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1.
J Clin Oncol ; 39(35): 3897-3907, 2021 12 10.
Article in English | MEDLINE | ID: mdl-34541864

ABSTRACT

PURPOSE: To study the impact of transarterial Yttrium-90 radioembolization (TARE) in combination with second-line systemic chemotherapy for colorectal liver metastases (CLM). METHODS: In this international, multicenter, open-label phase III trial, patients with CLM who progressed on oxaliplatin- or irinotecan-based first-line therapy were randomly assigned 1:1 to receive second-line chemotherapy with or without TARE. The two primary end points were progression-free survival (PFS) and hepatic PFS (hPFS), assessed by blinded independent central review. Random assignment was performed using a web- or voice-based system stratified by unilobar or bilobar disease, oxaliplatin- or irinotecan-based first-line chemotherapy, and KRAS mutation status. RESULTS: Four hundred twenty-eight patients from 95 centers in North America, Europe, and Asia were randomly assigned to chemotherapy with or without TARE; this represents the intention-to-treat population and included 215 patients in the TARE plus chemotherapy group and 213 patients in the chemotherapy alone group. The hazard ratio (HR) for PFS was 0.69 (95% CI, 0.54 to 0.88; 1-sided P = .0013), with a median PFS of 8.0 (95% CI, 7.2 to 9.2) and 7.2 (95% CI, 5.7 to 7.6) months, respectively. The HR for hPFS was 0.59 (95% CI, 0.46 to 0.77; 1-sided P < .0001), with a median hPFS of 9.1 (95% CI, 7.8 to 9.7) and 7.2 (95% CI, 5.7 to 7.6) months, respectively. Objective response rates were 34.0% (95% CI, 28.0 to 40.5) and 21.1% (95% CI, 16.2 to 27.1; 1-sided P = .0019) for the TARE and chemotherapy groups, respectively. Median overall survival was 14.0 (95% CI, 11.8 to 15.5) and 14.4 months (95% CI, 12.8 to 16.4; 1-sided P = .7229) with a HR of 1.07 (95% CI, 0.86 to 1.32) for TARE and chemotherapy groups, respectively. Grade 3 adverse events were reported more frequently with TARE (68.4% v 49.3%). Both groups received full chemotherapy dose intensity. CONCLUSION: The addition of TARE to systemic therapy for second-line CLM led to longer PFS and hPFS. Further subset analyses are needed to better define the ideal patient population that would benefit from TARE.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Chemoradiotherapy/mortality , Colorectal Neoplasms/therapy , Embolization, Therapeutic/mortality , Liver Neoplasms/therapy , Yttrium Radioisotopes/therapeutic use , Bevacizumab/administration & dosage , Case-Control Studies , Colorectal Neoplasms/pathology , Female , Follow-Up Studies , Humans , Irinotecan/administration & dosage , Liver Neoplasms/secondary , Male , Middle Aged , Oxaliplatin/administration & dosage , Prognosis , Survival Rate
2.
Chirurgia (Bucur) ; 117(6): 635-642, 2022 Dec.
Article in English | MEDLINE | ID: mdl-36584055

ABSTRACT

Surgical treatments of advanced tumors have expanded in the last two decades as a result of ad-vances in surgical techniques, advanced interventional radiology methods, improved intensive care unit settings and increased overall life expectancy. Advanced liver tumors represent a broad category from various malignancies such as liver metastasis or native liver tumors. Not uncom-monly these tumors are not amenable to curative treatment and require down-staging, or local control at the initial diagnosis. Herein we discuss the portal vein embolization (PVE), transarterial radioembolization (TARE) with Yttrium-90 (Y-90), and surgical options namely, two-staged hepatectomy (TSH), and associating liver partition and portal vein ligation for staged hepatecto-my (ALPPS) as bridging strategies for definitive surgical treatment.


