Radioembolization with Yttrium-90 Microspheres (SIRT) in Pancreatic Cancer Patients with Liver Metastases: Efficacy, Safety and Prognostic FactorsMichl M. · Haug A.R. · Jakobs T.F. · Paprottka P. · Hoffmann R.-T. · Bartenstein P. · Boeck S. · Haas M. · Laubender R.P. · Heinemann V.
aDepartment of Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center, and Departments of bNuclear Medicine, and cRadiology, Ludwig Maximilians University, dDepartment of Diagnostic and Interventional Radiology, Hospital Barmherzige Brüder Munich, and eInstitute of Medical Informatics, Biometry, and Epidemiology, University of Munich, Munich, and fInstitute and Policlinic for Diagnostic Radiology, University Hospital Carl Gustav Carus, Dresden, Germany
Objective: To analyze the clinical efficacy of 90Y radioembolization in liver metastases from pancreatic cancer, to describe treatment toxicities and to identify biomarkers as predictors of outcome. Methods: Data from 19 pancreatic cancer patients (9 females/10 males) who had received 90Y radioembolization for metastatic liver disease between 06/2004 and 01/2011 were analyzed retrospectively. Results: The median age at 90Y radioembolization was 63 years (range 43-77). In 16 patients, previous palliative gemcitabine-based chemotherapy was given for metastatic disease. Objective response in the liver after 90Y radioembolization was 47%. Median local progression-free survival in the liver was 3.4 months (range 0.9-45.0). Median overall survival (OS) was 9.0 months (range 0.9-53.0) and 1-year survival was 24%. Cox regression models for baseline biomarkers at 90Y radioembolization revealed correlations of increased carbohydrate antigen 19-9 (p = 0.02) and C-reactive protein (p = 0.03) with shorter OS. Short-term adverse events (nausea, vomiting, fatigue, fever and abdominal pain) did not exceed grade 3. As long-term adverse events, liver abscesses, gastroduodenal ulceration, cholestasis and cholangitis, ascites and spleen infarction were observed. Conclusion:90Y radioembolization is able to induce an encouraging local response rate of liver metastases of pancreatic cancer patients. Most short-term toxicities are manageable; however, patients should be followed up carefully for severe long-term toxicities.