Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 4/2009

Open Access 01-04-2009 | Oncology

Yttrium-90 microsphere radioembolization for the treatment of liver malignancies: a structured meta-analysis

Authors: M. A. D. Vente, M. Wondergem, I. van der Tweel, M. A. A. J. van den Bosch, B. A. Zonnenberg, M. G. E. H. Lam, A. D. van het Schip, J. F. W. Nijsen

Published in: European Radiology | Issue 4/2009

Login to get access

Abstract

Radioembolization with yttrium-90 microspheres (90Y-RE), either glass- or resin-based, is increasingly applied in patients with unresectable liver malignancies. Clinical results are promising but overall response and survival are not yet known. Therefore a meta-analysis on tumor response and survival in patients who underwent 90Y-RE was conducted. Based on an extensive literature search, six groups were formed. Determinants were cancer type, microsphere type, chemotherapy protocol used, and stage (deployment in first-line or as salvage therapy). For colorectal liver metastases (mCRC), in a salvage setting, response was 79% for 90Y-RE combined with 5-fluorouracil/leucovorin (5-FU/LV), and 79% when combined with 5-FU/LV/oxaliplatin or 5-FU/LV/irinotecan, and in a first-line setting 91% and 91%, respectively. For hepatocellular carcinoma (HCC), response was 89% for resin microspheres and 78% for glass microspheres. No statistical method is available to assess median survival based on data presented in the literature. In mCRC, 90Y-RE delivers high response rates, especially if used neoadjuvant to chemotherapy. In HCC, 90Y-RE with resin microspheres is significantly more effective than 90Y-RE with glass microspheres. The impact on survival will become known only when the results of phase III studies are published.
Literature
1.
Salem R, Thurston K (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 17:1571–1593PubMed
2.
Vente M, Hobbelink M, van het Schip A et al (2007) Radionuclide liver cancer therapies: from concept to current clinical status. Anticancer Agents Med Chem 7:441–459PubMedCrossRef
3.
Bierman H, Byron R, Kelley K et al (1951) Studies on the blood supply of tumors in man. III. Vascular patterns of the liver by hepatic arteriography in vivo. J Natl Cancer Inst 12:107–131PubMed
4.
Gulec S, Fong Y (2007) Yttrium 90 microsphere selective internal radiation treatment of hepatic colorectal metastases. Arch Surg 142:675–682PubMedCrossRef
5.
Murthy R, Kamat P, Nunez R et al (2008) Yttrium-90 microsphere radioembolotherapy of hepatic metastatic neuroendocrine carcinomas after hepatic arterial embolization. J Vasc Interv Radiol 19:145–151PubMedCrossRef
6.
Sato K, Lewandowski R, Mulcahy M et al (2008) Unresectable chemorefractory liver metastases: radioembolization with 90Y microspheres-safety, efficacy, and survival. Radiol 247:507–515CrossRef
7.
Jakobs T (2007) mCRC treament outcomes: US and EU data review. Presented at the emerging trends in radioembolisation using microspheres, clinical workshop, Chicago, IL, 4–5 May 2007
8.
9.
10.
Carr B (2004) Hepatocellular carcinoma: current management and future trends. Gastroenterology 127:S218–S224PubMedCrossRef
11.
Andrews J, Walker S, Ackermann R et al (1994) Hepatic radioembolization with yttrium-90 containing glass microspheres: preliminary results and clinical follow-up. J Nucl Med 35:1637–1644PubMed
12.
Hamza T, Van Houwelingen H, Stijnen T (2008) The binomial distribution of meta-analysis was preferred to model within-study variability. J Clin Epidemiol 61:41–51PubMedCrossRef
13.
Gray B, Anderson J, Burton M et al (1992) Regression of liver metastases following treatment with yttrium-90 microspheres. Aust N Z J Surg 62:105–110PubMed
14.
