Y-90 SIR-Sphere treatment of unresectable primary or metastatic liver tumors

Objectives To evaluate the efficacy and safety of Y-90 SIR-Sphere treatment in patients (pts) with unresectable liver tumors.

Methods 109 pts with unresectable primary or metastatic liver tumors: carcinoid (46), neuroendocrine (NET) (10), hepatocellular carcinoma (HCC) (32), colon cancer (10), and other cancers (11) underwent 130 Y-90 SIR-Sphere treatments. Tc-99m MAA imaging was used to evaluate lung shunting (LS). 82 of 130 treatments were evaluated for toxicity and response. The response was assessed by CT, PET/CT, OcteoScan, MR, and/or tumor markers.

Results The median absorbed doses for the tumor and liver were 60.3 Gy and 21.9 Gy, respectively. The median LS was 4.6%. 18 treatments were injected with calculated standard doses (median 1.55 GBq), and 64 doses were reduced by 25%-40% (median 1.2 GBq). 41 treatments (50%) had positive responses (PR), 22 (26.8%) had stable disease (SD), and 19 (23.2%) had progression of disease (PD). Pts with carcinoid or NET showed a higher PR rate (62.0%) compared to pts with HCC and other cancers (34.3%). There was no significant response difference between pts treated with calculated standard dose vs. reduced dose. There was no radiation hepatitis and treatment-induced liver failure observed. 3 pts had gastric ulceration after therapy, 2 were managed conservatively and 1 had surgical treatment.

Conclusions Y-90 SIR-Sphere treatment is a useful modality with a remarkable objective response rate and with acceptable toxicity for the treatment of pts with unresectable primary or metastatic liver tumors.

Research Support Supported by the Carcinoid Cancer Foundation^TM.