The value of radioembolisation therapy on metastatic liver tumours – a single centre experience

Abstract

Objective Local treatments used in metastatic liver tumours efficiently control the disease and survival. Transarterial radioembolisation (TARE) is a safely used locoregional treatment method. We aim to investigate the impact of TARE on different kinds of metastatic liver tumours and the effect of pre-treatment clinical findings.

Material and Methods The patients with metastatic liver tumours referred to our department for radioembolisation were retrospectively evaluated. All patients were given a Y-90 glass microsphere after being selected by the appropriate clinical and imaging criteria, lung shunt fraction levels, vascular investigation, and macro aggregated albumin (MAA) scintigraphy performed in the angiography unit.

Results Thirty-four (17 women, 17 men) patients were suitable for the treatment. Patients were treated with 115.88±47.84 Gy Y-90 glass Microspheres. The mean survival rate was 14.59±12.59 months after treatment. Higher survival rates were detected in patients who had higher pre-treatment serum albumin levels. The optimum cut-off value of albumin to predict response to treatment was 4 g/dl with 88.89% sensitivity, 62.50% specificity, 72.73% PPV and 83.33% NPV. Furthermore, one unit increase in age increased mortality 1.152 times in our patient group.

Conclusion Radioembolisation is a safe and efficient method for controlling metastatic liver disease. Albumin levels significantly affect predicting response; higher albumin levels are related to higher survival rates. Furthermore, older age positively correlated with mortality rates in our patient group.