Gray B, Van Hazel G, Hope M et al (2001) Randomised trial of SIR-Spheres plus chemotherapy vs. chemotherapy. Ann Oncol 12:1711–1720CrossRef
15.
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 88:78–85PubMedCrossRef
16.
Stubbs R, Cannan R, Mitchell A (2001) Selective internal radiation therapy with 90yttrium microspheres for extensive colorectal liver metastases. J Gastrointest Surg 5:294–302PubMedCrossRef
17.
Murthy R, Xiong H, Nunez R et al (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 16:937–945PubMed
18.
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 35:222–227PubMedCrossRef
19.
Lim L, Gibbs P, Yip D et al (2005) A prospective evaluation of treatment with selective internal radiation therapy (SIR-Spheres) in patients with unresectable liver metastases from colorectal cancer previously treated with 5-FU based chemotherapy. BMC Cancer 5:132–137PubMedCrossRef
20.
Mancini R, Carpanese L, Sciuto R et al (2006) A multicentric phase II clinical trial on intra-arterial hepatic radiotherapy with 90yttrium SIR-Spheres in unresectable, colorectal liver metastases refractory to i.v. chemotherapy: preliminary results on toxicity and response rates. In Vivo 20:711–714PubMed
21.
Kennedy A, Coldwell D, Nutting C et al (2006) Resin (90)Y-microsphere brachytherapy for unresectable colorectal liver metastases: modern USA experience. Int J Radiat Oncol Biol Phys 65:412–425PubMed
22.
Stubbs R, O’Brien I, Correia M (2006) Selective internal radiation therapy with 90Y microspheres for colorectal liver metastases: single-centre experience with 100 patients. ANZ J Surg 76:696–703PubMedCrossRef
23.
Sharma R, Van Hazel G, Morgan B et al (2007) Radioembolization of liver metastases from colorectal cancer using yttrium-90 microspheres with concomitant systemic oxaliplatin, fluorouracil, and leucovorin chemotherapy. J Clin Oncol 25:1099–1106PubMedCrossRef
24.
Jakobs T, Hoffmann R, Poepperl G et al (2007) Mid-term results in otherwise treatment refractory primary or secondary liver confined tumours treated with selective internal radiation therapy (SIRT) using (90)Yttrium resin-microspheres. Eur Radiol 17:1320–1330PubMedCrossRef
25.
Anderson J, Goldberg J, Bessent R et al (1992) Glass yttrium-90 microspheres for patients with colorectal liver metastases. Radiother Oncol 25:137–139PubMedCrossRef
26.
Wong C, Salem R, Raman S et al (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 29:815–820PubMedCrossRef
27.
Lewandowski R, Thurston K, Goin J 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 16:1641–1651PubMed
28.
Gray B, Van Hazel M, Buck M et al (2000) Treatment of colorectal liver metastases with SIR-Spheres plus chemotherapy. GI Cancer 3:249–257
29.
Stubbs R, Cannan R, Mitchell A et al (1999) An initial experience with selective internal radiation therapy (SIRT) for non-resectable colorectal liver metastases. GI Cancer 3:135–143
30.
Geschwind J, Salem R, Carr B et al (2004) Yttrium-90 microspheres for the treatment of hepatocellular carcinoma. Gastroenterology 127:S194–S205PubMedCrossRef
31.
Lau W, Leung W, Ho S et al (1994) Treatment of inoperable hepatocellular carcinoma with intrahepatic arterial yttrium-90 microspheres: a phase I and II study. Br J Cancer 70:994–999PubMed
32.
Lau W, Ho S, Leung T et al (1998) Selective internal radiation therapy for nonresectable hepatocellular carcinoma with intraarterial infusion of 90yttrium microspheres. Int J Radiat Oncol Biol Phys 40:583–592PubMed
33.
Sangro B, Bilbao J, Boan J et al (2006) Radioembolization using 90Y-resin microspheres for patients with advanced hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 66:792–800PubMed
34.
