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Radiation segmentectomy of hepatic metastases with Y-90 glass microspheres

  • Interventional Radiology
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate safety and efficacy of radiation segmentectomy (RS) with 90Y glass microspheres in patients with limited metastatic liver disease not amenable to resection or percutaneous ablation.

Methods

Patients with ≤ 3 tumors treated with RS from 6/2015 to 12/2017 were included. Target tumor radiation dose was > 190 Gy based on medical internal radiation dose (MIRD) dosimetry. Tumor response, local tumor progression (LTP), LTP-free survival (LTPFS) and disease progression rate in the treated segment were defined using Choi and RECIST 1.1 criteria. Toxicities were evaluated using modified SIR criteria.

Results

Ten patients with 14 tumors underwent 12 RS. Median tumor size was 3 cm (range 1.4–5.6). Median follow-up was 17.8 months (range 1.6–37.3). Response rates per Choi and RECIST 1.1 criteria were 8/8 (100%) and 4/9 (44%), respectively. Overall LTP rate was 3/14 (21%) during the study period. One-, two- and three-year LTPFS was 83%, 83% and 69%, respectively. Median LTPFS was not reached. Disease progression rate in the treated segment was 6/18 (33%). Median overall survival was 41.5 months (IQR 16.7–41.5). Median delivered tumor radiation dose was 293 Gy (range 163–1303). One major complication was recorded in a patient post-Whipple procedure who suffered anaphylactic reaction to prophylactic cefotetan and liver abscess in RS region 6.5 months post-RS. All patients were alive on last follow-up.

Conclusion

RS of ≤ 3 hepatic segments can safely provide a 2-year local tumor control rate of 83% in selected patients with limited metastatic liver disease and limited treatment options. Optimal dosimetry methodology requires further investigation.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials. Raw data were generated at Memorial Sloan Kettering Cancer Center. Derived data supporting the findings of this study are available from the corresponding author C.T. Sofocleous on request.

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Acknowledgements

This research was supported by the Memorial Sloan Kettering Cancer Center Support Grant/Core Grant (P30 CA008748).

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Authors and Affiliations

  1. Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    I. Kurilova, A. Bendet, E. N. Petre, F. E. Boas & C. T. Sofocleous

  2. Department of Radiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    I. Kurilova & R. G. H. Beets-Tan

  3. Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    E. K. Fung & J. L. Humm

  4. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    C. H. Crane

  5. Department of Gastrointestinal Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    N. Kemeny & A. Cercek

  6. Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    T. P. Kingham & M. I. D’Angelica

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  1. I. Kurilova
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Correspondence to C. T. Sofocleous.

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Conflict of interest

Dr. E. Ziv: Research grants from SIR, RSNA, NANETS, Cycle for survival, MSK Society, MSK FGI, AACR, Ethicon, and Novartis. All conflicts of interest are outside the submitted work. Dr. C.T. Sofocleous: Research Support from National Institute of Health (NIH, R01 CA240569-01). Research support from industry: SIRTEX Medical Inc, BTG and Ethicon J&J. Dr. Sofocleous is consultant/ member of advisory board for: J&J/ Ethicon, Terumo, BTG/Boston Scientific, SIRTEX, Varian. All conflicts of interest are outside the submitted work. Dr. F.E. Boas is a co-founder of Claripacs, LLC. He received research funding (investigator-initiated) from Guerbet. He received research support (investigator-initiated) from GE. He received research supplies (investigator-initiated) from Bayer. He received a research grant and speaker fees from Society of Interventional Oncology, which were sponsored by Guerbet. He attended research meetings sponsored by Guerbet. He is an investor in Labdoor, Qventus, CloudMedx, Notable Labs, and Xgenomes. He is the inventor and assignee on US patent 8233586, and is an inventor on US provisional patent applications 62/754,139 and 62/817,116. All conflicts of interest are outside the submitted work. Other authors have co conflicts of interest.

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Kurilova, I., Bendet, A., Fung, E.K. et al. Radiation segmentectomy of hepatic metastases with Y-90 glass microspheres. Abdom Radiol 46, 3428–3436 (2021). https://doi.org/10.1007/s00261-021-02956-6

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