Skip to main content
SpringerLink
Log in

Radiographic Response to Yttrium-90 Radioembolization in Anterior Versus Posterior Liver Segments

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

The purpose of our study was to determine if preferential radiographic tumor response occurs in tumors located in posterior versus anterior liver segments following radioembolization with yttrium-90 glass microspheres. One hundred thirty-seven patients with chemorefractory liver metastases of various primaries were treated with yttrium-90 glass microspheres. Of these, a subset analysis was performed on 89 patients who underwent 101 whole-right-lobe infusions to liver segments V, VI, VII, and VIII. Pre- and posttreatment imaging included either triphasic contrast material-enhanced CT or gadolinium-enhanced MRI. Responses to treatment were compared in anterior versus posterior right lobe lesions using both RECIST and WHO criteria. Statistical comparative studies were conducted in 42 patients with both anterior and posterior segment lesions using the paired-sample t-test. Pearson correlation was used to determine the relationship between pretreatment tumor size and posttreatment tumor response. Median administered activity, delivered radiation dose, and treatment volume were 2.3 GBq, 118.2 Gy, and 1,072 cm3, respectively. Differences between the pretreatment tumor size of anterior and posterior liver segments were not statistically significant (p = 0.7981). Differences in tumor response between anterior and posterior liver segments were not statistically significant using WHO criteria (p = 0.8557). A statistically significant correlation did not exist between pretreatment tumor size and posttreatment tumor response (r = 0.0554, p = 0.4434). On imaging follow-up using WHO criteria, for anterior and posterior regions of the liver, (1) response rates were 50% (PR = 50%) and 45% (CR = 9%, PR = 36%), and (2) mean changes in tumor size were −41% and −40%. In conclusion, this study did not find evidence of preferential radiographic tumor response in posterior versus anterior liver segments treated with yttrium-90 glass microspheres.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Bartolozzi C (ed) (2003) Liver malignancies, 1st edn. Springer, New York

    Google Scholar 

  2. Carr BI (2004) Hepatic arterial 90Yttrium glass microspheres (therasphere) for unresectable hepatocellular carcinoma: interim safety and survival data on 65 patients. Liver Transpl 10:S107–S110

    Article  PubMed  Google Scholar 

  3. Geschwind JF, Salem R, Carr BI et al (2004) Yttrium-90 microspheres for the treatment of hepatocellular carcinoma. Gastroenterology 127:S194–S205

    Article  PubMed  CAS  Google Scholar 

  4. Gray B, Van Hazel G, Hope M et al (2001) Randomised trial of SIR-Spheres plus chemotherapy vs. chemotherapy alone for treating patients with liver metastases from primary large bowel cancer. Ann Oncol 12:1711–1720

    Article  PubMed  CAS  Google Scholar 

  5. Lewandowski RJ, Sato KT, Atassi B et al (2007) Radioembolization with (90)y microspheres: angiographic and technical considerations. CardioVasc Interv Radiol 30:571–592

    Article  Google Scholar 

  6. Salem R, Lewandowski RJ, Atassi B et al (2005) Treatment of unresectable hepatocellular carcinoma with use of 90Y microspheres (therasphere): safety, tumor response, and survival. J Vasc Interv Radiol 16:1627–1639

    PubMed  Google Scholar 

  7. Van Hazel G, Blackwell A, Anderson J et al (2004) Randomised phase 2 trial of SIR-Spheres plus fluorouracil/leucovorin chemotherapy versus fluorouracil/leucovorin chemotherapy alone in advanced colorectal cancer. J Surg Oncol 88:78–85

    Article  PubMed  CAS  Google Scholar 

  8. Breedis C, Young G (1954) The blood supply of neoplasms in the liver. Am J Pathol 30:969–977

    PubMed  CAS  Google Scholar 

  9. Lien WM, Ackerman NB (1970) The blood supply of experimental liver metastases. II. A microcirculatory study of the normal and tumor vessels of the liver with the use of perfused silicone rubber. Surgery 68:334–340

