Neuroendocrine tumor liver metastases treated with yttrium-90 radioembolization

Katherine Y. Fan, Aaron T. Wild, Vivek G. Halappa, Rachit Kumar, Susannah Ellsworth, Mark Ziegler, Tanu Garg, Lauren M. Rosati, Zheng Su, Amy Hacker-Prietz, Timothy M. Pawlik, David P. Cosgrove, Kelvin K. Hong, Ihab R. Kamel, Jean Francois Geschwind, Joseph M. Herman

Research output: Contribution to journalArticle

Abstract

Objective Yttrium-90 (Y-90) radioembolization is an emerging treatment option for unresectable neuroendocrine liver metastases (NELM). However, the data regarding this treatment are currently limited. This study evaluates the efficacy and tolerability of Y-90 radioembolization and identifies prognostic factors for radiographic response and survival. Methods and materials Thirty-eight patients underwent Y-90 radioembolization for NELM at our institution between April 2004 and February 2012. Patients were assessed radiographically (RECIST criteria, enhancement), serologically, and clinically at 1 month, and then at every 3 months after treatment for tumor response, toxicity, and survival outcomes. Results Median length of follow-up was 17.0 months (IQR, 9.0–37.0). Median survival was 29.2 months. Three patients (9%) had a radiographic complete response to treatment, 6 (17%) had a partial response, 21 (60%) had stable disease, and 5 (14%) developed progressive disease. Two factors were significantly associated with a good radiographic response (complete/partial response): islet cell histological subtype (p = 0.043) and hepatic tumor burden ≥ 33% (p = 0.031). Multivariate analysis revealed that patients requiring multiple Y-90 treatments (HR 2.9, p = 0.035) and patients who had previously failed systemic therapy with octreotide/chemotherapy (HR 4.4, p = 0.012) had worse survival. Grade 3 serologic toxicity was observed in 2 patients (5%; hyperbilirubinemia, elevated alkaline phosphatase) after treatment. Grade 3 non-serologic toxicities included abdominal pain (11%), fatigue (11%), nausea/vomiting (5%), ascites (5%), dyspnea (3%), diarrhea (3%), and peripheral edema (3%). No grade 4 or 5 toxicity was reported. Conclusions Y-90 radioembolization is a promising treatment option for inoperable NELM and is associated with low rates of grade ≥ 3 toxicity.

Original languageEnglish (US)
Pages (from-to)143-149
Number of pages7
JournalContemporary Clinical Trials
Volume50
DOIs
StatePublished - Sep 1 2016

Keywords

  • Liver metastasis
  • Microsphere
  • Neuroendocrine tumor
  • Radioembolization
  • Unresectable
  • Yttrium-90

ASJC Scopus subject areas

  • Pharmacology (medical)

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    Fan, K. Y., Wild, A. T., Halappa, V. G., Kumar, R., Ellsworth, S., Ziegler, M., Garg, T., Rosati, L. M., Su, Z., Hacker-Prietz, A., Pawlik, T. M., Cosgrove, D. P., Hong, K. K., Kamel, I. R., Geschwind, J. F., & Herman, J. M. (2016). Neuroendocrine tumor liver metastases treated with yttrium-90 radioembolization. Contemporary Clinical Trials, 50, 143-149. https://doi.org/10.1016/j.cct.2016.08.001