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Published in: Clinical and Translational Oncology 5/2022

01-05-2022 | Portal Vein Thrombosis | Review Article

Ytrrium-90 transarterial radioembolization in patients with gastrointestinal malignancies

Authors: D. Viñal, A. Minaya-Bravo, I. Prieto, J. Feliu, N. Rodriguez-Salas

Published in: Clinical and Translational Oncology | Issue 5/2022

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Abstract

Transarterial radioembolization (TARE) with yttrium-90 (Y90) is a promising alternative strategy to treat liver tumors and liver metastasis from colorectal cancer (CRC), as it selectively delivers radioactive isotopes to the tumor via the hepatic artery, sparring surrounding liver tissue. The landscape of TARE indications is constantly evolving. This strategy is considered for patients with hepatocellular carcinoma (HCC) with liver-confined disease and preserved liver function in whom neither TACE nor systemic therapy is possible. In patients with liver metastases from CRC, TARE is advised when other chemotherapeutic options have failed. Recent phase III trials have not succeeded to prove benefit in overall survival; however, it has helped to better understand the patients that may benefit from TARE based on subgroup analysis. New strategies and treatment combinations are being investigated in ongoing clinical trials. The aim of this review is to summarize the clinical applications of TARE in patients with gastrointestinal malignancies.
Literature
4.
go back to reference Simon N, Warner R, Baron M, Rudavsky A. Intra-arterial irradiation of carcinoid tumors of the liver. Am J Roentgenol. 1968;102:552–61.CrossRef Simon N, Warner R, Baron M, Rudavsky A. Intra-arterial irradiation of carcinoid tumors of the liver. Am J Roentgenol. 1968;102:552–61.CrossRef
10.
go back to reference 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;17:1251–78.CrossRefPubMed 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;17:1251–78.CrossRefPubMed
11.
12.
go back to reference Kavali PK, Gandhi RT. Suvranu Ganguli. Yttrium-90 radioembolization mapping and therapy. Endovasc Today. 2016;15(4):66–71. Kavali PK, Gandhi RT. Suvranu Ganguli. Yttrium-90 radioembolization mapping and therapy. Endovasc Today. 2016;15(4):66–71.
15.
go back to reference Vogel A, Cervantes I, Chau B, Daniele J, Llovet T, Meyer J-C, Nault U, Neumann J, Ricke B, et al. Hepatocellular carcinoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29(Suppl 4):iv238–55.CrossRefPubMed Vogel A, Cervantes I, Chau B, Daniele J, Llovet T, Meyer J-C, Nault U, Neumann J, Ricke B, et al. Hepatocellular carcinoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29(Suppl 4):iv238–55.CrossRefPubMed
16.
go back to reference The Cancer of the Liver Italian Program (CLIP) investigators. A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients: the Cancer of the Liver Italian Program (CLIP) investigators. Hepatology. 1998;28(3):751. The Cancer of the Liver Italian Program (CLIP) investigators. A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients: the Cancer of the Liver Italian Program (CLIP) investigators. Hepatology. 1998;28(3):751.
20.
go back to reference Teo JY, Goh BK, Cheah FK, Allen JC, Lo RH, Bg DC, et al. Underlying liver disease influences volumetric changes in the spared hemiliver after selective internal radia- tion therapy with 90Y in patients with hepatocellular carcinoma. J Digest Dis. 2014;15(8):444–50. https://doi.org/10.1111/1751-2980.12162.CrossRef Teo JY, Goh BK, Cheah FK, Allen JC, Lo RH, Bg DC, et al. Underlying liver disease influences volumetric changes in the spared hemiliver after selective internal radia- tion therapy with 90Y in patients with hepatocellular carcinoma. J Digest Dis. 2014;15(8):444–50. https://​doi.​org/​10.​1111/​1751-2980.​12162.CrossRef
23.
go back to reference Vouche M, Habib A, Ward TJ, et al. Unresectable solitary hepatocellular carcinoma not amenable to radiofrequency ablation: multicenter radiology–pathology correlation and survival of radiation segmentectomy. Hepatology. 2014;60(1):192.CrossRefPubMed Vouche M, Habib A, Ward TJ, et al. Unresectable solitary hepatocellular carcinoma not amenable to radiofrequency ablation: multicenter radiology–pathology correlation and survival of radiation segmentectomy. Hepatology. 2014;60(1):192.CrossRefPubMed
29.
