Radioembolization of Secondary Hepatic Malignancies

Abstract

Cancer has become the leading cause of mortality in America, and the majority of patients eventually develop hepatic metastasis. As liver metastases are frequently unresectable, the value of liver-directed therapies, such as transarterial radioembolization (TARE), has become increasingly recognized as an integral component of patient management. Outcomes after radioembolization of hepatic malignancies vary not only by location of primary malignancy but also by tumor histopathology. This article reviews the outcomes of TARE for the treatment of metastatic colorectal cancer, metastatic breast cancer, and metastatic neuroendocrine tumors, as well as special considerations when treating metastatic disease with TARE.

Keywords

radioembolization - hepatic metastasis - liver-directed therapies

Publikationsverlauf

Artikel online veröffentlicht:
07. Oktober 2021

• References

• 1 Mattiuzzi C, Lippi G. Current cancer epidemiology. J Epidemiol Glob Health 2019; 9 (04) 217-222
• 2 Riihimäki M, Hemminki A, Sundquist J, Hemminki K. Patterns of metastasis in colon and rectal cancer. Sci Rep 2016; 6: 29765
• 3 Helling TS, Martin M. Cause of death from liver metastases in colorectal cancer. Ann Surg Oncol 2014; 21 (02) 501-506
• 4 Benson AB, Venook AP, Al-Hawary MM. et al. Colon cancer, version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19 (03) 329-359
• 5 Van Cutsem E, Cervantes A, Adam R. et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol 2016; 27 (08) 1386-1422
• 6 Wasan HS, Gibbs P, Sharma NK. et al; FOXFIRE Trial Investigators; SIRFLOX Trial Investigators; FOXFIRE-Global Trial Investigators. First-line selective internal radiotherapy plus chemotherapy versus chemotherapy alone in patients with liver metastases from colorectal cancer (FOXFIRE, SIRFLOX, and FOXFIRE-Global): a combined analysis of three multicentre, randomised, phase 3 trials. Lancet Oncol 2017; 18 (09) 1159-1171
• 7 Chauhan N, Mulcahy MF, Salem R. et al. TheraSphere yttrium-90 glass microspheres combined with chemotherapy versus chemotherapy alone in second-line treatment of patients with metastatic colorectal carcinoma of the liver: protocol for the EPOCH Phase 3 randomized clinical trial. JMIR Res Protoc 2019; 8 (01) e11545
• 8 van Hazel GA, Heinemann V, Sharma NK. et al. SIRFLOX: randomized phase III trial comparing first-line mFOLFOX6 (plus or minus bevacizumab) versus mFOLFOX6 (plus or minus bevacizumab) plus selective internal radiation therapy in patients with metastatic colorectal cancer. J Clin Oncol 2016; 34 (15) 1723-1731
• 9 Gibbs P, Heinemann V, Sharma NK. et al; SIRFLOX and FOXFIRE Global Trial Investigators. Effect of primary tumor side on survival outcomes in untreated patients with metastatic colorectal cancer when selective internal radiation therapy is added to chemotherapy: combined analysis of two randomized controlled studies. Clin Colorectal Cancer 2018; 17 (04) e617-e629
• 10 Petrelli F, Tomasello G, Borgonovo K. et al. Prognostic survival associated with left-sided vs right-sided colon cancer: a systematic review and meta-analysis. JAMA Oncol 2017; 3 (02) 211-219
• 11 van Hazel GA, Pavlakis N, Goldstein D. et al. Treatment of fluorouracil-refractory patients with liver metastases from colorectal cancer by using yttrium-90 resin microspheres plus concomitant systemic irinotecan chemotherapy. J Clin Oncol 2009; 27 (25) 4089-4095
• 12 Kennedy A, Cohn M, Coldwell DM. et al. Updated survival outcomes and analysis of long-term survivors from the MORE study on safety and efficacy of radioembolization in patients with unresectable colorectal cancer liver metastases. J Gastrointest Oncol 2017; 8 (04) 614-624