Houle S, Yip T, Sheperd F et al (1989) Hepatocellular carcinoma: pilot trial of treatment with Y-90 microspheres. Radiology 172:857–860PubMed
35.
Dancey J, Shepherd F, Paul K et al (2000) Treatment of nonresectable hepatocellular carcinoma with intrahepatic 90Y-microspheres. J Nucl Med 41:1673–1681PubMed
36.
Carr B (2004) Hepatic arterial 90yttrium glass microspheres (Therasphere) for unresectable hepatocellular carcinoma: interim safety and survival data on 65 patients. Liver Transpl 10(Suppl 2):S107–S110PubMedCrossRef
37.
Liu M, Uaje M, Al Ghazi M et al (2004) Use of yttrium-90 TheraSphere for the treatment of unresectable hepatocellular carcinoma. Am Surg 70:947–953PubMed
38.
Salem R, Lewandowski R, 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 16:1627–1639PubMed
39.
Sato K, Lewandowski R, Bui J et al (2006) Treatment of unresectable primary and metastatic liver cancer with yttrium-90 microspheres (TheraSphere®): assessment of hepatic arterial embolization. Cardiovasc Intervent Radiol 29:522–529PubMedCrossRef
40.
Kulik L, Atassi B, Van Holsbeeck L et al (2006) Yttrium-90 microspheres (TheraSphere) treatment of unresectable hepatocellular carcinoma: downstaging to resection, RFA and bridge to transplantation. J Surg Oncol 94:572–586PubMedCrossRef
41.
Therasse P, Arbuck S, Eisenhauer E 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 92:205–216PubMedCrossRef
42.
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–S55PubMedCrossRef
43.
Pöpperl G, Helmberger T, Münzing W et al (2005) Selective internal radiation therapy with SIR-Spheres® in patients with nonresectable liver tumors. Cancer Biother Radiopharm 20:200–208PubMedCrossRef
44.
Saar B, Kellner-Weldon F (2008) Radiological diagnosis of hepatocellular carcinoma. Liver Int 28:189–199PubMed
45.
Salem R, Thurston K (2006) Radioembolization with 90yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies part 2: special topics. J Vasc Interv Radiol 17:1425–1439PubMed
46.
Coldwell D, Kennedy A (2005) Treatment of hepatic metastases from breast cancer with yttrium-90 SIR-Spheres radioembolization. Society of Interventional Radiology 2005 annual meeting, New Orleans, LA.
47.
Goin J, Dancey J, Roberts C et al (2004) Comparison of post-embolization syndrome in the treatment of patients with unresectable hepatocellular carcinoma: trans-catheter arterial chemo-embolization versus yttrium-90 glass microspheres. World J Nucl Med 3:49–56
48.
Murthy R, Brown D, Salem R et al (2007) Gastrointestinal complications associated with hepatic arterial yttrium-90 microsphere therapy. J Vasc Interv Radiol 18:553–562PubMedCrossRef
49.
Carretero C, Munoz-Navas M, Betes M et al (2007) Gastroduodenal injury after radioembolization of hepatic tumors. Am J Gastroenterol 102:1216–1220PubMedCrossRef
50.
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 17:1251–1278PubMedCrossRef
51.
Lewandowski R, Salem R (2004) Incidence of radiation cholecystitis in patients receiving Y-90 treatment for unresectable liver malignancies [Abstract]. J Vasc Interv Radiol 15:S162
52.
Leung T, Lau W, Ho S et al (1995) Radiation pneumonitis after selective internal radiation treatment with intraarterial 90yttrium-microspheres for inoperable hepatic tumors. Int J Radiat Oncol Biol Phys 33:919–924PubMed
53.
Salem R, Lewandowski R, Sato K et al (2007) Technical aspects of radioembolization with 90Y microspheres. Tech Vasc Interv Radiol 1:12–29CrossRef
54.
Neff R, Abdel-Misih R, Khatri J et al (2008) The toxicity of liver directed yttrium-90 micrcospheres in primary and metastatic liver tumors. Cancer Invest 26:173–177PubMedCrossRef
55.
Wollner I, Knutsen C, Ullrich K et al (1987) Effects of hepatic arterial yttrium-90 microsphere administration alone and combined with regional bromodeoxyuridine infusion in dogs. Cancer Res 47:3285–3290PubMed
