Yttrium-90 Radioembolization of Advanced, Unresectable Breast Cancer Liver Metastases—A Single-Center Experience

Metastatic liver disease is a major cause of cancer-related morbidity and mortality. Surgical resection is considered the only curative treatment, yet only a minority is eligible. Patients who present with unresectable disease are treated with systemic agents and/or locoregional therapies. The latter include thermal ablation and catheter-based transarterial interventions. Thermal ablation is reserved for those with limited tumor burden. It is used to downstage the disease to enable curative surgical resection, as an adjunct to surgery, or in select patients it is potentially curative. Transarterial therapies are indicated in those with more diffuse disease. The goals of care are to palliate symptoms and prolong survival. The indications and supporting data for thermal ablation and transarterial interventions are reviewed, technical and tumor factors that need to be considered prior to intervention are outlined, and finally several cases are presented.

Section: Tarementioning

confidence: 87%

Section: Uveal Melanoma Liver Metastases-indications For Locoregionalmentioning

confidence: 99%

Metastatic Liver Disease: Indications for Locoregional Therapy and Supporting Data

Shamimi-Noori

Gonsalves

Shaw

2017

“…Pieper et al recently published cohort of 44 patients treated with radioembolization primarily with resin microspheres. 25 Thirteen patients (29.5%) had new or worsening ascites within 3 months, one patient (2.2%) had duodenal ulceration requiring surgery, and the 30-day mortality rate was 4.8%. Partial response (RECIST v1.1) was 39.5% in the treated liver.…”

Section: Y90mentioning

confidence: 97%

Making the Case: Intra-arterial Therapy for Less Common Metastases

Gordon

Uddin

Riaz

et al. 2017

Intra-arterial therapies have high antitumor activity for both primary and secondary hepatic malignancies. Selective infusions allow increased delivery of cytoreductive therapy to the tumor bed while sparing the normal hepatic parenchyma. These therapies are now often applied in the outpatient setting or with short overnight hospital stays and have a growing role in the treatment of liver-dominant disease from metastatic colorectal cancer and from neuroendocrine tumors. Less commonly, intra-arterial therapies are applied to treat secondary hepatic malignancies from breast cancer, melanoma, pancreatic adenocarcinoma, and soft-tissue sarcomas. The available data are limited and generally retrospective observational cohort series of single institutions. The purpose of this article is to summarize the recent literature on outcomes for intra-arterial therapy in nonsurgical patients. Multi-institutional registries and prospective data are greatly needed, as intra-arterial therapies are increasingly applied in these patients to stop progression of chemorefractory tumors.

“…Pieper et al published on a cohort of 44 patients treated with radioembolization with resin microspheres. 46 This was a heavily pretreated cohort, with 73% (n ¼ 32) having previously undergone more than five lines of systemic chemotherapy. The majority of patients (n ¼ 25, 57%) had greater than 25% tumor burden.…”

Section: Breast Cancermentioning

confidence: 99%

Locoregional Therapies for the Treatment of Hepatic Metastases from Breast and Gynecologic Cancers

Mouli

Gupta

Sheth

et al. 2018

Breast cancer is the most common women's malignancy in the United States and is the second leading cause of cancer death. More than half of patients with breast cancer will develop hepatic metastases; this portends a poorer prognosis. In the appropriately selected patient, there does appear to be a role for curative (surgery, ablation) or palliative (intra-arterial treatments) locoregional therapy. Gynecologic malignancies are less common and metastases to the liver are most often seen in the setting of disseminated disease. The role of locoregional therapies in these patients is not well reported. The purpose of this article is to review the outcomes data of locoregional therapies in the treatment of hepatic metastases from breast and gynecologic malignancies.