• 13 Salem R, Thurston KG. 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 2006; 17 (08) 1251-1278
• 14 Benson III AB, Geschwind JF, Mulcahy MF. et al. Radioembolisation for liver metastases: results from a prospective 151 patient multi-institutional phase II study. Eur J Cancer 2013; 49 (15) 3122-3130
• 15 Sofocleous CT, Violari EG, Sotirchos VS. et al. Radioembolization as a salvage therapy for heavily pretreated patients with colorectal cancer liver metastases: factors that affect outcomes. Clin Colorectal Cancer 2015; 14 (04) 296-305
• 16 Kurilova I, Beets-Tan RGH, Flynn J. et al. Factors affecting oncologic outcomes of 90Y radioembolization of heavily pre-treated patients with colon cancer liver metastases. Clin Colorectal Cancer 2019; 18 (01) 8-18
• 17 Kennedy AS, Ball D, Cohen SJ. et al. Multicenter evaluation of the safety and efficacy of radioembolization in patients with unresectable colorectal liver metastases selected as candidates for (90)Y resin microspheres. J Gastrointest Oncol 2015; 6 (02) 134-142
• 18 Saxena A, Meteling B, Kapoor J, Golani S, Morris DL, Bester L. Is yttrium-90 radioembolization a viable treatment option for unresectable, chemorefractory colorectal cancer liver metastases? A large single-center experience of 302 patients. Ann Surg Oncol 2015; 22 (03) 794-802
• 19 Lewandowski RJ, Thurston KG, Goin JE. et al. 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 2005; 16 (12) 1641-1651
• 20 Kennedy AS, Coldwell D, Nutting C. et al. Resin 90Y-microsphere brachytherapy for unresectable colorectal liver metastases: modern USA experience. Int J Radiat Oncol Biol Phys 2006; 65 (02) 412-425
• 21 Jakobs TF, Hoffmann RT, Dehm K. et al. Hepatic yttrium-90 radioembolization of chemotherapy-refractory colorectal cancer liver metastases. J Vasc Interv Radiol 2008; 19 (08) 1187-1195
• 22 Mulcahy MF, Lewandowski RJ, Ibrahim SM. et al. Radioembolization of colorectal hepatic metastases using yttrium-90 microspheres. Cancer 2009; 115 (09) 1849-1858
• 23 Cianni R, Urigo C, Notarianni E. et al. Selective internal radiation therapy with SIR-spheres for the treatment of unresectable colorectal hepatic metastases. Cardiovasc Intervent Radiol 2009; 32 (06) 1179-1186
• 24 Evans KA, Richardson MG, Pavlakis N, Morris DL, Liauw W, Bester L. Survival outcomes of a salvage patient population after radioembolization of hepatic metastases with yttrium-90 microspheres. J Vasc Interv Radiol 2010; 21 (10) 1521-1526
• 25 Cosimelli M, Golfieri R, Cagol PP. et al; Italian Society of Locoregional Therapies in Oncology (SITILO). Multi-centre phase II clinical trial of yttrium-90 resin microspheres alone in unresectable, chemotherapy refractory colorectal liver metastases. Br J Cancer 2010; 103 (03) 324-331
• 26 Hendlisz A, Van den Eynde M, Peeters M. et al. Phase III trial comparing protracted intravenous fluorouracil infusion alone or with yttrium-90 resin microspheres radioembolization for liver-limited metastatic colorectal cancer refractory to standard chemotherapy. J Clin Oncol 2010; 28 (23) 3687-3694
• 27 Hickey R, Lewandowski RJ, Prudhomme T. et al. 90Y radioembolization of colorectal hepatic metastases using glass microspheres: safety and survival outcomes from a 531-patient multicenter study. J Nucl Med 2016; 57 (05) 665-671
• 28 Bester L, Meteling B, Pocock N. et al. Radioembolization versus standard care of hepatic metastases: comparative retrospective cohort study of survival outcomes and adverse events in salvage patients. J Vasc Interv Radiol 2012; 23 (01) 96-105
