Intra-arterial treatment with 90yttrium microspheres in treatment-refractory and unresectable liver metastases of neuroendocrine tumors and the use of 111in-octreotide scintigraphy in the evaluation of treatment response.

PURPOSE: The aim of this study was to examine the efficacy of intra-arterial (90)Yttrium treatment in the management of unresectable hepatic neuroendocrine tumors (NET) metastases unresponsive to treatment and the role of (111)In-octreotide scintigraphy in the evaluation of treatment response. METHODS: Thirteen (13) patients with a mean age of 53.3 years not eligible for surgical treatment were included. Before the procedure, routine tests for renal/hepatic functions and bilirubin levels as well as (99m)Tc-macroaggregated albumin test to detect any leakage to the lungs were done. Treatment doses were calculated using body surface area method and all patients received (90)Y resin microspheres through hepatic artery catheter. Abdominopelvic computed tomography (CT) and (111)In-octreotide scintigraphy were done before and after treatment. Patients were divided into two groups based on their treatment response as assessed by either (111)In-octreotide scintigraphy or CT: group 1, responders; group 2, nonresponders. RESULTS: For all patients, 1-year survival rate and overall survival was 84.7% and 20 months, respectively. Based on (111)In-octreotide scintigraphy findings, 1-year survival rate was 90% and 66.7% for responders and nonresponders, respectively, whereas corresponding overall survival was 21.3 months and 15.3 months. Survival data based on CT findings were as follows: 1-year survival rate, responders, 80%; nonresponders, 100%; overall survival, responders, 20.4 months, nonresponders, 18.5 months. CONCLUSIONS: Intra-arterial treatment with (90)Y has survival benefits in treatment-refractory liver metastases from NETs and it could be used in these patients. Since it is a functional imaging method, (111)In-octreotide scintigraphy may be better discriminates patients responding to treatment from patients not responding.

Selective intraarterial radionuclide therapy with Yttrium-90 (Y-90) microspheres for unresectable primary and metastatic liver tumors.

BACKGROUND: The aim of this study was to evaluate the success of selective intraarterial radionuclide therapy (SIRT) with Yttrium-90 (Y-90) microspheres in liver metastases of different tumors. We also interpreted the contribution of SIRT to survival times according to responder- non responder and hepatic- extra hepatic disease. METHODS: The clinical and follow-up data of 124 patients who were referred to our department for SIRT between June 2008 [corrected] and October 2010 were evaluated retrospectively. SIRT has been applied to 78 patients who were suitable for treatment. All the patients had primary liver tumor or unresectable liver metastasis of different malignancies. The treatment was repeated at least one more time in 5 patients to the same or other lobes. Metabolic treatment response evaluated by fluorine-18 fluorodeoxyglucose (F18-FDG) positron emission tomography/computed tomography (PET/CT) in the 6th week after treatment. F18-FDG PET/CT was repeated in per six weeks periods. The response criterion had been described as at least 20% decrease of SUV value. Also in patients with neuroendocrine tumor serial Gallium-68 (Ga-68) PET/CT was used for evaluation of response. Patients were divided into 2 groups according to their treatment response. RESULTS: 68 patients received treatment for the right lobe, seven patients received treatment for the left lobe and 3 patients for both lobes. The mean treatment dose was estimated at 1.62 GBq. In the evaluation of treatment response; 43(55%) patients were responder (R) and 35 (45%) patients were non-responder (NR) in the sixth week F18-FDG PET/CT. Mean pretreatment SUVmax value of R group was 11.6 and NR group was 10.7. While only 11 (31%) out of 35 NR patients had H disease, 30 (69%) out of 43 R patients had H disease (p < 0.05). The mean overall survival time of R group was calculated as 25.63 ± 1.52 months and NR group's 20.45 ± 2.11 (p = 0.04). The mean overall survival time of H group was computed as 25.66 ± 1.52 months and EH group's 20.76 ± 1.97 (p = 0.09). CONCLUSIONS: SIRT is a useful treatment method which can contribute to the lengthening of survival times in patients with primary or metastatic unresectable liver malignancies. Also F18-FDG PET/CT is seen to be a successful imaging method in evaluating treatment response for predicting survival times in this patient group.

Selective intra-arterial Y-90 microsphere therapy in hemangioendothelioma.

Epithelioid hemangioendothelioma is a malignant soft tissue tumor originating from the endothelial cell. Its clinical course varies from benign hemangioma to angiosarcoma. The therapy procedure remains unclear. Although resection of the tumor is the most frequently suggested treatment, due to its multinodular type, transplantation is frequently performed. Therapy regimens other than transplantation and resection are not effective and the median survival in hemangioendothelioma with unresectable lesions is approximately eight months. In this case, we report the therapeutic effect of selective intra-arterial radionuclide yttrium (Y)-90 microspheres and the value of F-18 fluorodeoxyglucose positron emission tomography/computed tomography to evaluate therapy response in hemangioendothelioma.

Ocular Involvement in Mantle Cell Lymphoma Detected by F 18 FDG PET/CT.

UNLABELLED: Mantle Cell Lymphoma (MCL) is an uncommon but aggressive form of non-Hodgkin's lymphoma. The extranodal involvement is not unusual especially in bone marrow, spleen, gastrointestinal tract and Waldeyer's ring. Ocular involvement is very exceptional and the most commonly affected site is the orbit (90%), followed by the lacrimal gland (50%) and the eyelids (50%). Today, PET/CT is widely used in non-Hodgkin's lenfoma especially in staging and evaluation of treatment response. Authors report MCL with ocular involvement that was detected on PET/CT scan. CONFLICT OF INTEREST: None declared.