Abstract
The purpose was to determine the response and survival and to analyse the feasibility of single-session, whole-liver SIRT in patients with non-resectable, otherwise non-responding liver cancer. Thirty-nine patients qualified for SIRT. Eighteen patients suffered from colorectal-cancer metastases (CRC), breast-cancer metastases (MBC, 7), HCC (5) and other tumours (9). Response was assessed by tumour-markers and CT-imaging. At 2–4, 5–7 and 8–9 months follow-up in 3/17, 5/15 and 5/10 of CRC-patients CEA-levels were higher than before. In the MBC group 1–3 and 4–6 months after SIRT tumour-marker-levels were higher in 2/6 and 3/3 patients, respectively. In all HCC-patients AFP-levels dropped 1–3 months after SIRT. Using RECIST, in the CRC-group progressive liver disease (PD) was found in 4/17, 2/12, 2/10 and 2/5 patients at 2–4, 5–8, 9–10 and 12–14 months follow-up. Concerning MBC, after 3 months 7/7 patients presented with stable-disease (SD) or partial-response (PR). At 5–6 months, 1/5 patients showed PD. All HCC-patients showed SD/PR at 2–3 months with no PD at 5–8 months. In the mixed-group 5/6 patients presented with SD/PR at 3–4 months and with SD in 2/3 patients at 5–6 months. The median time-to-PD was 6.5, 8.5 and 8 months for the CRC-, MBC- and mixed-group, respectively. SIRT is a promising, liver-targeted approach for patients with otherwise treatment-refractory liver tumours.
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References
August DA, Ottow RT, Sugarbaker PH (1984) Clinical perspective of human colorectal cancer metastasis. Cancer Metastasis Rev 3:303–324
Deans GT, Parks TG, Rowlands BJ, Spence RA (1992) Prognostic factors in colorectal cancer. Br J Surg 79:608–613
Jardines L, Callans LS, Torosian MH (1993) Recurrent breast cancer: presentation, diagnosis, and treatment. Semin Oncol 20:538–547
Hoe AL, Royle GT, Taylor I (1991) Breast liver metastases-incidence, diagnosis and outcome. J R Soc Med 84:714–716
O’Reilly SM, Richards MA, Rubens RD (1990) Liver metastases from breast cancer: the relationship between clinical, biochemical and pathological features and survival. Eur J Cancer 26:574–577
Choti MA (2002) Surgical management of hepatocellular carcinoma: resection and ablation. J Vasc Interv Radiol 13:S197–S203
Llovet JM, Beaugrand M (2003) Hepatocellular carcinoma: present status and future prospects. J Hepatol 38 Suppl 1:S136–S149
Llovet JM (2002) Evidence-based medicine in the treatment of hepatocellular carcinoma. J Gastroenterol Hepatol 17 Suppl 3:S428–S433
Clark HP, Carson WF, Kavanagh PV, Ho CP, Shen P, Zagoria RJ (2005) Staging and current treatment of hepatocellular carcinoma. Radiographics 25 Suppl 1:S3–S23
Kudo M (2005) Early detection and curative treatment of early-stage hepatocellular carcinoma. Clin Gastroenterol Hepatol 3:S144–S148
Lencioni R, Della Pina C, Bartolozzi C (2005) Percutaneous image-guided radiofrequency ablation in the therapeutic management of hepatocellular carcinoma. Abdom Imaging 30:401–408
Bruix J, Llovet JM, Castells A, Montana X, Bru C, Ayuso MC et al (1998) Transarterial embolization versus symptomatic treatment in patients with advanced hepatocellular carcinoma: results of a randomized, controlled trial in a single institution. Hepatology 27:1578–1583
Veltri A, Moretto P, Doriguzzi A, Pagano E, Carrara G, Gandini G (2005) Radiofrequency thermal ablation (RFA) after transarterial chemoembolization (TACE) as a combined therapy for unresectable non-early hepatocellular carcinoma (HCC). Eur Radiol 1–9
Rubin D, Nutting C, Jones B (2004) Metastatic breast cancer in a 54-year-old woman: integrative treatment with yttrium-90 radioembolization. Integr Cancer Ther 3:262–267
Van Hazel G, Blackwell A, Anderson J, Price D, Moroz P, Bower G 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
Stubbs RS, Cannan RJ, Mitchell AW (2001) Selective internal radiation therapy (SIRT) with 90Yttrium microspheres for extensive colorectal liver metastases. Hepatogastroenterology 48:333–337
Lau WY, Ho S, Leung TW, Chan M, Ho R, Johnson PJ et al (1998) Selective internal radiation therapy for nonresectable hepatocellular carcinoma with intraarterial infusion of 90yttrium microspheres. Int J Radiat Oncol Biol Phys 40:583–592
Lau WY, Leung WT, Ho S, Leung NW, Chan M, Lin J et al (1994) Treatment of inoperable hepatocellular carcinoma with intrahepatic arterial yttrium-90 microspheres: a phase I and II study. Br J Cancer 70:994–999
Liu DM, Salem R, Bui JT, Courtney A, Barakat O, Sergie Z et al (2005) Angiographic considerations in patients undergoing liver-directed therapy. J Vasc Interv Radiol 16:911–935
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
Dancey JE, Shepherd FA, Paul K, Sniderman KW, Houle S, Gabrys J et al (2000) Treatment of nonresectable hepatocellular carcinoma with intrahepatic 90Y-microspheres. J Nucl Med 41:1673–1681
Ho S, Lau WY, Leung TW, Chan M, Johnson PJ, Li AK (1997) Clinical evaluation of the partition model for estimating radiation doses from yttrium-90 microspheres in the treatment of hepatic cancer. Eur J Nucl Med 24:293–298
Goin JE, Salem R, Carr BI, Dancey JE, Soulen MC, Geschwind JF et al (2005) Treatment of unresectable hepatocellular carcinoma with intrahepatic yttrium 90 microspheres: factors associated with liver toxicities. J Vasc Interv Radiol 16:205–213
Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L et al (2000) New guidelines to evaluate the response to treatment in solid tumours. 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
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 tumours. Cancer Biother Radiopharm 20:200–208
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
Steele G Jr, Bleday R, Mayer RJ, Lindblad A, Petrelli N, Weaver D (1991) A prospective evaluation of hepatic resection for colorectal carcinoma metastases to the liver: Gastrointestinal tumour Study Group Protocol 6584. J Clin Oncol 9:1105–1112
Doci R, Gennari L, Bignami P, Montalto F, Morabito A, Bozzetti F (1991) One hundred patients with hepatic metastases from colorectal cancer treated by resection: analysis of prognostic determinants. Br J Surg 78:797–801
Scheele J, Stangl R, Altendorf-Hofmann A, Gall FP (1991) Indicators of prognosis after hepatic resection for colorectal secondaries. Surgery 110:13–29
Machover D (1997) A comprehensive review of 5-fluorouracil and leucovorin in patients with metastatic colorectal carcinoma. Cancer 80:1179–1187
Saltz LB, Cox JV, Blanke C, Rosen LS, Fehrenbacher L, Moore MJ et al (2000) Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. Irinotecan Study Group. N Engl J Med 343:905–914
Machover D, Diaz-Rubio E, de Gramont A, Schilf A, Gastiaburu JJ, Brienza S et al (1996) Two consecutive phase II studies of oxaliplatin (L-OHP) for treatment of patients with advanced colorectal carcinoma who were resistant to previous treatment with fluoropyrimidines. Ann Oncol 7:95–98
Gray B, Van Hazel G, Hope M, Burton M, Moroz P, Anderson J 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
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
Zinser JW, Hortobagyi GN, Buzdar AU, Smith TL, Fraschini G (1987) Clinical course of breast cancer patients with liver metastases. J Clin Oncol 5:773–782
Bathe OF, Kaklamanos IG, Moffat FL, Boggs J, Franceschi D, Livingstone AS (1999) Metastasectomy as a cytoreductive strategy for treatment of isolated pulmonary and hepatic metastases from breast cancer. Surg Oncol 8:35–42
Carlini M, Lonardo MT, Carboni F, Petric M, Vitucci C, Santoro R et al (2002) Liver metastases from breast cancer. Results of surgical resection. Hepatogastroenterology 49:1597–1601
Kondo S, Katoh H, Omi M, Hirano S, Ambo Y, Tanaka E et al (2000) Hepatectomy for metastases from breast cancer offers the survival benefit similar to that in hepatic metastases from colorectal cancer. Hepatogastroenterology 47:1501–1503
Maksan SM, Lehnert T, Bastert G, Herfarth C (2000) Curative liver resection for metastatic breast cancer. Eur J Surg Oncol 26:209–212
Raab R, Nussbaum KT, Behrend M, Weimann A (1998) Liver metastases of breast cancer: results of liver resection. Anticancer Res 18:2231–2233
Livraghi T, Goldberg SN, Solbiati L, Meloni F, Ierace T, Gazelle GS (2001) Percutaneous radio-frequency ablation of liver metastases from breast cancer: initial experience in 24 patients. Radiology 220:145–149
Mack MG, Straub R, Eichler K, Sollner O, Lehnert T, Vogl TJ (2004) Breast cancer metastases in liver: Laser-induced interstitial thermotherapy-local tumour control rate and survival data. Radiology 233(2):400–409
Llovet JM, Bruix J (2004) Unresectable hepatocellular carcinoma: meta-analysis of arterial embolization. Radiology 230:300–301; author reply 301–302
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
Geschwind JF, Salem R, Carr BI, Soulen MC, Thurston KG, Goin KA et al (2004) Yttrium-90 microspheres for the treatment of hepatocellular carcinoma. Gastroenterology 127:S194–S205
Steel J, Baum A, Carr B (2004) Quality of life in patients diagnosed with primary hepatocellular carcinoma: hepatic arterial infusion of Cisplatin versus 90-Yttrium microspheres (Therasphere). Psychooncology 13:73–79
Veit P, Antoch G, Stergar H, Bockisch A, Forsting M, Kuehl H (2006) Detection of residual tumour after radiofrequency ablation of liver metastasis with dual-modality PET/CT: initial results. Eur Radiol 16:80–87
Wong CY, Salem R, Raman S, Gates VL, Dworkin HJ (2002) Evaluating 90Y-glass microsphere treatment response of unresectable colorectal liver metastases by [18F]FDG PET: a comparison with CT or MRI. Eur J Nucl Med Mol Imaging 29:815–820
Wong CY, Qing F, Savin M, Campbell J, Gates VL, Sherpa KM et al (2005) Reduction of metastatic load to liver after intraarterial hepatic yttrium-90 radioembolization as evaluated by [18F]fluorodeoxyglucose positron emission tomographic imaging. J Vasc Interv Radiol 16:1101–1106
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Parts of these data were collected and evaluated in the context of the dissertation of Mrs. A. Schmitz.
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Drs. Jakobs and Hoffmann contributed equally to this manuscript.
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Jakobs, T.F., Hoffmann, RT., Poepperl, G. et al. Mid-term results in otherwise treatment refractory primary or secondary liver confined tumours treated with selective internal radiation therapy (SIRT) using 90Yttrium resin-microspheres. Eur Radiol 17, 1320–1330 (2007). https://doi.org/10.1007/s00330-006-0508-7
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DOI: https://doi.org/10.1007/s00330-006-0508-7