• 29 Seidensticker R, Denecke T, Kraus P. et al. Matched-pair comparison of radioembolization plus best supportive care versus best supportive care alone for chemotherapy refractory liver-dominant colorectal metastases. Cardiovasc Intervent Radiol 2012; 35 (05) 1066-1073
• 30 Grothey A, Van Cutsem E, Sobrero A. et al; CORRECT Study Group. Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet 2013; 381 (9863): 303-312
• 31 Mayer RJ, Van Cutsem E, Falcone A. et al; RECOURSE Study Group. Randomized trial of TAS-102 for refractory metastatic colorectal cancer. N Engl J Med 2015; 372 (20) 1909-1919
• 32 Rosenbaum CE, Verkooijen HM, Lam MG. et al. Radioembolization for treatment of salvage patients with colorectal cancer liver metastases: a systematic review. J Nucl Med 2013; 54 (11) 1890-1895
• 33 Sato KT, Lewandowski RJ, Mulcahy MF. et al. Unresectable chemorefractory liver metastases: radioembolization with 90Y microspheres--safety, efficacy, and survival. Radiology 2008; 247 (02) 507-515
• 34 Walter T, Hawkins NS, Pollock RF, Colaone F, Shergill S, Ross PJ. Systematic review and network meta-analyses of third-line treatments for metastatic colorectal cancer. J Cancer Res Clin Oncol 2020; 146 (10) 2575-2587
• 35 Lahti SJ, Xing M, Zhang D, Lee JJ, Magnetta MJ, Kim HS. KRAS status as an independent prognostic factor for survival after yttrium-90 radioembolization therapy for unresectable colorectal cancer liver metastases. J Vasc Interv Radiol 2015; 26 (08) 1102-1111
• 36 Dabrowiecki A, Sankhla T, Shinn K. et al. Impact of genomic mutation and timing of Y90 radioembolization in colorectal liver metastases. Cardiovasc Intervent Radiol 2020; 43 (07) 1006-1014
• 37 Abbott AM, Kim R, Hoffe SE. et al. Outcomes of therasphere radioembolization for colorectal metastases. Clin Colorectal Cancer 2015; 14 (03) 146-153
• 38 Jakobs TF, Paprottka KJ, Raeßler F. et al. Robust evidence for long-term survival with ⁹⁰Y radioembolization in chemorefractory liver-predominant metastatic colorectal cancer. Eur Radiol 2017; 27 (01) 113-119
• 39 Narsinh KH, Van Buskirk M, Kennedy AS. et al. Hepatopulmonary shunting: a prognostic indicator of survival in patients with metastatic colorectal adenocarcinoma treated with ⁹⁰Y radioembolization. Radiology 2017; 282 (01) 281-288
• 40 Kalva SP, Rana RS, Liu R. et al. Yttrium-90 radioembolization as salvage therapy for liver metastases from colorectal cancer. Am J Clin Oncol 2017; 40 (03) 288-293
• 41 Damm R, Seidensticker R, Ulrich G. et al. Y90 radioembolization in chemo-refractory metastastic, liver dominant colorectal cancer patients: outcome assessment applying a predictive scoring system. BMC Cancer 2016; 16: 509
• 42 Deipolyi AR, Iafrate AJ, Zhu AX, Ergul EA, Ganguli S, Oklu R. High lung shunt fraction in colorectal liver tumors is associated with distant metastasis and decreased survival. J Vasc Interv Radiol 2014; 25 (10) 1604-1608
• 43 Adam R, Aloia T, Krissat J. et al. Is liver resection justified for patients with hepatic metastases from breast cancer?. Ann Surg 2006; 244 (06) 897-907 , discussion 907–908
• 44 Cianni R, Pelle G, Notarianni E. et al. Radioembolisation with (90)Y-labelled resin microspheres in the treatment of liver metastasis from breast cancer. Eur Radiol 2013; 23 (01) 182-189
• 45 Gradishar WJ, Anderson BO, Abraham J. et al. Breast cancer, version 3.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18 (04) 452-478
• 46 Cardoso F, Paluch-Shimon S, Senkus E. et al. 5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5). Ann Oncol 2020; 31 (12) 1623-1649
• 47 Pieper CC, Meyer C, Wilhelm KE. et al. Yttrium-90 radioembolization of advanced, unresectable breast cancer liver metastases - a single-center experience. J Vasc Interv Radiol 2016; 27 (09) 1305-1315