    PubMed  CAS  Google Scholar 

  10. Murthy R, Nunez R, Szklaruk J et al (2005) Yttrium-90 microsphere therapy for hepatic malignancy: devices, indications, technical considerations, and potential complications. Radiographics 25(Suppl 1):S41–S55

    Article  PubMed  Google Scholar 

  11. Nordion MDS (2004) Therasphere Yttrium-90 microspheres package insert. MDS Nordion, Kanata, Canada

    Google Scholar 

  12. Salem R, Thurston KG (2006) Radioembolization with 90yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 1: technical and methodologic considerations. J Vasc Interv Radiol 17:1251–1278

    PubMed  Google Scholar 

  13. Welsh JS, Kennedy AS, Thomadsen B (2006) Selective internal radiation therapy (SIRT) for liver metastases secondary to colorectal adenocarcinoma. Int J Radiat Oncol Biol Phys 66:S62–S73

    PubMed  CAS  Google Scholar 

  14. Welsh JS (2007) Radiographically identified necrosis after 90Y microsphere brachytherapy: a new standard for oncologic response assessment? AJR 188:765–767

    Article  PubMed  Google Scholar 

  15. Sato KT, Lewandowski RJ, Mulcahy MF, Atassi B, Ryu RK, Gates VL, Nemcek AA, Jr., Barakat O, Benson A, III, Mandal R, Talamonti M, Wong CY, Miller FH, Newman SB, Shaw JM, Thurston KG, Omary RA, Salem R (2008) Unresectable chemorefractory liver metastases: radioembolization with 90Y microspheres–safety, efficacy, and survival. Radiology 247:507–515

  16. Lewandowski RJ, Thurston KG, Goin JE et al (2005) 90Y microsphere (therasphere) treatment for unresectable colorectal cancer metastases of the liver: response to treatment at targeted doses of 135–150 Gy as measured by [18F]fluorodeoxyglucose positron emission tomography and computed tomographic imaging. J Vasc Interv Radiol 16:1641–1651

    PubMed  Google Scholar 

  17. Dancey JE, Shepherd FA, Paul K et al (2000) Treatment of nonresectable hepatocellular carcinoma with intrahepatic 90Y-microspheres. J Nucl Med 41:1673–1681

    PubMed  CAS  Google Scholar 

  18. Salem R, Thurston KG, Carr BI, Goin JE, Geschwind JF (2002) Yttrium-90 microspheres: radiation therapy for unresectable liver cancer. J Vasc Interv Radiol 13:S223–S229

    Article  PubMed  Google Scholar 

  19. Russell JL, Carden JL, Herron HL (1988) Dosimetry calculations for yttrium-90 used in the treatment of liver cancer. Endocuriether/Hypertherm Oncol 4:171–186

    Google Scholar 

  20. Therasse P, Arbuck SG, Eisenhauer EA et al (2000) New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92:205–216

    Article  PubMed  CAS  Google Scholar 

  21. Campbell AM, Bailey IH, Burton MA (2000) Analysis of the distribution of intra-arterial microspheres in human liver following hepatic yttrium-90 microsphere therapy. Phys Med Biol 45:1023–1033

    Article  PubMed  CAS  Google Scholar 

  22. Campbell AM, Bailey IH, Burton MA (2001) Tumour dosimetry in human liver following hepatic yttrium-90 microsphere therapy. Phys Med Biol 46:487–498

    Article  PubMed  CAS  Google Scholar 

  23. Kennedy AS, Nutting C, Coldwell D, Gaiser J, Drachenberg C (2004) Pathologic response and microdosimetry of (90)Y microspheres in man: review of four explanted whole livers. Int J Radiat Oncol Biol Phys 60:1552–1563

