Radiation Segmentectomy of Hepatic Metastases with Y-90 Glass Microspheres

Overview

Journal Abdom Radiol (NY)

Publisher Springer

Specialties Gastroenterology
Radiology

Date 2021 Feb 19

PMID 33606062

Citations 6

Authors

I Kurilova

A Bendet

E K Fung

E N Petre

J L Humm

F E Boas

C H Crane

N Kemeny

T P Kingham

A Cercek

M I DAngelica

R G H Beets-Tan

C T Sofocleous

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate safety and efficacy of radiation segmentectomy (RS) with Y 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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