additive benefit of yttrium-90 radioembolization to systemic therapy in patients with hepatic metastases from colorectal cancer in the salvage setting: results of a propensity-score matched study

The benefit of yttrium-90 (Y90) radioembolization in the setting of hepatic metastases from colorectal cancer is controversial in the salvage setting. This study assessed the efficacy of adding Y90 radioembolization to systemic therapy in patients with metastatic colorectal cancer to the liver. In this retrospective propensity-score, matched-pair study, 21 patients who underwent radioembolization plus systemic therapy were matched with a cohort of 173 patients who received systemic chemotherapy alone in the salvage setting. Patients were matched one-to-one on the basis of their Eastern Cooperative Oncology Group Performance Status (ECOG), presence of extrahepatic disease, and presence of KRAS mutation on tumor genetic testing. Survival data was calculated using Kaplan-Meier analysis with regards to both date of primary diagnosis and date of hepatic metastases. Survival curves were statistically compared using the Gehan-Breslow-Wilcoxon test. All 21 patients in each study arm matched all three matching criteria. Radioembolization was done with either glass (n = 3), resin (n = 17), or combination (n = 1) Y90 microspheres, in a unilobar (n = 4), sequential bilobar (n = 13), or whole liver (n = 4) approach using standard dosimetry parameters. Patients who underwent radioembolization plus systemic therapy versus those who had systemic therapy alone had similar demographics with regards to median age (62 v 59 years) and gender (14 v 14 male). Median survival from date of primary diagnosis was 38 v 25 months in radioembolization versus control (hazard ratio, 0.67, 95% CI 0.34 to 1.32). Median survival from date of hepatic metastases was 31 v 20 months in radioembolization versus control (hazard ratio, 0.62, 95% CI, 0.32 to 1.20). Comparison of survival curves demonstrated significantly improved survival from date of hepatic metastases (P = 0.03) with clinically-meaningful improved survival from date of primary diagnosis (P = 0.17) in patients who underwent radioembolization. The addition of radioembolization with yttrium-90 to systemic therapy in patients with metastatic colorectal cancer to the liver may benefit patients with limited treatment options in the salvage setting.

3:27 PM Abstract No. 240 Glass and resin Yttrium-90 radioembolization of uveal melanoma hepatic metastases

To evaluate hepatic progression free survival and overall survival of patients with metastatic uveal melanoma treated with yttrium-90 radioembolization using either glass or resin microspheres. Single center, retrospective 33-month review of 14 patients with metastatic uveal melanoma who received 23 radioembolization treatments (9 with glass and 14 with resin microspheres). In addition to demographic data, reviewed clinical variables included hepatic disease burden, prior locoregional therapy, extrahepatic metastatic disease, and peri-procedural immunotherapy. Calculated radiation dose to liver was determined for each procedure. Progression of hepatic disease was determined using the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Overall survival and hepatic progression free survival were calculated from date of first treatment. Fewer patients treated with glass microspheres had bilobar disease (29 vs. 86%, P = 0.03); however, there was no significant difference in the number of lesions (86 vs. 100% with more than four lesions, P = 0.30) or largest lesion size (mean, 3.6 vs. 2.4 cm, P = 0.34) between the glass and resin groups. There was also no significant difference in prior locoregional therapy (86% vs. 57% had prior percutaneous ablation, P = 0.24), extrahepatic disease (P = 1.00) or immunotherapy regimens (P = 0.21). Calculated radiation dose to treated liver was significantly higher for the glass group (123.3 vs. 66.9 Gy, P <0.01). Hepatic progression free survival (median, 17.0 vs. 9.6 months, P = 0.02) and overall survival (median, 33.0 vs. 16.5 months, P = 0.05) were significantly longer for patients treated with glass microspheres. In this study, patients with liver dominant metastatic uveal melanoma treated with glass yttrium-90 microspheres demonstrated longer median hepatic progression free survival and overall survival compared to patients treated with resin yttrium-90 microspheres. This may be attributable to differing dose calculations based on the medical internal radiation dose (MIRD) model and body surface area (BSA) method respectively. Further analysis with a larger study population is warranted.