56.
Atassi B, Bangash A, Bahrani A et al (2008) Multimodality imaging following 90Y radioembolization: a comprehensive review and pictorial essay. Radiographics 28:81–99PubMedCrossRef
57.
Bienert M, McCook B, Carr B et al (2005) (90)Y microsphere treatment of unresectable liver metastases: changes in (18)F-FDG uptake and tumour size on PET/CT. Eur J Nucl Med Mol Imaging 32:778–787PubMedCrossRef
58.
Wong C, Qing F, Savin M 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 16:1101–1106PubMed
59.
Kwee TC, Takahara T, Ochiai R, Nievelstein RAJ, Luijten PR et al (2008) Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS): features and potential applications in oncology. Eur Radiol 18:1937–1952. doi:10.​1007/​s00330-008-0968-z
60.
61.
Bangash A, Atassi B, Kaklamani V et al (2007) 90Y radioembolization of metastatic breast cancer to the liver: toxicity, imaging response, survival. J Vasc Interv Radiol 18:621–628PubMedCrossRef
62.
Coldwell D, Kennedy A, Nutting C (2007) Use of yttrium-90 microspheres in the treatment of unresectable hepatic metastases from breast cancer. Int J Radiat Oncol Biol Phys 69:800–804PubMed
63.
Gulec S, Mesoloras G, Dezarn W et al (2007) Safety and efficacy of Y-90 microsphere treatment in patients with primary and metastatic liver cancer: the tumor selectivity of the treatment as a function of tumor to liver flow ratio. J Transl Med 5:15–23PubMedCrossRef
64.
Llovet S, Ricci V, Mazzaferro P et al (2007) Sorafenib improves survival in advanced hepatocellular carcinoma (HCC): results of a phase III randomized placebo-controlled trial (SHARP trial) [Abstract]. J Clin Oncol 25:18S
65.
Hochster H, Hart R, Hainsworth J et al (2006) Safety and efficacy of oxaliplatin/fluoropyrimidine regimens with or without bevacizumab as first-line treatment of metastatic colorectal cancer (mCRC): final analysis of the TREE-study [Abstract]. J Clin Oncol 24:148s
66.
Hochster H, Welles L, Hart R et al (2005) Safety and efficacy of bevacizumab (Bev) when added to oxaliplatin/fluoropyrimidine (O/F) regimens as first-line treatment of metastatic colorectal cancer (mCRC): TREE 1 & 2 Studies [Abstract]. J Clin Oncol 23:249sCrossRef
67.
Kennedy A (2007) 90Y microspheres + ChemoTx first line patients with mCRC. Presented at the emerging trends in radioembolisation using microspheres, clinical workshop, Chicago, IL, 4–5 May 2007
Metadata
Title
Yttrium-90 microsphere radioembolization for the treatment of liver malignancies: a structured meta-analysis
Authors
M. A. D. Vente
M. Wondergem
I. van der Tweel
M. A. A. J. van den Bosch
B. A. Zonnenberg
M. G. E. H. Lam
A. D. van het Schip
J. F. W. Nijsen
Publication date
01-04-2009
Publisher
Springer-Verlag
Published in
European Radiology / Issue 4/2009
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-008-1211-7

Other articles of this Issue 4/2009

European Radiology 4/2009 Go to the issue

Computer Tomography

Rat lumbar vertebrae bone densitometry using multidetector CT

Magnetic Resonance

MR urography for suspected upper tract urothelial carcinoma

Contrast Media

Risk of contrast-medium-induced nephropathy in high-risk patients undergoing MDCT – A pooled analysis of two randomized trials

Chest

Clinical and pulmonary thin-section CT findings in acute Klebsiella Pneumoniae pneumonia

Cardiac

Correctness of multi-detector-row computed tomography for diagnosing mechanical prosthetic heart valve disorders using operative findings as a gold standard

Gastrointestinal

Does a computer-aided detection algorithm in a second read paradigm enhance the performance of experienced computed tomography colonography readers in a population of increased risk?