PURPOSE
The purpose of this open-label, retrospective report was to determine the safety and effectiveness of locoregional therapy with yttrium-90 (90Y) radioembolization for patients with progressing breast cancer liver metastases (BCLM) despite polychemotherapy.
MATERIALS & METHODS
Seventy-five patients with progressing BCLM and stable extrahepatic disease were treated with radioembolization at our institution. Retrospective review of a prospectively collected database was performed to evaluate clinical and biochemical toxicities, tumor response, overall survival (OS), and time to progression (TTP). Radiologic response assessments included Response Evaluation Criteria in Solid Tumors in primary index lesions and metabolic activity on positron emission tomography. Univariate and multivariate analyses were performed.
RESULTS
30-day mortality was 4% (n=3). Grade 3+ clinical toxicity and hyperbilirubinemia occurred in 7.6% (n=5) and 5.9% (n=4), respectively. The rate of partial response was 35.3% (n=24), 63.2% (n=43) had stable disease, and progressive disease occurred in 1.5% (n=1). PET imaging was available in 25 patients and 21 (84%) had a complete or partial response or stable disease. The median OS was 6.6mo (95% CI, 5.0 to 9.2mo). The hazard ratio (HR) for OS was .39 (95% CI, .23 to .66) for tumor burden <25% compared to greater tumor burden in multivariate analysis. Elevated bilirubin reduced OS. The HR for hepatic progression was .22 (95% CI, .05 to .98) for solitary compared to multifocal disease.
CONCLUSIONS
Locoregional therapy with 90Y radioembolization is safe and stops or delays the progression of targeted chemorefractory breast cancer liver metastases. Adverse prognosticators are identified.
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