    PubMed  CAS  Google Scholar 

  24. Helmberger TK (2007) Percutaneous tumor ablation in medical radiology, 1st edn. Springer, Berlin/Heidelberg

    Google Scholar 

  25. Ho S, Lau JW, Leung TW (2001) Intrahepatic (90)Y-microspheres for hepatocellular carcinoma. J Nucl Med 42:1587–1589

    PubMed  CAS  Google Scholar 

  26. Herba MJ, Illescas FF, Thirlwell MP et al (1988) Hepatic malignancies: improved treatment with intraarterial Y-90. Radiology 169:311–314

    PubMed  CAS  Google Scholar 

  27. Ho S, Lau WY, Leung TW, Johnson PJ (1998) Internal radiation therapy for patients with primary or metastatic hepatic cancer: a review. Cancer 83:1894–1907

    Article  PubMed  CAS  Google Scholar 

  28. Kulik LM, Atassi B, van Holsbeeck L et al (2006) Yttrium-90 microspheres (therasphere(R)) treatment of unresectable hepatocellular carcinoma: downstaging to resection, RFA and bridge to transplantation. J Surg Oncol 94:572–586

    Article  PubMed  CAS  Google Scholar 

  29. Araki N, Nagata Y, Fujiwara K et al (2001) Evaluation of glass microspheres for intra-arterial radiotherapy in animal kidneys. Int J Radiat Oncol Biol Phys 49:459–463

    Article  PubMed  CAS  Google Scholar 

  30. Beck KC (1987) Regional trapping of microspheres in the lung compares well with regional blood flow. J Appl Physiol 63:883–889

    PubMed  CAS  Google Scholar 

  31. Wong CY, Savin M, Sherpa KM et al (2006) Regional yttrium-90 microsphere treatment of surgically unresectable and chemotherapy-refractory metastatic liver carcinoma. Cancer Biother Radiopharm 21:305–313

    Article  PubMed  CAS  Google Scholar 

  32. Herba MJ, Thirlwell MP (2002) Radioembolization for hepatic metastases. Semin Oncol 29:152–159

    Article  PubMed  Google Scholar 

  33. Lim L, Gibbs P, Yip D et al (2005) Prospective study of treatment with selective internal radiation therapy spheres in patients with unresectable primary or secondary hepatic malignancies. Intern Med J 35:222–227

    Article  PubMed  CAS  Google Scholar 

  34. Neff R, Abdel-Misih R, Khatri J et al (2008) The toxicity of liver directed yttrium-90 microspheres in primary and metastatic liver tumors. Cancer Invest 26:173–177

    Article  PubMed  CAS  Google Scholar 

  35. Popperl G, Helmberger T, Munzing W, Schmid R, Jacobs TF, Tatsch K (2005) Selective internal radiation therapy with SIR-Spheres in patients with nonresectable liver tumors. Cancer Biother Radiopharm 20:200–208

    Article  PubMed  Google Scholar 

  36. Kennedy AS, Coldwell D, Nutting C, Murthy R, Wertman DE Jr, Loehr SP, Overton C, Meranze S, Niedzwiecki J, Sailer S (2006) Resin 90Y-microsphere brachytherapy for unresectable colorectal liver metastases: modern USA experience. Int J Radiat Oncol Biol Phys 65:412–425

    Google Scholar 

  37. Lau WY, Ho S, Leung TW, Chan M, Ho R, Johnson PJ, Li AK (1998) Selective internal radiation therapy for nonresectable hepatocellular carcinoma with intraarterial infusion of 90yttrium microspheres. Int J Radiat Oncol Biol Phys 40:583–592

    Google Scholar 

  38. Lau WY, Leung WT, Ho S, Leung NW, Chan M, Lin J, Metreweli C, Johnson P, Li AK (1994) Treatment of inoperable hepatocellular carcinoma with intrahepatic arterial yttrium-90 microspheres: a phase I and II study. Br J Cancer 70:994–999

    Google Scholar 

  39. Murthy R, Xiong H, Nunez R, Cohen AC, Barron B, Szklaruk J, Madoff DC, Gupta S, Wallace MJ, Ahrar K, Hicks ME (2005) Yttrium 90 resin microspheres for the treatment of unresectable colorectal hepatic metastases after failure of multiple chemotherapy regimens: preliminary results. J Vasc Interv Radiol 16:937–945

