Transarterial Radioembolization of Hepatocellular Carcinoma, Liver-Dominant Hepatic Colorectal Cancer Metastases, and Cholangiocarcinoma Using Yttrium90 Microspheres: Eight-Year Single-Center Real-Life Experience

Abstract

Liver tumors are common and may be unamenable to surgery or ablative treatments. Consequently, other treatments have been devised. To assess the safety and efficacy of transarterial radioembolization (TARE) with Yttrium-90 for hepatocellular carcinoma (HCC), liver-dominant hepatic colorectal cancer metastases (mCRC), and cholangiocarcinoma (CCA), performed according to current recommendations, we conducted a single-center retrospective study in 70 patients treated with TARE (HCC, n = 44; mCRC, n = 20; CCA, n = 6). Safety and toxicity were assessed using the National Cancer Institute Common Terminology Criteria. Treatment response was evaluated every 3 months on imaging studies using Response Evaluation Criteria in Solid Tumors (RECIST) or mRECIST criteria. Overall survival and progression-free survival were estimated using the Kaplan-Meier method. The median delivered dose was 1.6 GBq, with SIR-Spheres® or TheraSphere® microspheres. TARE-related grade 3 adverse events affected 17.1% of patients. Median follow-up was 32.1 months. Median progression-free survival was 5.6 months and median overall time from TARE to death was 16.1 months and was significantly shorter in men. Progression-free survival was significantly longer in women (HR, 0.49; 95%CI, 0.26–0.90; p = 0.031). Risk of death or progression increased with the number of systemic chemotherapy lines. TARE can be safe and effective in patients with intermediate- or advanced-stage HCC, CCA, or mCRC refractory or intolerant to appropriate treatments.

Conversion therapy with an immune checkpoint inhibitor and an antiangiogenic drug for advanced hepatocellular carcinoma: A review

“…The incidence of serious adverse events is relatively low and recovery can be achieved through drug withdrawal or hormone therapy. Research by the current authors has indicated that a combination of an ICI and an TKI resulted in an adverse event incidence of about 46.9%, most of which are below grade three (63).The incidence of grade three or four adverse events was 6.1% which is significantly lower than that of other treatment modalities (18,42,(44)(45)(46)(64)(65)(66). Adverse events are grouped in accordance with the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0 (53).…”

“…Specific methods include associating liver partition and portal vein ligation for staged hepatectomy, ablation, TACE, HAIC, SBRT, CCRT, TARE, TKIs, ICIs, and multimodality treatment approaches (16,18,42,43). Conversion outcomes of various approaches are cited in Table 3 (16,18,42,(44)(45)(46). Despite controversies, mounting data have indicated that successful conversion treatment followed by subsequent surgery is achievable in the population of patients with advanced HCC (47).…”

Labeling of Hinokitiol with 90Y for Potential Radionuclide Therapy of Hepatocellular Carcinoma

“…Thus, numerous studies have demonstrated its therapeutic efficacy and safety [21,51]. Among its prominent applications is transarterial radioembolization for the treatment of primary and secondary liver cancers [52,53]. It takes advantage of the dual blood supply of the liver, which permits it to suppress the tumor feeding, while preserving the liver.…”

“…An amount of 1 mL of freshly prepared 90 Y-hinokitiol (45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64) in Lipiodol phase was taken with a syringe and put into a 12-mL flat bottom glass vial, containing 10 mL of physiological serum (previously weighed), and the vial was closed. Activity in the vial was measured with the dose calibrator.…”

Precision Imaging Guidance in the Era of Precision Oncology: An Update of Imaging Tools for Interventional Procedures

“…Transarterial radioembolization with yttrium-90 (90Y) microspheres is a form of brachytherapy that uses the hepatic arterial supply to permanently implant 90Y in the target tumor through the injection of resin or glass microspheres [ 23 ].…”