Abstract No. 555 Long-term survival outcomes from integrating Yttrium-90 radioembolization with capecitabine–temozolomide for grade 2 liver-dominant metastatic neuroendocrine tumors

This study reports long-term survival statistics from a sample of patients who were treated concomitantly with Yttrium-90 radioembolization (y90) and systemic capecitabine–temozolomide (CapTem) for grade 2 liver-dominant metastatic neuroendocrine tumors. Twenty-five patients with unresectable grade 2 NET liver-dominant metastases without contraindications to radioembolization or to CapTem initiated therapy with capecitabine 600 mg/m2 twice daily for 14 days and temozolomide 150 to 200 mg/m2 in two divided doses on days 10 to 14, with 12 days between cycles. The dominant lobe was then radioembolized on day 7 of the second cycle. These patients were then followed with contrast-enhanced MRI of the abdomen to evaluate for recurrent disease using the RECIST criteria. Median progression-free survival (PFS) was 38 months (95% CI 23-62 months), with PFS at 1 and 2 years being 87% and 67%, respectively. Median hepatic progression-free survival (HPFS) was 52 months (95% CI 23-68 months), with HPFS at 1 and 2 years being 83% and 67%, respectively. There was no significant difference in PFS or HFPS when stratified between primary pancreatic neuroendocrine tumors and other histologies, with hazard ratios of 1.52(0.53-4.33, P = 0.44) and 0.96(0.29-3.16, P = 0.95), respectively. CapTemY90 appears to provide a synergistic effect, exceeding the expected PFS for G2 neuroendocrine tumors.

3:45 PM Abstract No. 242 Muscle mass on magnetic resonance imaging predicts hepatocellular carcinoma survival following Yttrium-90 radioembolization

3:45 PM Abstract No. 242 Muscle mass on magnetic resonance imaging predicts hepatocellular carcinoma survival following Yttrium-90 radioembolization

Abstract No. 549 Assessing the need for repeat dosimetry estimates for recurrent Yttrium-90 (Y90) radioembolization: is there a need for repeat macroaggregated albumin mapping prior to additional Y90 treatments of the same arterial distribution?

Abstract No. 549 Assessing the need for repeat dosimetry estimates for recurrent Yttrium-90 (Y90) radioembolization: is there a need for repeat macroaggregated albumin mapping prior to additional Y90 treatments of the same arterial distribution?

Abstract No. 550 Comparison of efficacy of primary Yttrium-90 radiation segmentectomy versus percutaneous microwave ablation in patients with ≤4-cm hepatocellular carcinoma

