Transarterial Radioembolization Treatment of Pancreatic Cancer Patients with Liver-Dominant Metastatic Disease Using Yttrium-90 Glass Microspheres: A Single-Institution Retrospective Study

Kayaleh, R.; Krzyston, H.; Rishi, Anupam; Naziri, Jason; Frakes, Jessica M.; Choi, Junsung; El-Haddad, Ghassan; Parikh, Nainesh; Sweeney, Jennifer; Kis, Béla

doi:10.1016/j.jvir.2019.11.037

Cited by 7 publications

(7 citation statements)

References 22 publications

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“…Eight articles were identified that utilized SIRT, also known as TARE, for hepatic metastases in mPDAC (Table 6) [44][45][46][47][71][72][73][74]. A total of 302 patients with mPDAC (136 with liver only disease, 166 with liver + extrahepatic disease (EHD)) were included, of whom 59 were treated with pancreatic resection or SBRT and SIRT of the liver, 93 received SIRT of the liver only, 120 were used as matched controls receiving chemotherapy only, and 30 others (unknown primary treatment or different local metastatic treatment).…”

Section: Selective Internal Radiation Therapy (Sirt)/transarterial Radioembolization (Tare)mentioning

confidence: 99%

“…However, most of these (lower) survival outcomes after SIRT include non-stratified data of patients with and without primary pancreatic resection and with and without EHD, hence limiting their power. In this regard, Gibbs et al [72] demonstrated meaningful results by stratifying their results based on primary surgical treatment. They found that patients who received both primary resection and SIRT of the liver had significantly improved OS compared to those receiving SIRT only (mOS 13.6 vs. 4.2 months, respectively; p = 0.015).…”

Section: Selective Internal Radiation Therapy (Sirt)/transarterial Radioembolization (Tare)mentioning

confidence: 99%

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Locoregional Treatment of Metastatic Pancreatic Cancer Utilizing Resection, Ablation and Embolization: A Systematic Review

Timmer

Geboers

Nieuwenhuizen

et al. 2021

Cancers

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The prognosis of metastatic pancreatic ductal adenocarcinoma (mPDAC) remains universally poor, requiring new and innovative treatment approaches. In a subset of oligometastatic PDAC patients, locoregional therapy, in addition to systemic chemotherapy, may improve survival. The aim of this systematic review was to explore and evaluate the current evidence on locoregional treatments for mPDAC. A systematic literature search was conducted on locoregional techniques, including resection, ablation and embolization, for mPDAC with a focus on hepatic and pulmonary metastases. A total of 59 studies were identified, including 63,453 patients. Although subject to significant bias, radical-intent local therapy for both the primary and metastatic sites was associated with a superior median overall survival from metastatic diagnosis or treatment (hepatic mPDAC 7.8–19 months; pulmonary mPDAC 22.8–47 months) compared to control groups receiving chemotherapy or best supportive care (hepatic mPDAC 4.3–7.6 months; pulmonary mPDAC 11.8 months). To recruit patients that may benefit from these local treatments, selection appears essential. Most significant is the upfront possibility of local radical pancreatic and metastatic treatment. In addition, a patient’s response to neoadjuvant systemic chemotherapy, performance status, metastatic disease load and, to a lesser degree, histological differentiation grade and tumor marker CA19-9 serum levels, are powerful prognostic factors that help identify eligible subjects. Although the exact additive value of locoregional treatments for mPDAC patients cannot be distillated from the results, locoregional primary pancreatic and metastatic treatment seems beneficial for a highly selected group of oligometastatic PDAC patients. For definite recommendations, well-designed prospective randomized controlled trials with strict in- and exclusion criteria are needed to validate these results.