• 48 Padia SA. Y90 clinical data update: cholangiocarcinoma, neuroendocrine tumor, melanoma, and breast cancer metastatic disease. Tech Vasc Interv Radiol 2019; 22 (02) 81-86
• 49 Saxena A, Kapoor J, Meteling B, Morris DL, Bester L. Yttrium-90 radioembolization for unresectable, chemoresistant breast cancer liver metastases: a large single-center experience of 40 patients. Ann Surg Oncol 2014; 21 (04) 1296-1303
• 50 Haug AR, Tiega Donfack BP, Trumm C. et al. 18F-FDG PET/CT predicts survival after radioembolization of hepatic metastases from breast cancer. J Nucl Med 2012; 53 (03) 371-377
• 51 Fendler WP, Lechner H, Todica A. et al. Safety, efficacy, and prognostic factors after radioembolization of hepatic metastases from breast cancer: a large single-center experience in 81 patients. J Nucl Med 2016; 57 (04) 517-523
• 52 Deipolyi AR, Riedl CC, Bromberg J. et al. Association of PI3K pathway mutations with early positron-emission tomography/CT imaging response after radioembolization for breast cancer liver metastases: results of a single-center retrospective pilot study. J Vasc Interv Radiol 2018; 29 (09) 1226-1235
• 53 Liberchuk AN, Deipolyi AR. Hepatic metastasis from breast cancer. Semin Intervent Radiol 2020; 37 (05) 518-526
• 54 Jakobs TF, Hoffmann RT, Fischer T. et al. Radioembolization in patients with hepatic metastases from breast cancer. J Vasc Interv Radiol 2008; 19 (05) 683-690
• 55 Gordon AC, Gradishar WJ, Kaklamani VG. et al. Yttrium-90 radioembolization stops progression of targeted breast cancer liver metastases after failed chemotherapy. J Vasc Interv Radiol 2014; 25 (10) 1523-1532 , 1532.e1–1532.e2
• 56 Deipolyi AR, England RW, Ridouani F. et al. PET/CT imaging characteristics after radioembolization of hepatic metastasis from breast cancer. Cardiovasc Intervent Radiol 2020; 43 (03) 488-494
• 57 Cheng B, Sethi I, Davisson N. et al. Yttrium-90 dosimetry and implications on tumour response and survival after radioembolisation of chemo-refractory hepatic metastases from breast cancer. Nucl Med Commun 2021; 42 (04) 402-409
• 58 Davisson NA, Bercu ZL, Friend SC. et al. Predictors of survival after yttrium-90 radioembolization of chemotherapy-refractory hepatic metastases from breast cancer. J Vasc Interv Radiol 2020; 31 (06) 925-933
• 59 Dasari A, Shen C, Halperin D. et al. Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncol 2017; 3 (10) 1335-1342
• 60 Pavel M, Valle JW, Eriksson B. et al; Antibes Consensus Conference Participants; Antibes Consensus Conference Participants. ENETS consensus guidelines for the standards of care in neuroendocrine neoplasms: systemic therapy - biotherapy and novel targeted agents. Neuroendocrinology 2017; 105 (03) 266-280
• 61 Hallet J, Law CH, Cukier M, Saskin R, Liu N, Singh S. Exploring the rising incidence of neuroendocrine tumors: a population-based analysis of epidemiology, metastatic presentation, and outcomes. Cancer 2015; 121 (04) 589-597
• 62 Riihimäki M, Hemminki A, Sundquist K, Sundquist J, Hemminki K. The epidemiology of metastases in neuroendocrine tumors. Int J Cancer 2016; 139 (12) 2679-2686
• 63 National Comprehensive Cancer Network. NCCN Guidelines Version 1.2021 Neuroendocrine and Adrenal Tumors. 2021: Plymouth Meeting, PA; 19462. p. Accessed June 30, 2021 at: https://www.nccn.org/professionals/physician_gls/pdf/neuroendocrine.pdf
• 64 Rubin de Celis Ferrari AC, Glasberg J, Riechelmann RP. Carcinoid syndrome: update on the pathophysiology and treatment. Clinics (São Paulo) 2018; 73 (Suppl. 01) e490s