Keywords

Radioembolisation - Y-90 - metastatic liver tumour - albumin

Publication History

Received: 20 December 2022

Accepted after revision: 01 February 2023

Article published online:
28 February 2023

• References

• 1 Donadon M, Ribero D, Morris-Stiff G. et al. New paradigm in the management of liver-only metastases from colorectal cancer. Gastrointest Cancer Res: GCR 2007; 1: 20-27
• 2 Schelhorn J, Richly H, Ruhlmann M. et al. A single-center experience in radioembolization as salvage therapy of hepatic metastases of uveal melanoma. Acta Radiol Open 2015; 4: 2047981615570417
• 3 Sucandy I, Cheek S, Golas BJ. et al. Longterm survival outcomes of patients undergoing treatment with radiofrequency ablation for hepatocellular carcinoma and metastatic colorectal cancer liver tumors. HPB: Off J Int Hepato Pancreato Biliary Assoc 2016; 18: 756-763
• 4 Egger ME, Armstrong E, Martin 2nd RC. et al. Transarterial Chemoembolization vs Radioembolization for Neuroendocrine Liver Metastases: A Multi-Institutional Analysis. J Am Coll Surg 2020; 230: 363-370
• 5 Vogl TJ, Jaraysa Y, Martin SS. et al. A prospective randomized trial comparing microwave and radiofrequency ablation for the treatment of liver metastases using a dual ablation system - The Mira study. Eur J Radiol Open 2022; 9: 100399
• 6 Van Cutsem E, Cervantes A, Nordlinger B. et al. Metastatic colorectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 25: iii1-9
• 7 Benson AB, Venook AP, Al-Hawary MM. et al. Colon Cancer, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19: 329-359
• 8 Kennedy A, Bester L, Salem R. et al. “Role of hepatic intraarterial therapies in metastatic neuroendocrine tumours (NET): guidelines from the NET-Liver-Metastases Consensus Conference”. Hpb 2015; 17: 29-37
• 9 Lam M, Garin E, Maccauro M. et al. A global evaluation of advanced dosimetry in transarterial radioembolisation of hepatocellular carcinoma with Yttrium-90: the TARGET study. Eur J Nucl Med Mol Imaging 2022; 49: 3340-3352
• 10 Levey AO, Elsayed M, Lawson DH. et al. Predictors of Overall and Progression-Free Survival in Patients with Ocular Melanoma Metastatic to the Liver Undergoing Y90 Radioembolization. Cardiovasc Intervent Radiol 2020; 43: 254-263
• 11 Filippiadis DK, Efthymiou E, Palialexis K. et al. Interventional oncology procedures for breast cancer metastatic disease: current role and clinical applications. Diagn Interv Radiol 2022; 28: 249-256
• 12 Kiszkaą J, Karczmarek-Borowska B. Radioembolization treatment for liver metastases. Contemp Oncol (Pozn) 2017; 21: 274-278
• 13 Saxena A, Chua TC, Bester L. et al. Factors predicting response and survival after yttrium-90 radioembolization of unresectable neuroendocrine tumor liver metastases: a critical appraisal of 48 cases. Ann Surg 2010; 251: 910-916
• 14 Mouli S, Memon K, Baker T. et al. Yttrium-90 radioembolization for intrahepatic cholangiocarcinoma: safety, response, and survival analysis. J Vasc Interv Radiol 2013; 24: 1227-1234
• 15 Padia SA. Y90 Clinical Data Update: Cholangiocarcinoma, Neuroendocrine Tumor, Melanoma, and Breast Cancer Metastatic Disease. Tech Vasc Interv Radiol 2019; 22: 81-86
• 16 Cianni R, Urigo C, Notarianni E. et al. Radioembolisation using yttrium 90 (Y-90) in patients affected by unresectable hepatic metastases. Radiol Med 2010; 115: 619-633
• 17 Triviño-Ibáñez EM, Pardo Moreno P, Ciampi Dopazo JJ. et al. Biomarkers associated with survival and favourable outcome of radioembolization with yttrium-90 glass microspheres for colon cancer liver metastases: Single centre experience. Rev Esp Med Nucl Imagen Mol (Engl Ed) 2022; 41: 231-238
• 18 Orwat KP, Beckham TH, Cooper SL. et al. Pretreatment albumin may aid in patient selection for intrahepatic Y-90 microsphere transarterial radioembolisation (TARE) for malignancies of the liver. J Gastrointest Oncol 2017; 8: 1072-1078
• 19 Saxena A, Meteling B, Kapoor J. et al. Is Yttrium- 90 radioembolization a viable treatment option for unresectable, chemorefractory colorectal cancer liver metastases? A large single- center experience of 302 patients. Ann Surg Oncol 2015; 22: 794-802
• 20 Lewandowski RJ, Memon K, Mulcahy MF. et al. Twelve-year experience of radioembolisation for colorectal, hepatic metastases in 214 patients: survival by era and chemotherapy. Eur J Nucl Med Mol Imaging 2014; 41: 1861-1869
• 21 Hickey R, Lewandowski RJ, Prudhomme T. et al. 90Y Radioembolization of Colorectal Hepatic Metastases Using Glass Microspheres: Safety and Survival Outcomes from a 531-Patient Multicenter Study. J Nucl Med 2016; 57: 665-671
• 22 Tsang ES, Loree JM, Davies JM. et al. Efficacy and Prognostic Factors for Y-90 Radioembolization (Y-90) in Metastatic Neuroendocrine Tumors with Liver Metastases. Can J Gastroenterol Hepatol 2020; 5104082
• 23 Cao C, Yan TD, Morris DL. et al. Radioembolization with yttrium-90 microspheres for pancreatic cancer liver metastases: results from a pilot study. Tumori 2010; 96: 955-958
• 24 Michl M, Haug AR, Jakobs TF. et al. Radioembolization with Yttrium-90 microspheres (SIRT) in pancreatic cancer patients with liver metastases: efficacy, safety and prognostic factors. Oncology 2014; 86: 24-32
• 25 Kim AY, Unger K, Wang H. et al. Incorporating Yttrium-90 trans-arterial radioembolization (TARE) in the treatment of metastatic pancreatic adenocarcioma: a single centre experience. BMC Cancer 2016; 16: 492
• 26 Lacayo EA, Velayati S, Elsakka A. et al. Safety and Efficacy of Arterially Directed Liver Therapies in the Treatment of Hepatic Metastatic Ovarian Cancer: A Retrospective Single-Institution Study. J Vasc Interv Radiol 2021; 32: 853-860
• 27 Kaliki S, Shields CL. Uveal melanoma: relatively rare but deadly cancer. Eye 2017; 31: 241-257
• 28 Gonsalves CF, Eschelman DJ, Sullivan KL. et al. Radioembolization as salvage therapy for hepatic metastasis of uveal melanoma: a single-institution experience. AJR Am J Roentgenol 2011; 196: 468-473
• 29 Klingenstein A, Haug AR, Zech CJ. et al. Radioembolization as locoregional therapy of hepatic metastases in uveal melanoma patients. Cardiovasc Interv Radiol 2013; 36: 158-165