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Section: Selective Internal Radiation Therapy (Sirt)/transarterial Radioembolization (Tare)mentioning

confidence: 99%

Section: Selective Internal Radiation Therapy (Sirt)/transarterial Radioembolization (Tare)mentioning

confidence: 99%

Locoregional Treatment of Metastatic Pancreatic Cancer Utilizing Resection, Ablation and Embolization: A Systematic Review

Timmer

Geboers

Nieuwenhuizen

et al. 2021

Cancers

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“…Three workgroups published studies that evaluated the safety and efficacy of TARE in liver-dominant metastatic pancreatic cancer (Table 8 )[ 96 - 100 ]. Michl et al [ 96 ] published a retrospective study of 19 patients treated with Y90-labelled resin microspheres.…”

Section: Minimally Invasive Treatments Of Pancreatic Cancer Liver Metastasesmentioning

confidence: 99%

“…Grade 3 adverse events were noted in 2 patients. Very recently we reported our experience of Y90 TARE using Y90-labelled glass microspheres in 26 patients with liver dominant metastatic pancreatic cancer[ 100 ]. Median OS was 7 mo and 3 patients (11.5%) had grade 3 clinical toxicity in this study.…”

Section: Minimally Invasive Treatments Of Pancreatic Cancer Liver Metastasesmentioning

confidence: 99%

Minimally invasive image-guided therapy of primary and metastatic pancreatic cancer

Bibok

Kim

Malafa

et al. 2021

WJG

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Pancreatic cancer is a challenging malignancy with limited treatment options and poor life expectancy. The only curative option is surgical resection, but only 15%-20% of patients are resectable at presentation because more than 50% of patients has distant metastasis at diagnosis and the rest of them has locally advanced pancreatic cancer (LAPC). The standard of care first line treatment for LAPC patients is chemotherapy with or without radiation therapy. Recent developments in minimally invasive ablative techniques may add to the treatment armamentarium of LAPC. There are increasing number of studies evaluating these novel ablative techniques, including radiofrequency ablation, microwave ablation, cryoablation and irreversible electroporation. Most studies which included pancreatic tumor ablation, demonstrated improved overall survival in LAPC patients. However, the exact protocols are yet to set up to which stage of the treatment algorithm ablative techniques can be added and in what kind of treatment combinations. Patients with metastatic pancreatic cancer has dismal prognosis with 5-year survival is only 3%. The most common metastatic site is the liver as 90% of pancreatic cancer patients develop liver metastasis. Chemotherapy is the primary treatment option for patients with metastatic pancreatic cancer. However, when the tumor is not responding to chemotherapy or severe drug toxicity develops, locoregional liver-directed therapies can provide an opportunity to control intrahepatic disease progression and improve survival in selected patients. During the last decade new therapeutic options arose with the advancement of minimally invasive technologies to treat pancreatic cancer patients. These new therapies have been a topic of increasing interest due to the severe prognostic implications of locally advanced and metastatic pancreatic cancer and the low comorbid risk of these procedures. This review summarizes new ablative options for patients with LAPC and percutaneous liver-directed therapies for patients with liver-dominant metastatic disease.

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“…Median OS from the time of pancreatic diagnosis, from the time of diagnosis of liver metastatic disease, and from the time of radioembolization were 33, 21.8, and 7 months, respectively. 10 Prospective studies have also been conducted to investigate the efficacy of radioembolization. A phase 2 study was conducted in 2015 to evaluate the combination of resin radioembolization and 5-FU in liver-dominant advanced pancreatic cancer or liver-only pancreatic cancer.…”

mentioning

confidence: 99%

Radioembolization for Rare Metastatic Disease

Niekamp

Narayanan

Schiro

et al. 2021

Digestive Disease Interventions

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Radioembolization has become a widespread treatment modality for both primary and metastatic hepatic malignancies. Although the majority of data and indication for yttrium-90 radioembolization have been for hepatocellular carcinoma and metastatic colorectal cancer, radioembolization with yttrium-90 has rapidly expanded into the treatment options for multiple tumor types with metastases to the liver. This article reviews the clinical data and expanding utilization of radioembolization for rare metastatic diseases with an emphasis on efficacy and safety.

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Transarterial Radioembolization Treatment of Pancreatic Cancer Patients with Liver-Dominant Metastatic Disease Using Yttrium-90 Glass Microspheres: A Single-Institution Retrospective Study

Cited by 7 publications

References 22 publications

Locoregional Treatment of Metastatic Pancreatic Cancer Utilizing Resection, Ablation and Embolization: A Systematic Review

Locoregional Treatment of Metastatic Pancreatic Cancer Utilizing Resection, Ablation and Embolization: A Systematic Review

Minimally invasive image-guided therapy of primary and metastatic pancreatic cancer

Radioembolization for Rare Metastatic Disease

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