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The Post-SIR-Spheres Surgery Study (P4S): Retrospective Analysis of Safety Following Hepatic Resection or Transplantation in Patients Previously Treated with Selective Internal Radiation Therapy with Yttrium-90 Resin Microspheres

  • Hepatobiliary Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Reports show that selective internal radiation therapy (SIRT) may downsize inoperable liver tumors to resection or transplantation, or enable a bridge-to-transplant. A small-cohort study found that long-term survival in patients undergoing resection following SIRT appears possible but no robust studies on postsurgical safety outcomes exist. The Post-SIR-Spheres Surgery Study was an international, multicenter, retrospective study to assess safety outcomes of liver resection or transplantation following SIRT with yttrium-90 (Y-90) resin microspheres (SIR-Spheres®; Sirtex).

Methods

Data were captured retrospectively at participating SIRT centers, with Y-90 resin microspheres, surgery (resection or transplantation), and follow-up for all eligible patients. Primary endpoints were perioperative and 90-day postoperative morbidity and mortality. Standard statistical methods were used.

Results

The study included 100 patients [hepatocellular carcinoma: 49; metastatic colorectal cancer (mCRC): 30; cholangiocarcinoma, metastatic neuroendocrine tumor, other: 7 each]; 36% of patients had one or more lines of chemotherapy pre-SIRT. Sixty-three percent of patients had comorbidities, including hypertension (44%), diabetes (26%), and cardiopathy (16%). Post-SIRT, 71 patients were resected and 29 received a liver transplant. Grade 3+ peri/postoperative complications and any grade of liver failure were experienced by 24 and 7% of patients, respectively. Four patients died <90 days postsurgery; all were trisectionectomies (mCRC: 3; cholangiocarcinoma: 1) and typically had one or more previous chemotherapy lines and presurgical comorbidities.

Conclusions

In 100 patients undergoing liver surgery after receiving SIRT, mortality and complication rates appeared acceptable given the risk profile of the recruited patients.

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Acknowledgments

The authors acknowledge the editorial assistance provided by Martin Gilmour of ESP Bioscience, Crowthorne, UK, funded by Sirtex, during the preparation of this manuscript. The guidelines issued by the International Committee of Medical Journal Editors and Good Publication Practice-3 were adhered to for the development of the manuscript.

Funding

This study was sponsored by Sirtex, with set funding provided for each study entrant, assuming 80% of the required data were collected. The authors received no payment for their involvement as authors of this manuscript.

Disclosure

Independently of P4S, the authors declare the following additional conflicts. Fernando Pardo has received lecture and consulting fees from Sirtex Medical; Bruno Sangro has received lecture and consulting fees from Sirtex Medical; Derek Manas has received support for travel to meetings, as well as honoraria for lecturing and attendance at advisory boards from Sirtex Medical; Pierce K. Chow has received honoraria and research grants from Sirtex Medical; Fernando Rotellar has received travel support and lecture and consulting fees from Sirtex Medical; IB has received lecture fees from Sirtex Medical. Paul J. Gow, Geert Maleux,Gianluca Masi, Lourens Bester, David L. Morris, Wan Y. Lau, Konstantinos Kouladouros, Georgios Katsanos, and Giorgio Ercolani have no conflict of interest to declare.

Author information

Authors and Affiliations

  1. HPB and Transplant Surgery, Clinica Universidad de Navarra, IDISNA, Pamplona, Navarra, Spain

    Fernando Pardo MD & Fernando Rotellar MD, PhD

  2. Liver Unit, Clinica Universidad de Navarra, IDISNA, CIBEREHD, Pamplona, Navarra, Spain

    Bruno Sangro MD, PhD

  3. Radiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan

    Rheun-Chuan Lee MD

  4. Institute of Transplantation, University of Newcastle Upon Tyne, Newcastle Upon Tyne, UK

    Derek Manas MBBCh, FCS(SA), FRCSEd

  5. Newcastle NHS Trust, Newcastle Upon Tyne, UK

    Derek Manas MBBCh, FCS(SA), FRCSEd

  6. Surgical Oncology, Methodist Dallas Medical Center, Dallas, TX, USA

    Rohan Jeyarajah MD

  7. Department of Surgery, Institut Jules Bordet, Université Libre de Bruxelles and Centre de Chirurgie Hépato-Biliaire de l’ULB, Brussels, Belgium