Current guidelines including Barcelona Clinic Liver Cancer (BCLC) criteria recommend thermal ablation for patients with 3 or fewer, <3-cm hepatocellular carcinoma (HCC) who are not surgical candidates. The objective of this study was to compare the tumor response and overall survival (OS) in patients with solitary, small (<4 cm) HCC treated with primary percutaneous microwave ablation (MWA) vs. Yttrium-90 (Y90) radioembolization radiation segmentectomy (RS). From March 2014 to March 2017, 118 consecutive treatment naïve patients with solitary HCC ≤4 cm were included. Baseline characteristics including patient age, gender, MELD score, BCLC stage and Child-Pugh (CP) scores were compared between the two groups using t-test and chi-square. Tumor response at 3 months post therapy was evaluated using modified Response Evaluation Criteria in Solid Tumors (m-RECIST). Survival from initial treatment was calculated using Kaplan-Meier estimation. Statistical analysis was performed using SPSS v25 (IBM, Armonk, NY) with significance set at 0.05. Overall, 118 consecutive patients were included of whom 75 patients were treated with MWA and 43 patients were treated with Y90 RS. Five of 75 patients (6.7%) in the MWA group and 2 of 43 patients in the RS were lost to follow-up. Median follow-up for the entire cohort was 30.2 months. The MWA group had smaller lesions diameter compared (1.7 cm) vs. those with RS (2.7 cm, P = 0.001). The MWA group had more patients who were ≤65 years (53.9% of patients) vs. RS group (37.2%, P = 0.079). While the MWA group had larger proportion of higher CP score (30.7% of CP B for MWA vs. 11.6% of CP B RS, P = 0.05), the RS group had higher BCLC B stage (76.7%) vs. 60.0% for MWA (P = 0.01). The incidence of favorable tumor response (partial or complete response) was similar for the two groups; 85.8% for MWA vs. 87.8% for RS (P = 0.49). There was no difference in OS from first procedure in the MWA group (46.4 months) vs. RS (43.7 months; P = 0.907). Our data suggests Y90 RS is noninferior to percutaneous MWA in the management of HCC lesions ≤4 cm with similar medium-term OS outcomes.Tabled 1MWAY90RSImaging Response (mRESIST) Complete Response57(76.0%)32(74.4%) Partial Response3(2.67%)4(9.30%) Stable Disease4(5.33%)2(4.65%)P=0.487 Progression of Disease6(8.0%)3(6.98%)Overall Survival (months)95% Confidence Interval46.3843.68P=0.907(41.47-51.286)(36.72-50.64) Open table in a new tab

Abstract No. 409 Survival and hepatic biochemical toxicities in patients treated with hepatic Yttrium-90 radioembolization for renal cell carcinoma metastases to the liver

To evaluate differences in biochemical toxicities and survival of patients who received whole liver versus partial liver Yttrium-90 (Y-90) glass microsphere radioembolization for renal cell carcinoma metastases (RCC) to the liver. A retrospective review of medical records was performed for 31 patients who received glass Y-90 microsphere hepatic radioembolization for metastatic RCC between July 2010 and July 2017 at a single institution. Patients were separated by whether they received whole liver (n = 12) or partial liver (n = 19) treatment, with the latter group encompassing single segmental, unilobar, and multisegmental treatment. Biochemical toxicities regarding AST, ALT, alkaline phosphatase, albumin, and total bilirubin were evaluated according to CTCAE 5.0 grading at most recent follow-up. Median follow-up from the last radioembolization for whole liver treatment was 12.66 months (range, 1 – 49.74 months) and for partial liver was 9.2 months (range, 1 – 72.6 months). Average dose per treatment for those receiving whole liver treatment was 140.58 Gy ± 32.62 and for partial liver treatment was 142.93 Gy ± 39.95. Patients receiving whole liver treatment displayed highest biochemical toxicity grades at most recent follow-up of 1, 2, 3, and 4 at rates of 25%, 33%, 33%, and 8.3% respectively. Patients receiving partial liver treatment displayed highest grades of 1, 2, and 3 at rates of 37%, 15.7%, and 5.2% respectively. There was a statistically significant difference in median survival from the date of liver metastases diagnosis, with 23.24 months for the whole liver group and 34.55 months for the partial liver group (P = 0.042). There was no statistically significant difference in survival from the date of radioembolization between the partial and whole liver groups, 21.56 vs. 16.41 months, respectively (P = 0.115). Patients receiving whole liver treatment experienced higher biochemical toxicities and shorter overall median survival from the date of diagnosis of liver metastases compared to partial liver treatment, which could be related to larger tumors burden, and/or higher radiation exposure.