Subject(s)
Liver Neoplasms , Yttrium Radioisotopes , Humans , Yttrium Radioisotopes/therapeutic use , Treatment Outcome , Liver Neoplasms/surgery , Liver Neoplasms/secondary , Liver , Hepatectomy/methods , Portal Vein/surgery , Ligation
3.
Rev. esp. med. nucl. imagen mol. (Ed. impr.) ; 41(6): 368-372, nov. - dic. 2022. ilus, graf
Article in Spanish | IBECS | ID: ibc-212062

ABSTRACT

Introducción Entre los objetivos en los tratamientos con esferas marcadas con ytrio-90 figura demostrar que se consigue la dosis tumoricida y que se evitan dosis hepatotóxicas, así como que no existe deposición extrahepática. Material y métodos Utilizamos diferentes cantidades de ytrio y un maniquí NEMA NU2-2007 para comprobar si el tomógrafo mantiene una respuesta que permita hacer cálculos dosimétricos reales. Resultados El tomógrafo Gemini responde de manera lineal en un rango amplio de actividades con una R2=0,9983. Conclusión La capacidad de detección del equipo PET nos permite realizar estudios de cuerpo estándar con finalidad dosimétrica con tiempos de 5min por BED, que además hacen posible verificar la ausencia de deposición extrahepática de cantidades significativas de esferas de ytrio-90 (AU)


Introduction Among the objectives in treatments with yttrium-90 spheres is to demonstrate that the tumoricidal dose is achieved and that hepatotoxic doses are avoided, as well as that there is no extrahepatic deposition. Material and methods We use different amounts of yttrium-90 resin micro-spheres and a NEMA NU2-2007 phantom to check if the scanner maintains a response that allows real dosimetric calculations. Results The Gemini tomograph responds linearly in a wide range of activities with R2=0.9983. Conclusion The detection capacity of the PET equipment allows us to carry out standard body studies with dosimetric purposes with times of five minutes per BED. It also make possible to verify the absence of extrahepatic deposition of significant amounts of yttrium 90 spheres (AU)


Subject(s)
Humans , Positron Emission Tomography Computed Tomography , Yttrium Radioisotopes/therapeutic use , Radiometry , Calibration
4.
Curr Oncol ; 29(10): 7051-7058, 2022 Sep 28.
Article in English | MEDLINE | ID: mdl-36290830

ABSTRACT

Purpose: We describe our experience with the development of hepatobiliary infection in patients with prior surgical, percutaneous, or endoscopic biliary interventions who are receiving transarterial radioembolization (TARE) with yttrium-90 (90Y) for primary or metastatic hepatobiliary lesions. Methods: Records of 15 patients with a history of prior biliary intervention and liver malignancy subsequently treated with TARE at the participating medical center from November 2009 to September 2015 were reviewed. The primary endpoint was the development of a hepatic abscess or cholangitis in a patient after radioembolization. Results: A total of 15 patients comprising 9 men and 6 women, with a median age of 49 years (range 30-73), underwent 17 TARE with 90Y procedures. Of the 15 patients, 2 (13.3%) of them developed a hepatobiliary infection. A single patient (6.6%) developed a hepatobiliary abscess. Conclusion: Our study shows a low incidence rate of hepatic abscess following TARE in patients with prior biliary intervention.


Subject(s)
Liver Abscess , Neoplasms , Sphincter of Oddi , Male , Humans , Female , Adult , Middle Aged , Aged , Yttrium Radioisotopes/therapeutic use , Liver Abscess/etiology , Anastomosis, Surgical/adverse effects , Neoplasms/complications
5.
Rev Esp Med Nucl Imagen Mol (Engl Ed) ; 41(6): 368-372, 2022.
Article in English | MEDLINE | ID: mdl-36195255

ABSTRACT

INTRODUCTION: Among the objectives in treatments with yttrium-90 spheres, is to demonstrate that the tumoricidal dose is achieved and that hepatotoxic doses are avoided, as well as that there is no extrahepatic deposition. MATERIAL AND METHODS: We use different amounts of yttrium-90 resin micro-spheres and a NEMA NU2-2007 phantom to check if the scanner maintains a response that allows real dosimetric calculations. RESULTS: The Gemini tomograph responds linearly in a wide range of activities with R2 = 0.9983. CONCLUSION: The detection capacity of the PET equipment allows us to carry out standard body studies with dosimetric purposes with times of five minutes per bed. It also make possible to verify the absence of extrahepatic deposition of significant amounts of yttrium 90 spheres.


