Clinical Outcomes of Patients With Unresectable Primary Liver Cancer Treated With Yttrium-90 Radioembolization With an Escalated Dose

Chin, R; Bommireddy, Anirudh; Fraum, Tyler J.; Ludwig, Daniel; Huang, Yong Mao; Zoberi, Jacqueline E.; Garcia-Ramirez, José; Maughan, Nichole M.; Chapman, William C.; Korenblat, Kevin; Henke, Lauren E.; Kim, Hyun; Badiyan, Shahed N.

doi:10.1016/j.adro.2022.100948

Cited by 4 publications

(2 citation statements)

References 44 publications

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“…This case series adds to the knowledge of 166 Ho-TARE use for ICC, as very limited evidence for this technique in ICC treatment has been published so far. Currently, a tumor dose of >150 Gy is recognized as a desirable threshold to achieve improved outcomes in primary liver tumors [18,26]. In our cohort, the high > 150 Gy tumor dose resulted in a sustained CR, but an ORR could also be observed at lower tumoral doses.…”

Section: Discussionmentioning

confidence: 57%

Holmium-166 Transarterial Radioembolization for the Treatment of Intrahepatic Cholangiocarcinoma: A Case Series

Vermeulen,

De Keukeleire,

Dorny

et al. 2023

Cancers

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Background: Transarterial radioembolization (TARE) is used to treat primary and secondary malignancies in the liver that are not amenable to curative resection. Accumulating evidence demonstrates the efficacy and safety of TARE with yttrium-90 (90Y), which is the most widely used radionuclide for TARE, and later with holmium-166 (166Ho) for various indications. However, the safety and efficacy of 166Ho TARE in patients with intrahepatic cholangiocarcinoma (ICC) remains to be studied. Methods: This was a retrospective case series study of seven consecutive patients with ICC who were treated with 166-Ho-TARE in our center. We recorded the clinical parameters and outcomes of the TARE procedures, the tumor response according to mRECIST, subsequent treatments, and adverse events. Results: Three out of the seven patients had a partial or complete response. Two patients had stable disease after the first TARE procedure, and two of the patients (one with a complete response, and one with stable disease) were alive at the time of analysis. No serious adverse events related to the procedure were recorded. Conclusions: This is the first case series reporting the safety and tumor response outcomes of 166Ho-TARE for ICC. The treatment demonstrated its versatility, allowing for reaching a high tumor dose, which is important for improving tumor response and treating patients in a palliative setting, where safety and the preservation of quality of life are paramount.

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Section: Discussionmentioning

confidence: 57%

Holmium-166 Transarterial Radioembolization for the Treatment of Intrahepatic Cholangiocarcinoma: A Case Series

Vermeulen,

De Keukeleire,

Dorny

et al. 2023

Cancers

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“…In a retrospective comparison study, SIRT and SBRT have been shown to provide similar overall and disease-specific survival benefit when utilized independently for treatment of unresectable HCC (Oladeru et al 2016). Recent SIRT dose escalation studies have demonstrated increased tumor control above certain dose thresholds, indicating that higher SIRT doses are required to improve control in part due to the heterogeneity of 90 Y microsphere deposition (Chin et al 2022). However, dose escalation in SIRT may not be achievable in all cases and could be limited by dose to NLT and the lungs (Garin et al 2021).…”

Section: Discussionmentioning

confidence: 99%

Stereotactic body radiation therapy (SBRT) following Yttrium-90 (⁹⁰Y) selective internal radiation therapy (SIRT): a feasibility planning study using ⁹⁰Y delivered dose

Mee

Polan²,

Dewaraja³

et al. 2023

Phys. Med. Biol.

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Objective: 90Y selective internal radiation therapy (SIRT) treatment of hepatocellular carcinoma (HCC) can potentially underdose lesions, as identified on post-therapy PET/CT imaging. This study introduces a methodology and explores the feasibility for selectively treating SIRT-underdosed HCC lesions, or lesion subvolumes, with stereotactic body radiation therapy (SBRT) following post-SIRT dosimetry. Approach: We retrospectively analyzed post-treatment PET/CT images of 20 HCC patients after 90Y SIRT. Predicted tumor response from SIRT was quantified based on personalized post-therapy dosimetry and corresponding response models. Predicted non-responding tumor regions were then targeted with a hypothetical SBRT boost plan using a framework for selecting eligible tumors and tumor subregions. SBRT boost plans were compared to SBRT plans targeting all tumors irrespective of SIRT dose with the same prescription and organ-at-risk (OAR) objectives. The potential benefit of SIRT followed by a SBRT was evaluated based on OAR dose and predicted toxicity compared to the independent SBRT treatment. Main results: Following SIRT, 14/20 patients had at least one predicted non-responding tumor considered eligible for a SBRT boost. When comparing SBRT plans, 10/14 (71%) SBRTboost and 12/20 (60%) SBRTalone plans were within OAR dose constraints. For three patients, SBRTboost plans were within OAR constraints while SBRTalone plans were not. Across the 14 eligible patients, SBRTboost plans had significantly less dose to the healthy liver (decrease in mean dose was on average ± standard deviation, 2.09 Gy ± 1.99 Gy, ) and reduced the overall targeted PTV volume (39% ± 21%) compared with SBRTalone. Significance: A clinical methodology for treating HCC using a synergized SIRT and SBRT approach is presented, demonstrating that it could reduce normal tissue toxicity risk in a majority of our retrospectively evaluated cases. Selectively targeting SIRT underdosed HCC lesions, or lesion subvolumes, with SBRT could improve tumor control and patient outcomes post-SIRT and allow SIRT to function as a target debulking tool for cases when SBRT is not independently feasible.

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Systemic Immunological Changes After Yttrium-90 Radioembolization: A Pilot Prospective Observational Study—Clinical Insights

Kitsel,

Petre,

Wong

et al. 2024

Cardiovasc Intervent Radiol

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Clinical Outcomes of Patients With Unresectable Primary Liver Cancer Treated With Yttrium-90 Radioembolization With an Escalated Dose

Cited by 4 publications

References 44 publications

Holmium-166 Transarterial Radioembolization for the Treatment of Intrahepatic Cholangiocarcinoma: A Case Series

Holmium-166 Transarterial Radioembolization for the Treatment of Intrahepatic Cholangiocarcinoma: A Case Series

Stereotactic body radiation therapy (SBRT) following Yttrium-90 (⁹⁰Y) selective internal radiation therapy (SIRT): a feasibility planning study using ⁹⁰Y delivered dose

Systemic Immunological Changes After Yttrium-90 Radioembolization: A Pilot Prospective Observational Study—Clinical Insights

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Clinical Outcomes of Patients With Unresectable Primary Liver Cancer Treated With Yttrium-90 Radioembolization With an Escalated Dose

Cited by 4 publications

References 44 publications

Holmium-166 Transarterial Radioembolization for the Treatment of Intrahepatic Cholangiocarcinoma: A Case Series

Holmium-166 Transarterial Radioembolization for the Treatment of Intrahepatic Cholangiocarcinoma: A Case Series

Stereotactic body radiation therapy (SBRT) following Yttrium-90 (90Y) selective internal radiation therapy (SIRT): a feasibility planning study using 90Y delivered dose

Systemic Immunological Changes After Yttrium-90 Radioembolization: A Pilot Prospective Observational Study—Clinical Insights

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Stereotactic body radiation therapy (SBRT) following Yttrium-90 (⁹⁰Y) selective internal radiation therapy (SIRT): a feasibility planning study using ⁹⁰Y delivered dose