Radioembolization for neuroendocrine liver metastases: Safety, imaging, and long-term outcomes

Khairuddin Memon, Robert J. Lewandowski, Mary F. Mulcahy, Ahsun Riaz, Robert K. Ryu, Kent T. Sato, Ramona Gupta, Paul Nikolaidis, Frank H. Miller, Vahid Yaghmai, Vanessa L. Gates, Bassel Atassi, Steven Newman, Reed A. Omary, Al B. Benson, Riad Salem

Research output: Contribution to journalArticle

82 Scopus citations

Abstract

Purpose: To present long-term outcomes on the safety and efficacy of Yttrium-90 radioembolization in the treatment of unresectable hepatic neuroendocrine metastases refractory to standard-of-care therapy. Methods and Materials: This study was approved by our institutional review board and was compliant with the Health Insurance Portability and Accountability Act. Forty patients with hepatic neuroendocrine metastases were treated with 90Y radioembolization at a single center. Toxicity was assessed using National Cancer Institute Common Terminology Criteria v3.0. Response to therapy was assessed by World Health Organization (WHO) guidelines for size and European Association for the Study of the Liver disease (EASL) guidelines for necrosis. Time to response and overall survival were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed. Results: The median dose was 113 Gy (29-299 Gy). Clinical toxicities included fatigue (63%), nausea/vomiting (40%), abdominal pain (18%), fever (8%), diarrhea and weight loss (5%); Grade 3 and 4 bilirubin toxicities were experienced by 2 patients and 1 patient, respectively. Different responses were noted by WHO (complete response, 1.2%; partial response, 62.7%) and EASL (complete response, 20.5%; partial response, 43.4%). Median time to response was 4 and 4.9 months by lesion and patient, respectively. The 1-, 2-, and 3-year overall survival rates were 72.5%, 62.5%, and 45%, respectively. Eastern Cooperative Oncology Group (ECOG) performance score 0 (p < 0.0001), tumor burden ≤25% (p = 0.0019), albumin ≥3.5 g/dL (p = 0.017), and bilirubin ≤1.2 mg/dL (p = 0.002) prognosticated survival on univariate analysis; only ECOG performance score 0 and bilirubin ≤1.2 mg/dL prognosticated better survival outcome on multivariate analysis (p = 0.0001 and p = 0.02). Conclusion: Yttrium-90 therapy for hepatic neuroendocrine metastases leads to satisfactory tumor response and patient survival with low toxicity, in line with published national guidelines recommending radioembolization as a potential option for unresectable hepatic neuroendocrine metastases.

Original languageEnglish (US)
Pages (from-to)887-894
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume83
Issue number3
DOIs
StatePublished - Jul 1 2012

Keywords

  • Neuroendocrine metastasis
  • Radioembolization
  • Response
  • Safety
  • Survival

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

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    Memon, K., Lewandowski, R. J., Mulcahy, M. F., Riaz, A., Ryu, R. K., Sato, K. T., Gupta, R., Nikolaidis, P., Miller, F. H., Yaghmai, V., Gates, V. L., Atassi, B., Newman, S., Omary, R. A., Benson, A. B., & Salem, R. (2012). Radioembolization for neuroendocrine liver metastases: Safety, imaging, and long-term outcomes. International Journal of Radiation Oncology Biology Physics, 83(3), 887-894. https://doi.org/10.1016/j.ijrobp.2011.07.041