Selective Internal Radiotherapy with Yttrium-90 Microspheres for Hepatic Metastatic Neuroendocrine Tumors: A Prospective Single Center StudyKalinowski M.a · Dressler M.a · König A.b · El-Sheik M.d · Rinke A.b · Höffken H.c · Gress T.M.b · Arnold R.b · Klose K.-J.a · Wagner H.-J.d
Departments of aDiagnostic Radiology, bGastroenterology/Endocrinology and Metabolism, and cNuclear Medicine, Philipps University Hospital, Marburg, and dDepartment of Radiology, Vivantes Hospitals im Friedrichshain and Am Urban, Berlin, Germany
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
Article / Publication Details
Background: To assess prospectively the safety and efficacy of Yttrium-90 microspheres in patients with unresectable liver metastases from neuroendocrine tumors. Materials and Methods: Microspheres were administered via a temporarily placed hepatic catheter. Patients were monitored prospectively. All patients were followed with laboratory and imaging studies at regular intervals to determine response rates. Toxicity and quality of life scores were measured. Results: Nine patients (7 female) with a mean age of 58.8 years were enrolled in this prospective trial. The mean tumor load was 58.8%. The estimated percentage shunting to the lungs on MAA scans was 5.04 ± 2.4%. Visceral artery embolization of extrahepatic arteries before treatment was performed in 6 patients. The median dose of microspheres was 2.1 ± 0.4 GBq. A total of 12 therapy sessions was performed. The mean follow-up was 21.7 months. Technical success was 100%. No major complications occurred. Survival rates were 100, 57 and 57% for 1, 2 and 3 years, respectively. Three months after SIRT therapy partial response (PR) was seen in 6 patients (66%). Calculated reduction of liver metastasis volume was 49%. In 3 patients (33%) stable disease was seen with a calculated tumor reduction of 13%. The estimated time to progression was 11.1 months. Conclusion: Radioembolization with 90Y microspheres is safe and produces high response rates even with extensive tumor replacement for up to 1 year. Acute and late toxicity was very low. Further investigations compared with other local ablative techniques is warranted.
© 2009 S. Karger AG, Basel
Delcore R, Friesen SR: Gastrointestinal neuroendocrine tumors. J Am Coll Surg 2004;178:188–211.
- Akerstrom G, Hellman P, Hessman O, et al: Management of midgut carcinoids. J Surg Oncol 2005;89:161–169.
- Kaltsas GA, Besser GM, Grossman AB: The diagnosis and medical management of advanced neuroendocrine tumors. Endocr Rev 2004;25:458–511.
- Modlin IM, Kidd M, Latich I, et al: Current status of gastrointestinal carcinoids. Gastroenterology 2005;128:1717–1751.
- Madoff DC, Gupta S, Ahrar K, Murthy R, Yao JC: Update on the management of neuroendocrine hepatic metastases. J Vasc Interv Radiol 2006;17:1235–1249.
- Modlin IM, Lye KD, Kidd M: A 5-decade analysis of 13,715 carcinoid tumors. Cancer 2003;97:934–959.
- Sun W, Lipsitz S, Catalano P, Maillard JA, Haller DA: Phase II/III study of doxorubicin with fluorouracil compared with streptozocin with fluorouracil or dacarbazine in the treatment of advanced carcinoid tumors: Eastern Cooperative Oncology Group Study E1281. J Clin Oncol 2005;23:4897–4904.
- Oberg K, Kvols S, Caplin M, et al: Consensus report on the use of somatostatin analogs for the management of neuroendocrine tumors of the gastroenteropancreatic system. Ann Oncol 2004;15:966–973.
- Ruszniewski P, Malka D: Hepatic arterial chemoembolization in the management of advanced digestive endocrine tumors. Digestion 2000;62(suppl 1):79–83.
- Gupta S, Johnson MM, Murthy R, et al: Hepatic arterial embolization and chemoembolization for the treatment of patients with metastatic neuroendocrine tumors: variables affecting response rates and survival. Cancer 2005;104:1590–1602.