go back to reference Agopian VG, Harlander-Locke MP, Ruiz RM, Klintmalm GB, Senguttuvan S, Florián SS, et al. Impact of pretransplant bridging locoregional therapy for patients with hepatocellular carcinoma within milan criteria undergoing liver trans-plantation: analysis of 3601 patients from the US Multicenter HCC Transplant Consortium. Ann Surg. 2017;266(3):525–35. https://doi.org/10.1097/SLA.0000000000002381.CrossRefPubMed Agopian VG, Harlander-Locke MP, Ruiz RM, Klintmalm GB, Senguttuvan S, Florián SS, et al. Impact of pretransplant bridging locoregional therapy for patients with hepatocellular carcinoma within milan criteria undergoing liver trans-plantation: analysis of 3601 patients from the US Multicenter HCC Transplant Consortium. Ann Surg. 2017;266(3):525–35. https://​doi.​org/​10.​1097/​SLA.​0000000000002381​.CrossRefPubMed
32.
go back to reference Salem R, Lewandowski RJ, Kulik L, et al. Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology. 2011;140:497–507.CrossRefPubMed Salem R, Lewandowski RJ, Kulik L, et al. Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology. 2011;140:497–507.CrossRefPubMed
33.
go back to reference Kumasi A, Acharya SK, Singh SP, Arora A, Dhiman RK, Aggarwal R, et al. 2019 Update of indian national association for study of the liver consensus on prevention, diagnosis, and management of hepatocellular carcinoma in india: the Puri II Recommendations. J Clin Exp Hepatol. 2020;10(1):43–80. https://doi.org/10.1016/j.jceh.2019.09.007 (Epub 23 Sep 2019).CrossRef Kumasi A, Acharya SK, Singh SP, Arora A, Dhiman RK, Aggarwal R, et al. 2019 Update of indian national association for study of the liver consensus on prevention, diagnosis, and management of hepatocellular carcinoma in india: the Puri II Recommendations. J Clin Exp Hepatol. 2020;10(1):43–80. https://​doi.​org/​10.​1016/​j.​jceh.​2019.​09.​007 (Epub 23 Sep 2019).CrossRef
34.
go back to reference Riaz A, Gabr A, Abouchaleh N, et al. Radioembolization for hepatocellular carcinoma: statistical confirmation of improved survival in responders by landmark analyses. Hepatology. 2018;67:873–83.CrossRefPubMed Riaz A, Gabr A, Abouchaleh N, et al. Radioembolization for hepatocellular carcinoma: statistical confirmation of improved survival in responders by landmark analyses. Hepatology. 2018;67:873–83.CrossRefPubMed
35.
go back to reference European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma [published correction ap-pears in J Hepatol. 2019 Apr;70(4):817]. J Hepatol. 2018;69(1):182–236. https://doi.org/10.1016/j.jhep.2018.03.019 European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma [published correction ap-pears in J Hepatol. 2019 Apr;70(4):817]. J Hepatol. 2018;69(1):182–236. https://​doi.​org/​10.​1016/​j.​jhep.​2018.​03.​019
36.
go back to reference Sato K, Lewandowski RJ, Bui JT, Omary R, Hunter RD, Kulik L, et al. Treatment of unresectable primary and metastatic liver cancer with yttrium-90 microspheres (TheraSphere(R)): assessment of hepatic arterial embolization. Cardiovasc Intervent Radiol. 2006;29:522–9.CrossRefPubMed Sato K, Lewandowski RJ, Bui JT, Omary R, Hunter RD, Kulik L, et al. Treatment of unresectable primary and metastatic liver cancer with yttrium-90 microspheres (TheraSphere(R)): assessment of hepatic arterial embolization. Cardiovasc Intervent Radiol. 2006;29:522–9.CrossRefPubMed
42.
go back to reference She WH, Cheung TT, Yau TC, Chan AC, Chok KS, Chu FS, et al. Survival analysis of transarterial radioembolization with Yttrium-90 for hepatocellular carcinoma patients with HBV infection. Hepatobiliary Surg Nutr. 2014;3:185–93.PubMedPubMedCentral She WH, Cheung TT, Yau TC, Chan AC, Chok KS, Chu FS, et al. Survival analysis of transarterial radioembolization with Yttrium-90 for hepatocellular carcinoma patients with HBV infection. Hepatobiliary Surg Nutr. 2014;3:185–93.PubMedPubMedCentral
43.
