Radioembolization with 90 Y Resin Microspheres of Neuroendocrine Liver Metastases After Initial Peptide Receptor Radionuclide Therapy

Cardiovasc Intervent Radiol. 2020 Feb;43(2):246-253. doi: 10.1007/s00270-019-02350-2. Epub 2019 Oct 23.

Abstract

Purpose: Peptide receptor radionuclide therapy (PRRT) and radioembolization are increasingly used in neuroendocrine neoplasms patients. However, concerns have been raised on cumulative hepatotoxicity. The aim of this sub-analysis was to investigate hepatotoxicity of yttrium-90 resin microspheres radioembolization in patients who were previously treated with PRRT.

Methods: Patients treated with radioembolization after systemic radionuclide treatment were retrospectively analysed. Imaging response according to response evaluation criteria in solid tumours (RECIST) v1.1 and clinical response after 3 months were collected. Clinical, biochemical and haematological toxicities according to common terminology criteria for adverse events (CTCAE) v4.03 were also collected. Specifics on prior PRRT, subsequent radioembolization treatments, treatments after radioembolization and overall survival (OS) were collected.

Results: Forty-four patients were included, who underwent a total of 58 radioembolization procedures, of which 55% whole liver treatments, at a median of 353 days after prior PRRT. According to RECIST 1.1, an objective response rate of 16% and disease control rate of 91% were found after 3 months. Clinical response was seen in 65% (15/23) of symptomatic patients after 3 months. Within 3 months, clinical toxicities occurred in 26%. Biochemical and haematological toxicities CTCAE grade 3-4 occurred in ≤ 10%, apart from lymphocytopenia (42%). Radioembolization-related complications occurred in 5% and fatal radioembolization-induced liver disease in 2% (one patient). A median OS of 3.5 years [95% confidence interval 1.8-5.1 years] after radioembolization for the entire study population was found.

Conclusion: Radioembolization after systemic radionuclide treatments is safe, and the occurrence of radioembolization-induced liver disease is rare.

Level of evidence: 4, case series.

Keywords: NEN; Neuroendocrine tumours; PRRT; Radioembolization; SIRT; Yttrium-90.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Brachytherapy / methods*
  • Female
  • Humans
  • Liver Neoplasms / radiotherapy*
  • Male
  • Microspheres
  • Middle Aged
  • Neuroendocrine Tumors / radiotherapy*
  • Neuroendocrine Tumors / secondary
  • Receptors, Peptide / therapeutic use
  • Response Evaluation Criteria in Solid Tumors
  • Retrospective Studies
  • Treatment Outcome
  • Yttrium Radioisotopes / therapeutic use*

Substances

  • Receptors, Peptide
  • Yttrium Radioisotopes