ABSTRACT
Yttrium-90 microspheres have been recently approved by the Food and Drug Administration and have become available to physicians in the United States for the treatment of hepatic neoplasia. Published results regarding the benefits of 90Y radioembolotherapy within the rapidly evolving landscape of systemic therapies for advanced unresectable colorectal cancer are limited. In that context, outcomes in patients who have received the recently approved biologic agents bevacizumab and cetuximab in addition to chemotherapy are unknown. This report briefly describes the authors' treatment experience with this cohort of patients.
Subject(s)
Angiogenesis Inhibitors/therapeutic use , Antibodies, Monoclonal/therapeutic use , Antineoplastic Agents/therapeutic use , Colorectal Neoplasms/pathology , Liver Neoplasms/drug therapy , Liver Neoplasms/radiotherapy , Liver Neoplasms/secondary , Radiopharmaceuticals/therapeutic use , Yttrium Radioisotopes/therapeutic use , Aged , Antibodies, Monoclonal, Humanized , Bevacizumab , Cetuximab , Colorectal Neoplasms/drug therapy , Combined Modality Therapy , Female , Humans , Male , Microspheres , Middle Aged , Tomography, Emission-Computed, Single-Photon , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Hepatic arterial therapy with yttrium-90 microspheres exploits the avenue provided by the neoplastic microvasculature to deliver high-energy, low-penetrating therapeutic doses of radiation. Variant hepatic arterial anatomy, collateral vessels, and changes in flow dynamics during treatment can affect particle dispersion and lead to nontarget particle distribution and subsequent gastrointestinal morbidity. Awareness of these variances and techniques to prevent gastrointestinal tract microsphere delivery is essential in mitigating this serious complication. Our aim is to increase the understanding of the role of various imaging and preventative techniques in minimizing this undesired effect.
Subject(s)
Adenocarcinoma/radiotherapy , Brachytherapy/adverse effects , Embolization, Therapeutic/adverse effects , Hepatic Artery , Liver Neoplasms/radiotherapy , Peptic Ulcer Hemorrhage/etiology , Peptic Ulcer/etiology , Yttrium Radioisotopes/adverse effects , Adenocarcinoma/diagnostic imaging , Adenocarcinoma/secondary , Adult , Aged , Gastrointestinal Tract/blood supply , Humans , Injections, Intra-Arterial , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/secondary , Male , Microspheres , Peptic Ulcer/complications , Peptic Ulcer/pathology , Peptic Ulcer Hemorrhage/pathology , Radionuclide Imaging , Radiopharmaceuticals , Retrospective Studies , Technetium Tc 99m Aggregated Albumin , Yttrium Radioisotopes/administration & dosageABSTRACT
Although the adverse health consequences of obesity in the general population have been well documented, recent evidence suggests that obesity is associated with better outcomes in patients with heart failure (HF). Studies of patients with HF that specifically examined the impact of body mass index (BMI) on outcomes have suggested the existence of an "obesity paradox." However, closer examination of these studies raises important questions on the validity of the paradox. First, the diagnosis of HF in obese patients, particularly when made using clinical variables, may not be accurate; the obese patients in these studies may actually be "healthier" than their nonobese comparators. Second, the deleterious effects of cachexia, rather than the salutary ones of obesity, are likely the main reason for the inverse correlation between BMI and HF outcome, especially once the underlying biologic mechanisms behind cachexia and obesity in patients with HF are considered. Furthermore, few studies have specifically examined the more severely obese population (BMI >35 kg/m(2)) when assessing outcomes, and those that have suggest that severely obese patients may have worse outcomes than patients with normal weights or those who are mildly obese. Therefore, a "U-shaped" outcome curve according to BMI for patients with HF may actually exist, in which mortality is greatest in cachectic patients; lower in normal, overweight, and mildly obese patients; but higher again in more severely obese patients. Further prospective studies assessing the impact of more marked degrees of obesity on outcomes in patients with HF are needed to more conclusively determine whether the obesity paradox truly exists.