Subject(s)
Positron Emission Tomography Computed Tomography , Positron-Emission Tomography , Calibration , Yttrium Radioisotopes/therapeutic use
6.
Appl Radiat Isot ; 190: 110423, 2022 Dec.
Article in English | MEDLINE | ID: mdl-36183659

ABSTRACT

Selective-intra-arterial radionuclide therapy (SIRT) using radiolabeled microspheres are being widely employed for the delivery of therapeutic radioisotope to liver cancers by exploiting the dual blood supply to liver. It delivers the therapeutic radiations to tumor and spares the healthy liver. Several radiolabeled microspheres formulations, labelled with 90Y, are commercially available. However, high-cost leads to unaffordability for several patients. 188Re-based therapy seems affordable due to commercial availability of 188W/188Re generator that have long shelf-life of more than 6 months. To provide affordable solution, the microsphere cold kit with quick and facile methodology for 188Re radiolabeling has been developed. The microsphere cold kit has been characterized for their physicochemical properties. The Quality Control (QC) tests were also performed for clinical application. The feasibility studies were performed to study distribution and retention of 188Re microspheres in tumor. The results demonstrated that the developed cold kit enables facile and quick radiolabeling with 188Re. 188Re microspheres showed good retention in tumor and found suitable for SIRT.


Subject(s)
Liver Neoplasms , Rhenium , Sirtuins , Humans , Microspheres , Feasibility Studies , Rhenium/therapeutic use , Radioisotopes/therapeutic use , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/radiotherapy , Liver Neoplasms/blood supply , Yttrium Radioisotopes/therapeutic use , Yttrium Radioisotopes/chemistry
7.
Cardiovasc Intervent Radiol ; 45(12): 1842-1847, 2022 Dec.
Article in English | MEDLINE | ID: mdl-36175653

ABSTRACT

PURPOSE: To investigate the reduction of elevated shunts after treatment with sorafenib in hepatocellular carcinoma (HCC) patients planned for transarterial radioembolization (TARE). MATERIALS AND METHODS: Sixteen HCC patients treated with sorafenib were investigated. Shunts were evaluated by SPECT/CT after Technetium-99 m Tc-macroaggregated albumin injection. RESULTS: All patients had high LSF (median 43.5%, range 28-86), and two (12.5%) of them had widespread intrahepatic shunts with concomitants elevated (36%) and acceptable (18%) lung shunt fraction (LSF). The mean duration of the sorafenib use was 134.4 ± 59.2 days. While one patient (6.25%) developed hand-foot syndrome, minor side effects were seen in all patients. After sorafenib use, LSF fell below 20% in eight patients, and TARE was applied to all of them. There was strong negative correlation between the failure of shunt reduction and presence of macrovascular invasion (ρ = - 0.775) and infiltrative tumour type (ρ = - 0.775). CONCLUSION: Sorafenib use may be beneficial in some selected HCC patients with elevated shunts. Expected results may not be obtained in patients with infiltrative tumour type or macrovascular invasion, but patients with nodular tumour type with the absence of macrovascular invasion may be appropriate candidates for shunt reduction with ensuring subsequent TARE. Further investigations with sufficient patient population and standardized protocols of follow-up periods are needed to clarify the values for sorafenib use in HCC patients with evaluated shunts.


Subject(s)
Carcinoma, Hepatocellular , Embolization, Therapeutic , Liver Neoplasms , Humans , Carcinoma, Hepatocellular/drug therapy , Carcinoma, Hepatocellular/pathology , Sorafenib/therapeutic use , Yttrium Radioisotopes/therapeutic use , Liver Neoplasms/therapy , Retrospective Studies , Embolization, Therapeutic/methods , Treatment Outcome
8.
Cardiovasc Intervent Radiol ; 45(11): 1579-1589, 2022 Nov.
Article in English | MEDLINE | ID: mdl-36104632

ABSTRACT

The liver represents the most frequent location of metastatic disease in colorectal cancer (CRC). In oligometastatic disease, while surgery remains the mainstay of treatment, loco-regional therapies allow to locally control tumor progression and prolong survival. There is consensus in the use of transhepatic arterial radioembolization (TARE) in metastatic CRC chemorefractory patients, with liver-only or liver-dominant disease. Beyond this indication, TARE may be considered in other clinical scenarios, such as in the second-line combined with chemotherapy, as a bridge in between different lines of systemic therapies, and as ablative technique under specific circumstances. This paper outlines the current evidence for TARE in mCRC and presents possible future indications and directions.