go back to reference Somma F, Stoia V, Serra N, D’Angelo R, Gatta G, Fiore F. Yttrium-90 trans-arterial radioembolization in advanced-stage HCC: The impact of portal vein thrombosis on survival. PLoS ONE. 2019;14(5):e0216935.CrossRefPubMedPubMedCentral Somma F, Stoia V, Serra N, D’Angelo R, Gatta G, Fiore F. Yttrium-90 trans-arterial radioembolization in advanced-stage HCC: The impact of portal vein thrombosis on survival. PLoS ONE. 2019;14(5):e0216935.CrossRefPubMedPubMedCentral
47.
go back to reference Viagrain V, Pereira H, Assenat E, Guiu B, Llonca AD, Pageaux GP, et al. Efficacy and safety of selective internal radiotherapy with yttrium-90 resin microspheres compared with sorafenib in locally advanced and inoperable hepatocellular carcinoma (SARAH): an open-label randomised controlled phase 3 trial. Lancet oncol. 2017;18(12):1624–36. https://doi.org/10.1016/S1470-2045(17)30683-6.CrossRef Viagrain V, Pereira H, Assenat E, Guiu B, Llonca AD, Pageaux GP, et al. Efficacy and safety of selective internal radiotherapy with yttrium-90 resin microspheres compared with sorafenib in locally advanced and inoperable hepatocellular carcinoma (SARAH): an open-label randomised controlled phase 3 trial. Lancet oncol. 2017;18(12):1624–36. https://​doi.​org/​10.​1016/​S1470-2045(17)30683-6.CrossRef
53.
go back to reference Van Hazel G, Blackwell A, Anderson J, et al. Randomised phase 2 trial of SIR-spheres plus fluorouracil/leucovorin chemo-therapy versus fluorouracil/leucovorin chemotherapy alone in advanced colorectal cancer. J Surg Oncol. 2004;88(2):78–85.CrossRefPubMed Van Hazel G, Blackwell A, Anderson J, et al. Randomised phase 2 trial of SIR-spheres plus fluorouracil/leucovorin chemo-therapy versus fluorouracil/leucovorin chemotherapy alone in advanced colorectal cancer. J Surg Oncol. 2004;88(2):78–85.CrossRefPubMed
54.
go back to reference 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 cáncer [published correction appears in J Clin Oncol. 2016 Nov 20;34(33):4059]. J Clin Oncol. 2016;34(15):1723–31. https://doi.org/10.1200/JCO.2015.66.1181.CrossRefPubMed 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 cáncer [published correction appears in J Clin Oncol. 2016 Nov 20;34(33):4059]. J Clin Oncol. 2016;34(15):1723–31. https://​doi.​org/​10.​1200/​JCO.​2015.​66.​1181.CrossRefPubMed
56.
57.
59.
go back to reference Wasan H, Sharma R, Heinemann V, et al. FOXFIRE-SIRFLOX-FOXFIRE global prospective randomised studies of first-line selective internal radiotherapy (SIRT) in patients with liver metastases from colorectal cancer: KRAS mutation and tumour site analysis. Ann Oncol. 2017;28:v615.CrossRef Wasan H, Sharma R, Heinemann V, et al. FOXFIRE-SIRFLOX-FOXFIRE global prospective randomised studies of first-line selective internal radiotherapy (SIRT) in patients with liver metastases from colorectal cancer: KRAS mutation and tumour site analysis. Ann Oncol. 2017;28:v615.CrossRef
61.
go back to reference Rostambeigi N, Dekarske AS, Austin EE, et al. Cost effectiveness of radioembolization compared with conventional transarterial chemoembolization for treatment of hepatocellular carcinoma. J Vasc Interv Radiol. 2014;25:1075–84.CrossRefPubMed Rostambeigi N, Dekarske AS, Austin EE, et al. Cost effectiveness of radioembolization compared with conventional transarterial chemoembolization for treatment of hepatocellular carcinoma. J Vasc Interv Radiol. 2014;25:1075–84.CrossRefPubMed
64.
go back to reference Hendlisz A, Van den Eynde M, Peeters M, Maleux G, Lam-bert B, Vannoote J, et al. Phase III trial comparing protracted intravenous fluorouracil infusion alone or with yttrium-90 resin microspheres radioembolization for liver-limited metastatic colo-rectal cancer refractory to standard chemotherapy. J Clin Oncol. 2010;28:3687–94.CrossRefPubMed Hendlisz A, Van den Eynde M, Peeters M, Maleux G, Lam-bert B, Vannoote J, et al. Phase III trial comparing protracted intravenous fluorouracil infusion alone or with yttrium-90 resin microspheres radioembolization for liver-limited metastatic colo-rectal cancer refractory to standard chemotherapy. J Clin Oncol. 2010;28:3687–94.CrossRefPubMed
70.