Abstract No. 716 Long-term outcomes of Yttrium-90 radioembolization for hepatocellular carcinoma due to underlying non-alcoholic steatohepatitis

Abstract No. 716 Long-term outcomes of Yttrium-90 radioembolization for hepatocellular carcinoma due to underlying non-alcoholic steatohepatitis

Abstract No. 567 Yttrium-90 radioembolization therapy for combined hepatocellular and cholangiocarcinoma

To report outcomes of transarterial radioembolization (TARE) using glass microspheres for the treatment of mixed hepatocellular-cholangiocarcinoma (HCC-CC). Between 2013 and 2019, 10 consecutive patients with histologically confirmed HCC-CC received 1 or 2 TARE treatments of a targeted territory using glass microspheres. Baseline demographics in addition to tumor distribution, Child Pugh score, and BCLC were recorded. Tumor response was assessed according to modified RECIST criteria. Six-month mortality and adverse events were monitored for each patient. Adverse events were graded by standardized criteria using the Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Eight (80%) patients (4 males, 4 females) received a single TARE treatment and two (20%) patients underwent two. Tumor responses at 6 months were complete and partial in 80% and 20% patients respectively. No patients demonstrated tumor progression. No major toxicity was observed after 1st or 2nd treatment of RE. Two grade 2 adverse events were seen (Table 1). 6-month mortality was 10% (n = 1). While outcomes of combined HCC-CC are poor and optimal treatment remains undefined, TARE appears to represent a safe and promising locoregional treatment for disease control with an acceptable toxicity profile.Table 1Patient #Adverse Events after 1st Procedure (CTCAE Grade)Adverse Events after 2nd Procedure (CTCAE Grade)6 Month Mortality1 Year Mortality2 Year MortalityChild Pugh ScoreBCLCTumor LocationRECIST Rating1NoneNoneYYY6 (A)BRPartial2Abdominal Pain and Fatigue (2)NoneNNN5 (A)BLComplete3Fever (2)NoneNNN5 (A)ARComplete4NoneNoneNNN5 (A)ABiliary DuctComplete5NoneNoneNNN6 (A)ALComplete6NoneNoneNNN5 (A)ARComplete7NoneNoneNNN5 (A)ARPartial8NoneNoneNNN5 (A)ARComplete9NoneNoneNNN5 (A)ARComplete10NoneNoneNNN5 (A)ALComplete Open table in a new tab

3:18 PM Abstract No. 24 Improved tumor response in patients undergoing yttrium-90 radioembolization segmentectomy for hepatocellular carcinoma while on metformin

3:18 PM Abstract No. 24 Improved tumor response in patients undergoing yttrium-90 radioembolization segmentectomy for hepatocellular carcinoma while on metformin

Yttrium-90 radioembolization for unresectable hepatic metastases of breast cancer: A systematic review.

BACKGROUNDLiver metastases secondary to breast cancer are associated with unfavourable prognosis. Radioembolization with ytrrium-90 is an emerging option for management of liver metastases of breast cancer when other systemic therapies have failed to achieve disease control. However, unlike the case of other liver tumours (colorectal/melanoma metastases/cholangiocarcinoma), its role in the management of breast liver metastases is yet to be elucidated.AIMThe aims of this systematic review were to (1) assess the effect of radioembolization with yttrium-90 on tumour response; and (2) to estimate patient survival post radioembolization.METHODSThe review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A systematic literature search was performed using the PubMed and EMBASE databases from January 2007 to December 2018. The initial search yielded 265 reports which were potentially suitable for inclusion in this review. Studies published in English reporting at least one outcome of interest were considered to be suitable for inclusion. Conference abstracts; case reports, animal studies and reports not published in English were excluded from this review. Data was retrieved from each individual report on the name of primary author, year of publication, patient demographics, type of microspheres used, radiation dose delivered to tumour, duration of follow-up, disease control rate (%), tumour response, and overall patient survival.RESULTSThe final number of studies which met the inclusion criteria was 12 involving 452 patients. There were no randomized controlled trials identified after the literature search. The age of the patients included in this review ranged from 52 to 61 years. The duration of the follow up period post-radioembolization ranged from 6 to 15.7 mo. The total number of patients with breast metastases not confined to the liver was 236 (52.2%). Cumulative analysis revealed that radioembolization with yttrium-90 conferred tumour control rate in 81% of patients. Overall survival post-radioembolization ranged from 3.6 to 20.9 mo with an estimated mean survival of 11.3 mo.CONCLUSIONRadioembolization with ytrrium-90 appears to confer control of tumour growth rate in most patients, however its effect on patient survival need to be elucidated further. Furthermore, quality evidence in the form of randomized trials is needed in order to assess the effect of radioembolization in more depth.