Subject(s)
Brachytherapy , Colonic Neoplasms , Colorectal Neoplasms , Embolization, Therapeutic , Liver Neoplasms , Rectal Neoplasms , Humans , Brachytherapy/methods , Colorectal Neoplasms/pathology , Embolization, Therapeutic/methods , Liver Neoplasms/therapy , Yttrium Radioisotopes/therapeutic use , Neoplasm Metastasis
9.
Cardiovasc Intervent Radiol ; 45(11): 1725-1734, 2022 Nov.
Article in English | MEDLINE | ID: mdl-36008574

ABSTRACT

PURPOSE: The primary objective of the REMEMBR Y90 study is to evaluate the efficacy of Yttrium-90 (Y90) radioembolization in patients with breast cancer metastases to the liver as a 2nd or 3rd line treatment option with systemic therapy by assessing liver-specific and overall progression-free survival. Secondary objectives include quality of life, overall survival benefit, and toxicity in relation to patients' tumor biology. MATERIALS AND METHODS: This trial is a multi-center, prospective, Phase 2, open-label, IRB-approved, randomized control trial in the final phases of activation. Eligible patients include those over 18 years of age with metastatic breast cancer to the liver with liver-only or liver-dominant disease, and history of tumor progression on 1-2 lines of chemotherapy. 60 patients will be randomized to radioembolization with chemotherapy versus chemotherapy alone. Permissible regimens include capecitabine, eribulin, vinorelbine, and gemcitabine within 2 weeks of enrollment for every patient. Patients receiving radioembolization will receive lobar or segmental treatment within 1-6 weeks of enrollment depending on their lesion. After final radioembolization, patients will receive clinical and imaging follow-up every 12-16 weeks for two years, including contrast-enhanced computed tomography or magnetic resonance imaging of the abdomen and whole-body positron emission tomography/computed tomography. DISCUSSION: This study seeks to elucidate the clinical benefit and toxicity of Y90 in patients with metastatic breast cancer to the liver who are receiving minimal chemotherapy. Given previous data, it is anticipated that the use of Y90 and chemotherapy earlier in the metastatic disease course would improve survival outcomes and reduce toxicity. LEVEL OF EVIDENCE: Level 1b, Randomized Controlled Trial. TRIAL REGISTRATION NUMBER: NCT05315687 on clinicaltrials.gov.


Subject(s)
Breast Neoplasms , Liver Neoplasms , Humans , Adolescent , Adult , Female , Yttrium Radioisotopes/therapeutic use , Liver Neoplasms/therapy , Prospective Studies , Quality of Life , Abdomen , Treatment Outcome , Randomized Controlled Trials as Topic , Multicenter Studies as Topic , Clinical Trials, Phase II as Topic
10.
Appl Radiat Isot ; 188: 110405, 2022 Oct.
Article in English | MEDLINE | ID: mdl-35987141

ABSTRACT

90Y bremsstrahlung Single-Photon Emission Tomography (SPECT) imaging is employed to check the possibility of extrahepatic uptake and the quantification of delivered dose in Transarterial Radioembolization (TARE). 90Y bremsstrahlung SPECT imaging is challenging due to the nature of bremsstrahlung photons. We reported a Monte Carlo study using the resin microspheres loaded with 90Y and Nanoparticles (NPs) in the TARE. By injection of Bismuth (Bi) and Europium (Eu) NPs into the resin microspheres, the sensitivity and the contrast to noise ratio increased for the bremsstrahlung planar images. The highest signal to background ratio was observed in the characteristic X-ray planar images taken with the energy window at the Kα1 ± 10 keV when Eu NPs were incorporated into the microsphere. The dose enhancement ratio decreased dramatically at NP concentrations >2.4 M. Incorporating NPs into the resin microspheres improves the quality of post-treatment images and establishes a standardized imaging protocol for post-treatment imaging by characteristic X-rays.


