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Radioembolization for Unresectable Neuroendocrine Hepatic Metastases Using Resin 90Y-Microspheres: Early Results in 148 Patients

Kennedy, Andrew S., MD, FACRO*; Dezarn, William A., PhD, DABR*; McNeillie, Patrick, BS, MS2; Coldwell, Doug, MD, PhD; Nutting, Charles, DO, FSIR§¶; Carter, Dennis, MD§; Murthy, Ravi, MD; Rose, Steven, MD**; Warner, Richard R. P., MD††; Liu, David, MD‡‡; Palmedo, Holger, MD§§; Overton, Carroll, MD¶¶; Jones, Bonita, RN, MSN; Salem, Riad, MD, MBA, FSIR∥∥

American Journal of Clinical Oncology: June 2008 - Volume 31 - Issue 3 - p 271-279
doi: 10.1097/COC.0b013e31815e4557
Original Article

Purpose: The use of 90Y-microspheres to treat unresectable liver metastases originating from a variety of neuroendocrine tumors was reviewed.

Materials and Methods: This is a retrospective review from 10 institutions of patients given 90Y-microsphere therapy for neuroendocrine hepatic metastases. Physical, radiographic, biochemical, and clinical factors associated with treatment and response were examined. All patients were followed with laboratory and imaging studies at regular intervals until death, or censured whether other therapy was given after brachytherapy. Toxicities (acute and late) were recorded, and survival of the group determined.

Results: A total of 148 patients were treated with 185 separate procedures. The median age was 58 years (26–95 years) at treatment with median performance status of Eastern Cooperative Oncology Group (0). The median activity delivered was 1.14 GBq (0.33–3.30 GBq) with a median of 99% of the planned activity able to be given (38.1%–147.4%). There were no acute or delayed toxicity of Common Terminology Criteria for Adverse Events v3.0 grade 3 in 67% of patients, with fatigue (6.5%) the most common side effect. Imaging response was stable in 22.7%, partial response in 60.5%, complete in 2.7% and progressive disease in 4.9%. No radiation liver failure occurred. The median survival is 70 months.

Conclusion: Radioembolization with 90Y-microspheres to the whole liver, or lobe with single or multiple fractions are safe and produce high response rates, even with extensive tumor replacement of normal liver and/or heavy pretreatment. The acute and delayed toxicity was very low without a treatment related grade 4 acute event or radiation induced liver disease in this modest-sized cohort. The significant objective response suggests that further investigation of this approach is warranted.

From the *Wake Radiology Oncology, Cary, NC; †University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC; ‡University of Texas Southwest, Dallas, TX; §Skyridge Medical Center, Denver, CO; ¶Banner Good Samaritan Medical Center, Phoenix, AZ; ∥The University of Texas MD Anderson Cancer Center, Houston, TX; **University of California, San Diego, San Diego, CA; ††Mt. Sinai Medical Center, New York, NY; ‡‡Inland Imaging, LLC. Spokane, WA; §§University Hospital of Bonn, Bonn, Germany; ¶¶Wake Radiology, Raleigh, NC; and ∥∥Northwestern Medical Center, Chicago, IL.

Reprints: Andrew Kennedy, MD, FACRO, Wake Radiology Oncology, 300 Ashville Ave., Suite 110, Cary, NC 27511. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.