Yttrium-90 radioembolization for hepatocellular carcinoma: Outcome prediction with MRI derived fat-free muscle area

PurposeSarcopenia is associated with adverse outcomes in several gastrointestinal malignancies and liver cirrhosis. We aimed to study the utility of magnetic resonance imaging (MRI) derived fat-free muscle area (FFMA) to predict clinical outcome in patients receiving yttrium-90 radioembolization (RE) for treatment of hepatocellular carcinoma (HCC). MethodsFifty-eight patients with unresectable HCC and pre-interventional liver MRI undergoing salvage RE were retrospectively evaluated. Using axial T2-weighted turbo spin echo sequences, FFMA was calculated by subtraction of the intramuscular adipose tissue area from the total cross-sectional area of paraspinal skeletal muscles at the superior mesenteric artery level. FFMA values lower than 3582 mm2 in male and 2301 mm2 in female patients were defined as low FFMA. Main outcomes were progression-free survival (PFS) and overall survival (OS). For outcome analysis, the Kaplan-Meier method with log rank test and multivariate cox regression analysis were used. ResultsMean time from pre-interventional MRI to RE was 27 ± 20 days. Median OS and PFS after RE were 250 (range: 21–1230 days) and 156 days (range: 21–674 days), respectively. Patients with low FFMA showed significantly reduced OS (197 vs. 294 days, P = 0.024) and tended to have shortened PFS (109 vs. 185 days, P = 0.068). Low FFMA (HR 2.675; P = 0.011), estimated liver tumor burden (HR 4.058; P = 0.001), and Eastern Cooperative Oncology Group (ECOG) performance status (1.763; P = 0.009) were independent predictors of OS on multivariate analysis. ConclusionsFFMA as a measure of sarcopenia predicts OS and might represent a promising new biomarker for survival prognosis in patients undergoing RE for treatment of unresectable HCC.

Immunotherapy with Y90-radioembolization for metastatic colorectal cancer (iRE-C).

TPS276 Background: Immune checkpoint inhibitors have revolutionized the treatment of a number of cancers. In colorectal cancers, their efficacy is limited to mismatch repair deficient or microsatellite stability-high (dMMR/MSI-High) tumors only. These constitute only 4-5% of all metastatic colorectal cancers (mCRC). Novel approaches are needed to make immunotherapy a viable option for mismatch repair proficient or microsatellite stable (pMMR/MSS) tumors. Increasing exposure of neo-antigens to the immune system could be one potential strategy to enhance the response of immunotherapy. Yttrium 90-radioembolization (Y90-RE) in combination with immunotherapy may work synergistically to enhance efficacy of each other. Additionally, radiation can potentially make the tumor microenvironment conducive to effector T-cell recruitment and function. Therefore, we hypothesize and propose the clinical trial of combining immunotherapy with Y90-RE as a feasible and safe strategy that will improve outcomes in patients with mCRC with liver-predominant metastases. Methods: This clinical trial will be conducted as a single-center, open-label, Phase I/II trial to evaluate initially the feasibility and safety of Y90-RE in combination with a fixed dose of immunotherapy (durvalumab) in subjects with liver-predominant, mCRC (Table). It will be offered in the refractory setting. The trial will be performed in 18 subjects with mCRC with liver metastasis and the safety of immunotherapy (durvalumab) with Y90-RE will be investigated in an accelerated titration design. This would allow a maximum tolerated dose with the minimum number of subjects. Correlative studies pertaining to serial circulating tumor DNA (ctDNA - liquid biopsies) testing as well as immune-panel based profiling will be performed alongside pre- and post-biopsies to study changes in the tumor microenvironment. Clinical trial information: NCT04108481. [Table: see text]