Subject(s)
Brachytherapy , Embolization, Therapeutic , Liver Neoplasms , Nanoparticles , Humans , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/radiotherapy , Microspheres , Tomography, Emission-Computed, Single-Photon/methods , Yttrium Radioisotopes/therapeutic use
11.
Cardiovasc Intervent Radiol ; 45(11): 1608-1621, 2022 Nov.
Article in English | MEDLINE | ID: mdl-35982334

ABSTRACT

Trans-arterial radioembolization is currently performed using 90Y-loaded glass or resin microspheres and also using 166Ho-loaded microspheres. The goal of this review is to present dosimetry and radiobiology concepts, the different dosimetry approaches available (simulation-based dosimetry and post-treatment dosimetry), main confounding factors as main clinical dosimetry results provided during the last decade for both hepatocellular carcinoma (HCC) and metastases of colorectal carcinoma (mCRC). Based on the different number of microspheres or different isotope used, radiobiology of the three devices is different, meaning that tumouricidal doses and maximal tolerated doses are different. Tumouricidal doses described for HCCs were 100-120 grays (Gy) with 90Y resin microspheres and 205 Gy with 90Y glass microspheres. For mCRC, it is 39-60 with 90Y resin microspheres, 139 Gy with 90Y glass microspheres and 90 Gy with 166Ho microspheres. An impact of tumoural doses with overall survival has also been reported. Personalised dosimetry has been developed and is now recommended by several international expert groups. Level-one evidence of the major impact of personalised dosimetry on response and overall survival in HCC is now available, bringing a new standard approach for TARE in clinical practice as well as for trial design.


Subject(s)
Brachytherapy , Carcinoma, Hepatocellular , Colorectal Neoplasms , Embolization, Therapeutic , Liver Neoplasms , Humans , Carcinoma, Hepatocellular/therapy , Liver Neoplasms/therapy , Embolization, Therapeutic/methods , Radiometry , Microspheres , Colorectal Neoplasms/pathology , Yttrium Radioisotopes/therapeutic use
12.
Cytokine Growth Factor Rev ; 67: 1-10, 2022 10.
Article in English | MEDLINE | ID: mdl-35945096

ABSTRACT

In the last decade, immunotherapy with immune checkpoint inhibitors (ICIs) has changed the therapeutic algorithm of cancer patients. ICIs combined with other therapeutic options, such as chemo- and targeted therapies, generate impressive results in cancer patients. Locoregional treatments (LRTs) play an important role in the management of various solid tumors (e.g., hepatocellular carcinoma (HCC), neuroendocrine tumors, etc.), and this therapeutic approach may enhance the activity of the immune response to tumor cells destroying primary tumors and leading to the release of several soluble molecules. This systematic review was performed to identify studies reporting objective response rate (ORR) and survival information in patients with solid tumors treated with ICIs plus LRTs. In the present work, fourteen studies were included, and the majority of them (five studies) enrolled patients with hepatocellular carcinoma (HCC), whereas the others included patients with different diseases. The highest ORRs were seen in HCC (67%, Y-90 RE plus ipilimumab and nivolumab) and melanoma (38%, dendritic cells with mRNA plus ipilimumab) patients. ORRs were not observed in liver metastases from melanoma and colorectal cancer. These data suggest that combination of ICIs and LRTs is feasible and more active in primary tumors (particularly HCC) than metastases with a synergistic effect on antitumor immunity. However, further studies are needed to better select patients, schedules, and setting of treatments.


