Matthew D Li1, Katrina F Chu1, Allegra DePietro2, Vincent Wu1, Eric Wehrenberg-Klee1, Omar Zurkiya1, Raymond W Liu1, Suvranu Ganguli3. 1. Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St., GRB 290 Boston, MA 02114. 2. Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St., GRB 290 Boston, MA 02114. 3. Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St., GRB 290 Boston, MA 02114. Electronic address: sganguli@partners.org.
Abstract
PURPOSE: To evaluate the feasibility of a same-day yttrium-90 (90Y) radioembolization protocol with resin microspheres (including pretreatment angiography, lung shunt fraction [LSF] determination, and radioembolization) for the treatment of hepatocellular carcinoma (HCC) and liver metastases. MATERIALS AND METHODS: All same-day radioembolization procedures performed over 1 y (February 2017 to January 2018) were included in this single-institutional retrospective analysis, in which 34 procedures were performed in 26 patients (median age, 63 y; 13 women), 19 with liver metastases and 7 with HCC. Yttrium-90 treatment activities were calculated by body surface area method. Tumor imaging response was assessed by Response Evaluation Criteria In Solid Tumors (RECIST) 1.1 for liver metastases and modified RECIST for HCC. Clinical side effects and adverse events were graded per Common Terminology Criteria for Adverse Events version 4.0. RESULTS: All planned cases were technically successful, and no cases were canceled for elevated LSF or vascular anatomic reasons. Pretreatment angiography modified the planned 90Y treatment activity in 1 case in which vascular anatomy required a lobar-dose split into 2 for segmental infusions. In 18% of cases, patients were briefly admitted after the procedure for observation or symptom management. Imaging evaluation of initial efficacy at 1 month demonstrated partial response in 25% and stable disease in 67% of patients with liver metastases and partial/complete response in 43% and stable disease in 14% of patients with HCC. Grade ≥ 3 adverse events occurred in 6% of cases, with no systemic therapy-limiting toxicities. The mean total procedure time was 4.2 hours. CONCLUSIONS: A same-day 90Y radioembolization protocol with resin microspheres is feasible in select patients, which can expedite cancer therapy.
PURPOSE: To evaluate the feasibility of a same-day yttrium-90 (90Y) radioembolization protocol with resin microspheres (including pretreatment angiography, lung shunt fraction [LSF] determination, and radioembolization) for the treatment of hepatocellular carcinoma (HCC) and liver metastases. MATERIALS AND METHODS: All same-day radioembolization procedures performed over 1 y (February 2017 to January 2018) were included in this single-institutional retrospective analysis, in which 34 procedures were performed in 26 patients (median age, 63 y; 13 women), 19 with liver metastases and 7 with HCC. Yttrium-90 treatment activities were calculated by body surface area method. Tumor imaging response was assessed by Response Evaluation Criteria In Solid Tumors (RECIST) 1.1 for liver metastases and modified RECIST for HCC. Clinical side effects and adverse events were graded per Common Terminology Criteria for Adverse Events version 4.0. RESULTS: All planned cases were technically successful, and no cases were canceled for elevated LSF or vascular anatomic reasons. Pretreatment angiography modified the planned 90Y treatment activity in 1 case in which vascular anatomy required a lobar-dose split into 2 for segmental infusions. In 18% of cases, patients were briefly admitted after the procedure for observation or symptom management. Imaging evaluation of initial efficacy at 1 month demonstrated partial response in 25% and stable disease in 67% of patients with liver metastases and partial/complete response in 43% and stable disease in 14% of patients with HCC. Grade ≥ 3 adverse events occurred in 6% of cases, with no systemic therapy-limiting toxicities. The mean total procedure time was 4.2 hours. CONCLUSIONS: A same-day 90Y radioembolization protocol with resin microspheres is feasible in select patients, which can expedite cancer therapy.
Authors: Mohammad Elsayed; Mohammad Loya; James Galt; David M Schuster; Zachary L Bercu; Janice Newsome; David Brandon; Sonia Benenati; Keywan Behbahani; Richard Duszak; Ila Sethi; Nima Kokabi Journal: World J Gastrointest Oncol Date: 2021-05-15