go back to reference 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 [published correction appears in J Gastrointest Oncol. 2018 Apr;9(2):E13-E14]. J Gastrointest Oncol. 2017;8(4):614–24. https://doi.org/10.2103/jgo.2017.03.10.CrossRefPubMedPubMedCentral 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 [published correction appears in J Gastrointest Oncol. 2018 Apr;9(2):E13-E14]. J Gastrointest Oncol. 2017;8(4):614–24. https://​doi.​org/​10.​2103/​jgo.​2017.​03.​10.CrossRefPubMedPubMedCentral
72.
go back to reference Lahti SJ, Xing M, Zhang D, et al. kras status as an independent prognostic factor for survival after yttrium-90 radioemboli-zation therapy for unresectable colorectal cancer liver metastases. J Vasc Interv Radiol. 2015;26:1102–11.CrossRefPubMed Lahti SJ, Xing M, Zhang D, et al. kras status as an independent prognostic factor for survival after yttrium-90 radioemboli-zation therapy for unresectable colorectal cancer liver metastases. J Vasc Interv Radiol. 2015;26:1102–11.CrossRefPubMed
73.
go back to reference Magnetta MJ, Ghodadra A, Lahti SJ, et al. Connecting cancer biology and clinical outcomes to imaging in KRAS mutant and wild-type colorectal cancer liver tumors following selective internal radiation therapy with yttrium-90. Abdom Radiol (NY). 2017;42:451–9.CrossRef Magnetta MJ, Ghodadra A, Lahti SJ, et al. Connecting cancer biology and clinical outcomes to imaging in KRAS mutant and wild-type colorectal cancer liver tumors following selective internal radiation therapy with yttrium-90. Abdom Radiol (NY). 2017;42:451–9.CrossRef
74.
go back to reference Bester L, Meteling B, Pocock N, et al. Radioembolization versus standard care of hepatic metastases: comparative retro-spective cohort study of survival outcomes and adverse events in salvage patients. J Vasc Interv Radiol. 2012;23:96–105.CrossRefPubMed Bester L, Meteling B, Pocock N, et al. Radioembolization versus standard care of hepatic metastases: comparative retro-spective cohort study of survival outcomes and adverse events in salvage patients. J Vasc Interv Radiol. 2012;23:96–105.CrossRefPubMed
75.
go back to reference 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;35:1066–73.CrossRefPubMed 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;35:1066–73.CrossRefPubMed
76.
go back to reference Fahmueller YN, Nagel D, Hoffmann RT, et al. Predictive and prognostic value of circulating nucleosomes and serum bi-omarkers in patients with metastasized colorectal cancer undergoing Selective Internal Radiation Therapy. BMC Cancer. 2012;12:5.CrossRefPubMedPubMedCentral Fahmueller YN, Nagel D, Hoffmann RT, et al. Predictive and prognostic value of circulating nucleosomes and serum bi-omarkers in patients with metastasized colorectal cancer undergoing Selective Internal Radiation Therapy. BMC Cancer. 2012;12:5.CrossRefPubMedPubMedCentral
77.
go back to reference Fahmueller YN, Nagel D, Hoffmann RT, et al. Immunogenic cell death biomarkers HMGB1, RAGE, and DNAse indicate response to radioembolization therapy and prognosis in colorectal cancer patients. Int J Cancer. 2013;132:2349–58.CrossRefPubMed Fahmueller YN, Nagel D, Hoffmann RT, et al. Immunogenic cell death biomarkers HMGB1, RAGE, and DNAse indicate response to radioembolization therapy and prognosis in colorectal cancer patients. Int J Cancer. 2013;132:2349–58.CrossRefPubMed
78.
go back to reference Carpizo DR, Gensure RH, Yu X, et al. Pilot study of angiogenic response to yttrium-90 radioembolization with resin mi-crospheres. J Vasc Interv Radiol. 2014;25:297-306.e1.CrossRefPubMed Carpizo DR, Gensure RH, Yu X, et al. Pilot study of angiogenic response to yttrium-90 radioembolization with resin mi-crospheres. J Vasc Interv Radiol. 2014;25:297-306.e1.CrossRefPubMed
79.