Subject(s)
Carcinoma, Hepatocellular , Liver Neoplasms , Melanoma , Carcinoma, Hepatocellular/drug therapy , Humans , Immune Checkpoint Inhibitors , Ipilimumab/therapeutic use , Liver Neoplasms/drug therapy , Melanoma/drug therapy , Yttrium Radioisotopes/therapeutic use
13.
Cardiovasc Intervent Radiol ; 45(11): 1622-1633, 2022 Nov.
Article in English | MEDLINE | ID: mdl-35941244

ABSTRACT

Selective internal radiation therapy represents an endovascular treatment option for patients with primary liver malignancies, in different clinical stages. Potential applications of this treatment are in early-stage hepatocellular carcinoma, as a curative option, or in combination with systemic treatments in intermediate and advanced-stages. This review, based on existing literature and ongoing trials, will focus on the future of this treatment in patients with hepatocellular carcinoma, in combination with systemic treatments, or with the use of new devices and technological developments; it will also describe new potential future indications and structural and organizational perspectives.


Subject(s)
Brachytherapy , Carcinoma, Hepatocellular , Liver Neoplasms , Sirtuins , Humans , Carcinoma, Hepatocellular/therapy , Liver Neoplasms/therapy , Yttrium Radioisotopes/therapeutic use , Sirtuins/therapeutic use
14.
Cardiovasc Intervent Radiol ; 45(12): 1793-1800, 2022 Dec.
Article in English | MEDLINE | ID: mdl-35925379

ABSTRACT

RATIONALE: Currently, the estimated absorbed radiation dose to the lung in 90Y radioembolization therapy is calculated using an assumed 1 kg lung mass for all patients. The aim of this study was to evaluate whether using a patient-specific lung mass measurement for each patient rather than a generic, assumed 1 kg lung mass would change the estimated lung absorbed dose. METHODS: A retrospective analysis was performed on 68 patients who had undergone 90Y radioembolization therapy at our institution. Individualized lung volumes were measured manually on CT scans for each patient, and these volumes were used to calculate personalized lung masses. The personalized lung masses were used to recalculate the estimated lung absorbed dose from the 90Y therapy, and this dose was compared to the estimated lung absorbed dose calculated using an assumed 1 kg lung mass. RESULTS: Patient-specific lung masses were significantly different from the generic 1 kg when compared individually for each patient (p < 0.0001). Median individualized lung mass was 0.71 (IQR: 0.59, 1.02) kg overall and was significantly different from the generic 1 kg lung mass for female patients [0.59 (0.50, 0.68) kg, (p < 0.0001)] but not for male patients [0.99 (0.71, 1.14) kg, (p = 0.24)]. Median estimated lung absorbed dose was 4.48 (2.38, 11.71) Gy using a patient-specific lung mass and 3.45 (1.81, 6.68) Gy when assuming a 1 kg lung mass for all patients. The estimated lung absorbed dose was significantly different using a patient-specific versus generic 1 kg lung mass when comparing the doses individually for each patient (p < 0.0001). The difference in the estimated lung absorbed dose between the patient-specific and generic 1 kg lung mass method was significant for female patients as a subgroup but not for male patients. CONCLUSIONS: The current method of assuming a 1 kg lung mass for all patients inaccurately estimates the lung absorbed dose in 90Y radioembolization therapy. Using patient-specific lung masses resulted in estimated lung absorbed doses that were significantly different from those calculated using an assumed 1 kg lung mass for all patients. A personalized dosimetry method that includes individualized lung masses is necessary and can warrant a 90Y dose reduction in some patients with lung masses smaller than 1 kg. LEVEL OF EVIDENCE: Level 3, Retrospective Study.


Subject(s)
Embolization, Therapeutic , Liver Neoplasms , Humans , Male , Female , Yttrium Radioisotopes/therapeutic use , Retrospective Studies , Yttrium , Radiometry , Lung/diagnostic imaging , Liver Neoplasms/drug therapy , Embolization, Therapeutic/methods , Microspheres
15.
Eur J Nucl Med Mol Imaging ; 49(13): 4716-4726, 2022 11.
Article in English | MEDLINE | ID: mdl-35916920