• 65 Braat AJAT, Kappadath SC, Ahmadzadehfar H. et al. Radioembolization with ⁹⁰Y resin microspheres of neuroendocrine liver metastases: international multicenter study on efficacy and toxicity. Cardiovasc Intervent Radiol 2019; 42 (03) 413-425
• 66 Cao CQ, Yan TD, Bester L, Liauw W, Morris DL. Radioembolization with yttrium microspheres for neuroendocrine tumour liver metastases. Br J Surg 2010; 97 (04) 537-543
• 67 Fan KY, Wild AT, Halappa VG. et al. Neuroendocrine tumor liver metastases treated with yttrium-90 radioembolization. Contemp Clin Trials 2016; 50: 143-149
• 68 Kennedy AS, Dezarn WA, McNeillie P. et al. Radioembolization for unresectable neuroendocrine hepatic metastases using resin 90Y-microspheres: early results in 148 patients. Am J Clin Oncol 2008; 31 (03) 271-279
• 69 Memon K, Lewandowski RJ, Mulcahy MF. et al. Radioembolization for neuroendocrine liver metastases: safety, imaging, and long-term outcomes. Int J Radiat Oncol Biol Phys 2012; 83 (03) 887-894
• 70 Saxena A, Chua TC, Bester L, Kokandi A, Morris DL. Factors predicting response and survival after yttrium-90 radioembolization of unresectable neuroendocrine tumor liver metastases: a critical appraisal of 48 cases. Ann Surg 2010; 251 (05) 910-916
• 71 Do Minh D, Chapiro J, Gorodetski B. et al. Intra-arterial therapy of neuroendocrine tumour liver metastases: comparing conventional TACE, drug-eluting beads TACE and yttrium-90 radioembolisation as treatment options using a propensity score analysis model. Eur Radiol 2017; 27 (12) 4995-5005
• 72 Jia Z, Wang W. Yttrium-90 radioembolization for unresectable metastatic neuroendocrine liver tumor: a systematic review. Eur J Radiol 2018; 100: 23-29
• 73 Chen JX, Rose S, White SB. et al. Embolotherapy for neuroendocrine tumor liver metastases: prognostic factors for hepatic progression-free survival and overall survival. Cardiovasc Intervent Radiol 2017; 40 (01) 69-80
• 74 King J, Quinn R, Glenn DM. et al. Radioembolization with selective internal radiation microspheres for neuroendocrine liver metastases. Cancer 2008; 113 (05) 921-929
• 75 Ezziddin S, Meyer C, Kahancova S. et al. 90Y radioembolization after radiation exposure from peptide receptor radionuclide therapy. J Nucl Med 2012; 53 (11) 1663-1669
• 76 Braat MN, van Erpecum KJ, Zonnenberg BA, van den Bosch MA, Lam MG. Radioembolization-induced liver disease: a systematic review. Eur J Gastroenterol Hepatol 2017; 29 (02) 144-152
• 77 Sangro B, Gil-Alzugaray B, Rodriguez J. et al. Liver disease induced by radioembolization of liver tumors: description and possible risk factors. Cancer 2008; 112 (07) 1538-1546
• 78 Currie BM, Hoteit MA, Ben-Josef E, Nadolski GJ, Soulen MC. Radioembolization-induced chronic hepatotoxicity: a single-center cohort analysis. J Vasc Interv Radiol 2019; 30 (12) 1915-1923
• 79 Su YK, Mackey RV, Riaz A. et al. Long-term hepatotoxicity of yttrium-90 radioembolization as treatment of metastatic neuroendocrine tumor to the liver. J Vasc Interv Radiol 2017; 28 (11) 1520-1526
• 80 Tomozawa Y, Jahangiri Y, Pathak P. et al. Long-term toxicity after transarterial radioembolization with yttrium-90 using resin microspheres for neuroendocrine tumor liver metastases. J Vasc Interv Radiol 2018; 29 (06) 858-865
• 81 Zuckerman DA, Kennard RF, Roy A, Parikh PJ, Weiner AA. Outcomes and toxicity following yttrium-90 radioembolization for hepatic metastases from neuroendocrine tumors-a single-institution experience. J Gastrointest Oncol 2019; 10 (01) 118-127
• 82 Strosberg J, El-Haddad G, Wolin E. et al; NETTER-1 Trial Investigators. Phase 3 trial of ¹⁷⁷Lu-Dotatate for midgut neuroendocrine tumors. N Engl J Med 2017; 376 (02) 125-135