Radioembolization with Yttrium-90 Microspheres (SIRT) in Pancreatic Cancer Patients with Liver Metastases: Efficacy, Safety and Prognostic Factors

Abstract

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.

Safety of Radioembolization with 90Yttrium Resin Microspheres Depending on Coiling or No-Coiling of Aberrant/High-Risk Vessels

“…There is a lot of data existing about the effectiveness of radioembolization therapy in patients suffering from hepatocellular carcinoma [6,26] and intrahepatic cholangiocarcinoma [8] as well as patients with unresectable liver metastases of colorectal cancer [9,27], breast carcinoma [7,23], pancreatic carcinoma [21], and neuroendocrine tumors [8,13,31].…”

Use of PERCIST for Prediction of Progression-Free and Overall Survival After Radioembolization for Liver Metastases from Pancreatic Cancer

“…Receiver-operating-characteristic analysis resulted in optimal cutoffs of 7.9 cm for baseline LD 2 , 5.1 for baseline SUV peak , and 55 for baseline TLG 5 . The results for univariate analysis of changes in SUV peak , TLG 5 , CEA, CA19-9, and baseline parameters are presented in Table 2 for OS and Table 3 for PFS and TTP.…”

“…Mean healthy-liver SUV was defined as SUV mean in a 15 cm 3 spheric volume of interest positioned in a nondiseased area of the right hepatic lobe. The sum of the product (SUV mean · metabolic tumor volume) from each of the 5 lesions was calculated as TLG 5 . Progressive disease (PD) was defined as an increase in either baseline PET parameter by more than 30% between baseline and follow-up or by the appearance of a new 18 F-FDG-avid lesion.…”

“…The results for univariate analysis of changes in SUV peak , TLG 5 , CEA, CA19-9, and baseline parameters are presented in Table 2 for OS and Table 3 for PFS and TTP. Figure 1 shows the corresponding Kaplan-Maier survival curves.…”

“…Liver represents the dominant metastatic site of pancreatic cancer; radioembolization using 90 Y microspheres has emerged as a new treatment option in patients with unresectable liver disease, although experience with this approach is quite limited to date (4). In our recent analysis of radioembolization in 19 patients with liver metastases from pancreatic cancer, we reported encouraging local response rates and manageable toxicities (5). However, the patients in this preliminary study had shown considerable variation in PFS after radioembolization, which ranged from only 1 mo to more than 1 y, indicating a need for prediction of treatment response.…”