ABSTRACT

PURPOSE: To compare the treatment response and progression-free survival (PFS) in advanced hepatocellular carcinoma (HCC) patients who received sorafenib treatment either alone or combined with radioembolization (RE). METHODS: Follow-up images of the patients treated within a multicenter phase II trial (SORAMIC) were assessed by mRECIST. A total of 177 patients (73 combination arm [RE + sorafenib] and 104 sorafenib arm) were included in this post-hoc analysis. Response and progression characteristics were compared between treatment arms. Survival analyses were done to compare PFS and post-progression survival between treatment arms. Multivariate Cox regression analysis was used to compare survival with factors known to influence PFS in patients with HCC. RESULTS: The combination arm had significantly higher objective response rate (61.6% vs. 29.8%, p < 0.001), complete response rate (13.7% vs. 3.8%, p = 0.022), and a trend for higher disease control rate (79.2% vs. 72.1%, p = 0.075). Progression was encountered in 116 (65.5%) patients and was more common in the sorafenib arm (75% vs. 52.0%, p = 0.001). PFS (median 8.9 vs. 5.4 months, p = 0.022) and hepatic PFS were significantly better in the combination arm (9.0 vs. 5.7 months, p = 0.014). Multivariate analysis confirmed the treatment arm as an independent predictor of PFS. CONCLUSION: In advanced HCC patients receiving sorafenib, combination with RE has an additive anticancer effect on sorafenib treatment resulting in a higher and longer tumor response. However, the enhanced response did not translate into prolonged survival. Better patient selection and superselective treatment could improve outcomes after combination therapy.


Subject(s)
Carcinoma, Hepatocellular , Liver Neoplasms , Humans , Carcinoma, Hepatocellular/therapy , Sorafenib/therapeutic use , Sorafenib/adverse effects , Yttrium Radioisotopes/therapeutic use , Liver Neoplasms/drug therapy , Phenylurea Compounds/therapeutic use
16.
Cardiovasc Intervent Radiol ; 45(11): 1590-1598, 2022 Nov.
Article in English | MEDLINE | ID: mdl-35918431

ABSTRACT

The liver is the most common site of metastasis for neuroendocrine tumors originating from the gastrointestinal tract. Neuroendocrine liver metastases (NELMs) portend a worsening clinical course, making local management important. Local treatment options include surgery, thermal ablation, and trans-catheter intra-arterial therapies, such as radioembolization. Radioembolization is generally preferred over other embolotherapies in patients with colonized biliary systems. Current best practice involves personalized treatment planning, optimizing tumor radiation absorbed dose and minimizing radiation to the normal hepatic parenchyma. As part of a multidisciplinary approach, radioembolization is a versatile embolotherapy offering neoadjuvant, palliative, and ablative treatment options for patients with NELMs.


Subject(s)
Brachytherapy , Embolization, Therapeutic , Liver Neoplasms , Neuroendocrine Tumors , Humans , Neuroendocrine Tumors/pathology , Yttrium Radioisotopes/therapeutic use , Liver Neoplasms/therapy , Embolization, Therapeutic/adverse effects
17.
Br J Radiol ; 95(1139): 20220470, 2022 Oct 01.
Article in English | MEDLINE | ID: mdl-35848755

ABSTRACT

In some patients undergoing radioembolization, lung toxicity is a limiting factor when calculating their dose. At the same time, it is known that the lung shunt fraction (LSF) is overestimated by the mapping exam. Furthermore, there are multiple methods to measure LSF. Planar measurement is both the most commonly utilized and easiest to perform, however new dosimetry software provides the ability to use more advanced 3D techniques. This paper reviews the different LSF calculation methods and elucidates the available data comparing the techniques, clinical relevance, and dose calculation.


Subject(s)
Brachytherapy , Embolization, Therapeutic , Liver Neoplasms , Humans , Yttrium Radioisotopes/therapeutic use , Liver Neoplasms/radiotherapy , Embolization, Therapeutic/methods , Lung
18.
Radiology ; 305(1): 228-236, 2022 10.
Article in English | MEDLINE | ID: mdl-35762890