- Murthy R, Xiong H, Nunez R, et al: Yttrium-90 microspheres for the treatment of unresectable colorectal hepatic metastases after failure of multiple chemotherapy regimens: preliminary results. J Vasc Interv Radiol 2005;16:937–945.
- Kennedy AS, Coldwell D, Nutting C, et al: Resin 90Y microsphere brachytherapy for unresecatbale colorectal liver metastases: modern USA experience. Int J Rad Oncol Biol Phys 2006;65:412–425.
- Murthy R, Nunez R, Szklaruk J, et al: Yttrium-90 microsphere therapy for hepatic malignancy: devices, indications, technical considerations, and potential complications. Radiographics 2005;25(suppl l):S41–S55.
- Gray B, Van Hazel G, Hope M, et al: Randomised trial of SIR-Spheres plus chemotherapy vs. chemotherapy alone for treating patients with liver metastases from primary large bowel cancer. Ann Oncol 2001;12:1711–1720.
- Carr B: Hepatic arterial 90yttrium glass microspheres (Therasphere) for unresectable hepatocellular carcinoma: interim safety and survival data on 65 patients. Liver Transpl 2004;10(suppl 1):S107–S110.
Coldwell D: Use of yttrium-90 SIRSpheres to treat unresectable metastatic neuroendocrine tumors to the liver. Program and Abstracts of the World Congress on Gastrointestinal Cancer, Barcelona, 2005, abstr O-002.
- Kennedy AS, Dezarn WA, McNeillie P, et al: Radioembolization for unresectable neuroendocrine hepatic metastases using resin 90Y-microspheres: early results in 148 patients. Am J Clin Oncol 2008;31:271–279.
- King J, Quinn R, Glenn DM, et al: Radioembolization with selective internal radiation microspheres for neuroendocrine liver metastases. Cancer 2008;113:921–929.
Kennedy AS, Liu D, Dezarn AW, et al: Resin 90Y microsphere brachytherapy for unresectable neuroendocrine hepatic metastases. Am J Oncol Rev 2006;4(suppl):1–8.
- Salem R, Thurston KG: Radioembolization with 90-yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. 1. Technical and methodologic considerations. J Vasc Interv Radiol 2006;17:1251–1278.
- Duffaud F, Therasse P: New guidelines to evaluate the response to treatment in solid tumors. Bull Cancer 2000;87:881–886.
- Aaronson NK, Ahmedzai S, et al: The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993;85:365–376.
- Kavadas V, Blazeba JM, et al: Development of an EORTC disease-specific quality of life questionnaire for use in patients with liver metastases from colorectal cancer. Eur J Cancer 2003;39:1259–1263.
- Veenendaal LM, Borel Rinkes IH, Lips CJ, et al: Liver metastases of neuroendocrine tumours; early reduction of tumour load to improve life expectancy. World J Surg Oncol 2006;4:35–39.
- Musunuru S, Chen H, Rajpal S, et al: Metastatic neuroendocrine hepatic tumors: resection improves survival. Arch Surg 2006;141:1000–1004.
- Kress O, Wagner HJ, Wied M, et al: Transarterial chemoembolization of advanced liver metastases of neuroendocrine tumors: a retrospective single-centre analysis. Digestion 2003;68:94–101.
- Roche A, Girish BV, de Baere T, et al: Trans-catheter arterial chemoembolization as first-line treatment for hepatic metastases from endocrine tumors. Eur Radiol 2003;13:136–140.
- Ho AS, Picus J, Darcy MD, et al: Long-term outcome after chemoembolization and embolization of hepatic metastatic lesions from neuroendocrine tumors. AJR Am J Roentgenol 2007;188:1201–1207.
- Steel J, Baum A, Carr B: Quality of life in patients diagnosed with primary hepatocellular carcinoma: hepatic arterial infusion of cisplatin versus 90-yttrium microspheres (therasphere). Psychooncology 2004;13:73–79.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.