go back to reference Tohme S, Sukato D, Chalhoub D, et al. Neutrophil-lymphocyte ratio is a simple and novel biomarker for prediction of sur-vival after radioembolization for metastatic colorectal cancer. Ann Surg Oncol. 2015;22:1701–2170.CrossRefPubMed Tohme S, Sukato D, Chalhoub D, et al. Neutrophil-lymphocyte ratio is a simple and novel biomarker for prediction of sur-vival after radioembolization for metastatic colorectal cancer. Ann Surg Oncol. 2015;22:1701–2170.CrossRefPubMed
81.
go back to reference Campbell SR, Balagamwala EH, Woody NM, Stephans KL. Multimodality management of colorectal liver oligometastases. Appl Rad Oncol. 2019;8(3):9–16. Campbell SR, Balagamwala EH, Woody NM, Stephans KL. Multimodality management of colorectal liver oligometastases. Appl Rad Oncol. 2019;8(3):9–16.
82.
go back to reference Ray CE, Edwards A, Smith MT. Metaanalysis of survival, complications, and imaging response following chemotherapy-based transarterial therapy in patients with unresectable intrahepatic cholangiocarcinoma. J Vasc Interv Radiol. 2013;24(8):1218–26.CrossRefPubMed Ray CE, Edwards A, Smith MT. Metaanalysis of survival, complications, and imaging response following chemotherapy-based transarterial therapy in patients with unresectable intrahepatic cholangiocarcinoma. J Vasc Interv Radiol. 2013;24(8):1218–26.CrossRefPubMed
86.
go back to reference Mouli S, Memon K, Baker T. Yttrium-90 radioembolization for intrahepatic cholangiocarcinoma: safety, response, and survival analysis. J Vasc Interv Radiol. 2013;24(8):1227–34.CrossRefPubMedPubMedCentral Mouli S, Memon K, Baker T. Yttrium-90 radioembolization for intrahepatic cholangiocarcinoma: safety, response, and survival analysis. J Vasc Interv Radiol. 2013;24(8):1227–34.CrossRefPubMedPubMedCentral
87.
go back to reference Martinez BK, Flanders V, Gupta NK, Natarajan K, Underhill MP, Cooke J. Development of a Y90 radioembolization program in a community hospital setting for treatment of metastatic and primary liver tumors. J Vasc Interv Radiol. 2013;24(5):759.e32-759.e33. Martinez BK, Flanders V, Gupta NK, Natarajan K, Underhill MP, Cooke J. Development of a Y90 radioembolization program in a community hospital setting for treatment of metastatic and primary liver tumors. J Vasc Interv Radiol. 2013;24(5):759.e32-759.e33.
95.
go back to reference Helmberger T, Golfieri R, Pech M, et al. Clinical application of trans-arterial radioembolization in hepatic malignancies in Europe: first results from the prospective Multicentre Observational Study CIRSE Registry for SIR-Spheres Therapy (CIRT). Cardiovasc Intervent Radiol. 2021;44(1):21–35. https://doi.org/10.1007/s00270-020-02642-y.CrossRefPubMed Helmberger T, Golfieri R, Pech M, et al. Clinical application of trans-arterial radioembolization in hepatic malignancies in Europe: first results from the prospective Multicentre Observational Study CIRSE Registry for SIR-Spheres Therapy (CIRT). Cardiovasc Intervent Radiol. 2021;44(1):21–35. https://​doi.​org/​10.​1007/​s00270-020-02642-y.CrossRefPubMed
98.
go back to reference Cao C, Yan TD, Morris DL, Bester L. Radioembolization with yttrium-90 microspheres for pancreatic cancer liver metastases: results from a pilot study. Tumori. 2010;96(6):955–8.CrossRefPubMed Cao C, Yan TD, Morris DL, Bester L. Radioembolization with yttrium-90 microspheres for pancreatic cancer liver metastases: results from a pilot study. Tumori. 2010;96(6):955–8.CrossRefPubMed
Metadata
Title
Ytrrium-90 transarterial radioembolization in patients with gastrointestinal malignancies
Authors
D. Viñal
A. Minaya-Bravo
I. Prieto
J. Feliu
N. Rodriguez-Salas
Publication date
01-05-2022
Publisher
Springer International Publishing
Published in
Clinical and Translational Oncology / Issue 5/2022
Print ISSN: 1699-048X
Electronic ISSN: 1699-3055
DOI
https://doi.org/10.1007/s12094-021-02745-z

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