Treatment parameters and outcome in 680 treatments of internal radiation with resin 90Y-microspheres for unresectable hepatic tumors

Int J Radiat Oncol Biol Phys. 2009 Aug 1;74(5):1494-500. doi: 10.1016/j.ijrobp.2008.10.005. Epub 2009 Jan 20.


Purpose: Radioembolization (RE) using (90)Y-microspheres is an effective and safe treatment for patients with unresectable liver malignancies. Radiation-induced liver disease (RILD) is rare after RE; however, greater understanding of radiation-related factors leading to serious liver toxicity is needed.

Methods and materials: Retrospective review of radiation parameters was performed. All data pertaining to demographics, tumor, radiation, and outcomes were analyzed for significance and dependencies to develop a predictive model for RILD. Toxicity was scored using the National Cancer Institute Common Toxicity Criteria Adverse Events Version 3.0 scale.

Results: A total of 515 patients (287 men; 228 women) from 14 US and 2 EU centers underwent 680 separate RE treatments with resin (90)Y-microspheres in 2003-2006. Multifactorial analyses identified factors related to toxicity, including activity (GBq) Selective Internal Radiation Therapy delivered (p < 0.0001), prescribed (GBq) activity (p < 0.0001), percentage of empiric activity (GBq) delivered (p < 0.0001), number of prior liver treatments (p < 0.0008), and medical center (p < 0.0001). The RILD was diagnosed in 28 of 680 treatments (4%), with 21 of 28 cases (75%) from one center, which used the empiric method.

Conclusions: There was an association between the empiric method, percentage of calculated activity delivered to the patient, and the most severe toxicity, RILD. A predictive model for RILD is not yet possible given the large variance in these data.

Publication types

  • Multicenter Study

MeSH terms

  • Carcinoma, Hepatocellular / pathology
  • Carcinoma, Hepatocellular / radiotherapy
  • Chemoembolization, Therapeutic / adverse effects*
  • Chemoembolization, Therapeutic / methods
  • Embolization, Therapeutic / methods
  • Female
  • Humans
  • Liver / radiation effects*
  • Liver Neoplasms / pathology
  • Liver Neoplasms / radiotherapy*
  • Male
  • Microspheres*
  • Models, Chemical
  • Radiation Injuries / etiology*
  • Radiation Injuries / pathology
  • Radiotherapy Dosage
  • Retrospective Studies
  • Treatment Outcome
  • Yttrium Radioisotopes / adverse effects*
  • Yttrium Radioisotopes / therapeutic use


  • Yttrium Radioisotopes