    Google Scholar 

  40. Popperl G, Helmberger T, Munzing W, Schmid R, Jacobs TF, Tatsch K (2005) Selective internal radiation therapy with SIR-Spheres in patients with nonresectable liver tumors. Cancer Biother Radiopharm 20:200–208

    Google Scholar 

  41. Stubbs RS, Cannan RJ, Mitchell AW (2001) Selective internal radiation therapy (SIRT) with 90Yttrium microspheres for extensive colorectal liver metastases. Hepato-gastroenterology 48:333–337

    Google Scholar 

  42. Stubbs RS, Cannan RJ, Mitchell AW (2001) Selective internal radiation therapy with 90yttrium microspheres for extensive colorectal liver metastases. J Gastrointest Surg 5:294–302

    Google Scholar 

  43. Van Hazel G, Blackwell A, Anderson J, Price D, Moroz P, Bower G, Cardaci G, Gray B (2004) Randomised phase 2 trial of SIR-Spheres plus fluorouracil/leucovorin chemotherapy versus fluorouracil/leucovorin chemotherapy alone in advanced colorectal cancer. J Surg Oncol 88:78–85

    Google Scholar 

  44. Yip D, Allen R, Ashton C, Jain S (2004) Radiation-induced ulceration of the stomach secondary to hepatic embolization with radioactive yttrium microspheres in the treatment of metastatic colon cancer. J Gastroenterol Hepatol 19:347–349

    Google Scholar 

  45. Stubbs RS, O’Brien I, Correia MM (2006) Selective internal radiation therapy with 90Y microspheres for colorectal liver metastases: single-centre experience with 100 patients. ANZ J Surg 76:696–703

    Google Scholar 

  46. Murthy R, Brown DB, Salem R et al (2007) Gastrointestinal complications associated with hepatic arterial yttrium-90 microsphere therapy. J Vasc Interv Radiol 18:553–561; quiz 562

    Article  PubMed  Google Scholar 

  47. Salem R, Thurston KG (2006) Radioembolization with yttrium-90 microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 3: comprehensive literature review and future direction. J Vasc Interv Radiol 17:1571–1593

    Article  PubMed  Google Scholar 

  48. Bruix J, Sherman M, Llovet JM et al (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35:421–430

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Section of Interventional Radiology, Northwestern University, 676 N. St. Claire, Suite 800, Chicago, IL, 60611, USA

    Saad M. Ibrahim, Robert J. Lewandowski, Robert K. Ryu, Kent T. Sato, Vanessa L. Gates, Reed A. Omary & Riad Salem

  2. Department of Nuclear Medicine, Northwestern University, Chicago, IL, USA

    Vanessa L. Gates

  3. Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA

    Mary F. Mulcahy

  4. Department of Medicine, Division of Hepatology, Northwestern University, Chicago, IL, USA

    Laura Kulik

  5. Department of Biomedical Engineering, Northwestern University, Chicago, IL, USA

    Andrew C. Larson

Authors
  1. Saad M. Ibrahim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert J. Lewandowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert K. Ryu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kent T. Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vanessa L. Gates
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mary F. Mulcahy
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Laura Kulik
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Andrew C. Larson
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Reed A. Omary
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Riad Salem
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Riad Salem.

Additional information

Disclosure: R.S. is a consultant for MDS Nordion and has disclosed a potential conflict of interest. None of the other authors have disclosed a conflict. The data were controlled by all authors. No industry support for this study was provided.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ibrahim, S.M., Lewandowski, R.J., Ryu, R.K. et al. Radiographic Response to Yttrium-90 Radioembolization in Anterior Versus Posterior Liver Segments. Cardiovasc Intervent Radiol 31, 1124–1132 (2008). https://doi.org/10.1007/s00270-008-9348-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-008-9348-y

Keywords

Search

Navigation