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90Y Radioembolization for Metastatic Neuroendocrine Liver Tumors: Preliminary Results From a Multi-institutional Experience

Rhee, Thomas K. MD*; Lewandowski, Robert J. MD*; Liu, David M. MD; Mulcahy, Mary F. MD; Takahashi, Gary MD§; Hansen, Paul D. MD; Benson, Al B. III; Kennedy, Andrew S. MD, FACRO; Omary, Reed A. MD, MS***; Salem, Riad MD, MBA, FSIR*‡

doi: 10.1097/SLA.0b013e3181728a45
Original Articles
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Purpose: Minimally invasive therapies such as transarterial chemoembolization and radiofrequency ablation are used for hepatic metastatic neuroendocrine tumor (NET) therapy. Results from another minimally invasive therapy, radioembolization, remain unknown. The purpose of this multicenter open label phase II study was to assess the efficacy and safety of yttrium-90 (90Y) radioembolization for treating hepatic metastatic NET using a primary outcome of tumor response and secondary outcomes of serologic toxicities and survival.

Material/Methods: In this multicenter study, all patients underwent lobar radioembolization using glass or resin 90Y radioembolic agents. Patients were assessed serologically and radiographically at 2 to 4 weeks and then at 1 to 3 month intervals after treatment. We 1) compared liver volumes, radiation doses, and serologic liver function tests (unpaired t test, P = 0.05) and 2) assessed tumor response, serologic toxicity, and median survival from first 90Y therapy. The clinicaltrials.gov identifier was NCT00532740.

Results: Forty-two patients underwent radioembolization using glass (mean age 58 ± 12 years) or resin (mean age 61 ± 11 years) microspheres. A statistically significant greater median radiation dose was delivered to each lobe using glass (right lobe 117 Gy; left lobe 108 Gy) than using resin (right 50.8 Gy; left 44.5 Gy) (P < 0.01). Using Response Criteria in Solid Tumors, 92% of glass and 94% of resin patients were classified as partial response or stable disease at 6 months after treatment. Six patients experienced grade 3/4 toxicities during the follow-up period. Median survival was 22 months (glass) and 28 months (resin) (P = 0.82).

Conclusion: 90Y radioembolization of metastatic NET is a viable therapy with acceptable toxicity. Further investigation is warranted.

Transarterial therapies are the standard of care for refractory neuroendocrine tumors (NET) of the liver. Our objective was to report on safety and efficacy outcomes of radioembolization using yttrium-90 microspheres for this condition. We conclude that this therapy represents another therapeutic option for liver dominant NET tumors.

From the *Department of Radiology, Northwestern University, Chicago, IL; †Angio/Interventional Section, Inland Imaging, LLC, Providence/Sacred Heart Medical Center, Spokane, WA; ‡Department of Medical Oncology, Northwestern University, Chicago, IL; §Medical Oncology Division, Pacific Oncology, PC, Providence/St Vincent Medical Center; ¶Minimally Invasive GI Surgery Section, The Oregon Clinic, PC, Providence/Portland Medical Center, Portland, OR; ∥Wake Radiology Oncology, Cary, NC; and **Department of Biomedical Engineering, Northwestern University, Chicago, IL.

Reprints: Riad Salem, MD, MBA, Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 800, Chicago, IL. E-mail: r-salem@northwestern.edu.

© 2008 Lippincott Williams & Wilkins, Inc.