ABSTRACT

Background Patients with unresectable, chemorefractory hepatic metastases from colorectal cancer have considerable mortality. The role of transarterial radioembolization (TARE) with yttrium 90 (90Y) microspheres is not defined because most reports are from a single center with limited patient numbers. Purpose To report outcomes in participants with colorectal cancer metastases treated with resin 90Y microspheres from a prospective multicenter observational registry. Materials and Methods This study treated enrolled adult participants with TARE using resin microspheres for liver-dominant metastatic colorectal cancer at 42 centers, with enrollment from July 2015 through August 2020. TARE was used as the first-, second-, or third-line therapy or beyond. Overall survival (OS), progression-free survival (PFS), and toxicity outcomes were assessed by line of therapy by using Kaplan-Meier analysis for OS and PFS and Common Terminology Criteria for Adverse Events, version 5, for toxicities. Results A total of 498 participants (median age, 60 years [IQR, 52-69 years]; 298 men [60%]) were treated. TARE was used in first-line therapy in 74 of 442 participants (17%), second-line therapy in 180 participants (41%), and third-line therapy or beyond in 188 participants (43%). The median OS of the entire cohort was 15.0 months (95% CI: 13.3, 16.9). The median OS by line of therapy was 13.9 months for first-line therapy, 17.4 months for second-line therapy, and 12.5 months for third-line therapy (χ2 = 9.7; P = .002). Whole-group PFS was 7.4 months (95% CI: 6.4, 9.5). The median PFS by line of therapy was 7.9 months for first-line therapy, 10.0 months for second-line therapy, and 5.9 months for third-line therapy (χ2 = 8.3; P = .004). TARE-attributable grade 3 or 4 hepatic toxicities were 8.4% for bilirubin (29 of 347 participants) and 3.7% for albumin (13 of 347). Grade 3 and higher toxicities were greater with third-line therapy for bilirubin (P = .01) and albumin (P = .008). Conclusion Median overall survival (OS) after transarterial radioembolization (TARE) with yttrium 90 microspheres for liver-dominant metastatic colorectal cancer was 15.0 months. The longest OS was achieved when TARE was part of second-line therapy. Grade 3 or greater hepatic function toxicity rates were less than 10%. Clinical trial registration no. NCT02685631 Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Liddell in this issue.


Subject(s)
Colonic Neoplasms , Embolization, Therapeutic , Liver Neoplasms , Rectal Neoplasms , Adult , Albumins , Bilirubin , Colonic Neoplasms/drug therapy , Embolization, Therapeutic/methods , Humans , Liver Neoplasms/secondary , Male , Microspheres , Middle Aged , Prospective Studies , Rectal Neoplasms/therapy , Registries , Retrospective Studies , Treatment Outcome , Yttrium Radioisotopes/therapeutic use
20.
Curr Oncol ; 29(6): 3825-3848, 2022 05 24.
Article in English | MEDLINE | ID: mdl-35735415

ABSTRACT

Selective internal radiation therapy (SIRT) with yttrium-90 (90Y)-loaded microspheres is increasingly used for the treatment of Intrahepatic Cholangiocarcinoma (ICC). Dosimetry verifications post-treatment are required for a valid assessment of any dose-response relationship. We performed a systematic review of the literature to determine how often clinics conducted post-treatment dosimetry verification to measure the actual radiation doses delivered to the tumor and to the normal liver in patients who underwent SIRT for ICC, and also to explore the corresponding dose-response relationship. We also investigated other factors that potentially affect treatment outcomes, including the type of microspheres used and concomitant chemotherapy. Out of the final 47 studies that entered our study, only four papers included post-treatment dosimetry studies after SIRT to quantitatively assess the radiation doses delivered. No study showed that one microsphere type provided a benefit over another, one study demonstrated better imaging-based response rates associated with the use of glass-based TheraSpheres, and two studies found similar toxicity profiles for different types of microspheres. Gemcitabine and cisplatin were the most common chemotherapeutic drugs for concomitant administration with SIRT. Future studies of SIRT for ICC should include dosimetry to optimize treatment planning and post-treatment radiation dosage measurements in order to reliably predict patient responses and liver toxicity.


Subject(s)
Bile Duct Neoplasms , Cholangiocarcinoma , Sirtuins , Bile Duct Neoplasms/drug therapy , Bile Duct Neoplasms/radiotherapy , Bile Ducts, Intrahepatic , Chemoradiotherapy , Cholangiocarcinoma/drug therapy , Cholangiocarcinoma/radiotherapy , Humans , Yttrium Radioisotopes/therapeutic use
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