Safety and efficacy of Y-90 microsphere treatment in patients with primary and metastatic liver cancer: The tumor selectivity of the treatment as a function of tumor to liver flow ratio

Abstract

Journal of Translational Medicine AbstractBackground: Treatment records and follow-up data on 40 patients with primary and metastatic liver malignancies who underwent a single whole-liver treatment with Y-90 resin microspheres (SIR-Spheres ® Sirtex Medical, Lake Forest, IL) were retrospectively reviewed. The objective of the study was to evaluate the anatomic and physiologic determinants of radiation dose distribution, and the dose response of tumor and liver toxicity in patients with liver malignancies who underwent hepatic arterial Y-90 resin microsphere treatment.Methods: Liver and tumor volume calculations were performed on pre-treatment CT scans. Fractional tumor and liver flow characteristics and lung shunt fractions were determined using hepatic arterial Tc-99m MAA imaging. Absorbed dose calculations were performed using the MIRD equations. Liver toxicity was assessed clinically and by liver function tests. Tumor response to therapy was assessed by CT and/or tumor markers.

A review of 3D image-based dosimetry, technical considerations and emerging perspectives in 90Y microsphere therapy

“…Their results provide reasoning to the D NL threshold noted in other clinical studies of 70 Gy using GMS [44] and approximately 40-50 Gy using RMS [13,45]. It should be noted that although no toxicity was noted with absorbed doses of up to 100 Gy [46], the manufacturer of RMS recommends a D NL of 80 Gy, and a recent summary suggests a preferable D NL of 50 Gy [29]. Toxicity of either GMS or RMS is not only dependent on the dose volume factors, but also on the patient population, underlying liver disease, liver function and concurrent therapies [47].…”

Yttrium-90 microsphere radioembolization for the treatment of liver malignancies: a structured meta-analysis

“…This is particularly the case for liver metastasized breast cancer, of which response rates of over 90% are reported [61,62]. 90 Y-RE has been applied in patients with neuroendocrine liver metastases, too, albeit in small numbers [11,63]. Reported response rates were 100%, and it would therefore be worthwhile to further explore the use of 90 Y-RE for this indication.…”

The effect of intra-arterial angiotensin II on the hepatic tumor to non-tumor blood flow ratio for radioembolization: a systematic review

“…Several studies reported that favorable T/N uptake ratios of 99m Tc-MAA are associated with improved post-treatment tumor response [7,8,9], whereas other studies contradict these findings and emphasize that assuming an equal intrahepatic distribution of 99m Tc-MAA and 90 Y-microspheres may not be justified. [10,11,12,13] Still, a consistent finding of these studies is a strong interindividual heterogeneity in T/N uptake ratio's, with a reported range of 0.…”

“…6-25.9. [7,8,9,11,12,14,15,16,17] Furthermore, a recent study assessing the radioactive microsphere biodistribution on post-treatment quantitative imaging following radioembolization, demonstrated that the T/N uptake ratio per tumor may also show marked variability within the same liver. Up to 60% of the patients had at least one tumor that received a concentration of radioactivity equal to or lower than the normal liver tissue (T/N #1).…”