    Vincent Donckier MD, PhD

  8. Radiology, University Hospitals Leuven, Louvain, Belgium

    Geert Maleux MD, PhD

  9. Hepatobiliary and Transplant Surgery, S. Orsola-Malpighi, University of Bologna, Bologna, Italy

    Antonio D. Pinna MD, PhD

  10. Interventional Radiology, St Vincent’s Hospital, Sydney, NSW, Australia

    Lourens Bester M Med Rad, FRANZCR, FACP

  11. Department of Surgery, St George Hospital, University of New South Wales, Kogarah, NSW, Australia

    David L. Morris MD, PhD

  12. HPB Surgery, Carolinas Medical Center, Charlotte, NC, USA

    David Iannitti MD

  13. Surgical Oncology, National Cancer Center, Singapore, Singapore

    Pierce K. Chow MD, PhD

  14. Hepatobiliary Surgery, Wakefield Clinic, Wellington, New Zealand

    Richard Stubbs MBChB, MD, FRCS (Eng), FRACS

  15. Transplant Hepatology, Austin Hospital, Heidelberg, VIC, Australia

    Paul J. Gow MD

  16. Medical Oncology, Ospedale Santa Chiara, Pisa, Italy

    Gianluca Masi MD

  17. Department of Surgery, Saint Francis Hospital, Tulsa, OK, USA

    Kevin T. Fisher DO, FACOS

  18. Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, Hong Kong

    Wan Y. Lau MD, DSc, FRCS, FRACS, FCSHK, FHKAM

  19. Klinikum Karlsruhe, Karlsruhe, Germany

    Konstantinos Kouladouros MD & Michael Schoen MD

  20. Department of Abdominal Surgery, Hôpital Erasme, Université Libre de Bruxelles and Centre de Chirurgie Hépato-Biliaire de l’ULB, Brussels, Belgium

    Georgios Katsanos MD, PhD

  21. Hepatobiliary and Transplant Surgery, Sant’Orsola Hospital, University of Bologna, Bologna, Italy

    Giorgio Ercolani MD, PhD

  22. Interventional Radiology, Clinica Universidad de Navarra, IDISNA, Pamplona, Navarra, Spain

    José I. Bilbao MD, PhD

Authors
  1. Fernando Pardo MD
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  2. Bruno Sangro MD, PhD
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  3. Rheun-Chuan Lee MD
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  4. Derek Manas MBBCh, FCS(SA), FRCSEd
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  5. Rohan Jeyarajah MD
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  6. Vincent Donckier MD, PhD
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  7. Geert Maleux MD, PhD
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  8. Antonio D. Pinna MD, PhD
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  9. Lourens Bester M Med Rad, FRANZCR, FACP
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  10. David L. Morris MD, PhD
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  11. David Iannitti MD
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  12. Pierce K. Chow MD, PhD
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  13. Richard Stubbs MBChB, MD, FRCS (Eng), FRACS
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  14. Paul J. Gow MD
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  15. Gianluca Masi MD
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  16. Kevin T. Fisher DO, FACOS
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  17. Wan Y. Lau MD, DSc, FRCS, FRACS, FCSHK, FHKAM
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  18. Konstantinos Kouladouros MD
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  19. Georgios Katsanos MD, PhD
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  20. Giorgio Ercolani MD, PhD
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  21. Fernando Rotellar MD, PhD
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  22. José I. Bilbao MD, PhD
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  23. Michael Schoen MD
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Corresponding author

Correspondence to Fernando Pardo MD.

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Pardo, F., Sangro, B., Lee, RC. et al. The Post-SIR-Spheres Surgery Study (P4S): Retrospective Analysis of Safety Following Hepatic Resection or Transplantation in Patients Previously Treated with Selective Internal Radiation Therapy with Yttrium-90 Resin Microspheres. Ann Surg Oncol 24, 2465–2473 (2017). https://doi.org/10.1245/s10434-017-5950-z

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