Safety, Efficacy, and Prognostic Factors After Radioembolization of Hepatic Metastases from Breast Cancer: A Large Single-Center Experience in 81 Patients

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FIGURE 1.
A 39-y-old female patient with new onset of ascites after radioembolization (RE) of WL in single session. Axial CT and fused ¹⁸F-FDG PET/CT images are shown at baseline (A and D) and 12 wk after radioembolization (C and F). Respective serum levels of bilirubin (Bili), AST, and ALT are given. Follow-up CT reveals signs of hepatic cirrhosis with appearance of ascites (arrow). Patient developed grade 2 toxicity for bilirubin/AST and grade 1 toxicity for ALT. Patient eventually recovered from liver toxicity but died from tumor progression at 23 wk after radioembolization. (B and E) Axial low-dose CT (E) and fused Bremsstrahlung SPECT/CT (B) after radioembolization of WL.
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FIGURE 2.
Incidence of adverse events by treatment group (n = 81). Difference between treatment groups (i.e., incidence toxicity SL minus WL) is depicted, with those exceeding 5% marked with *.
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FIGURE 3.
OS after radioembolization (RE) for entire study cohort (A), separated by tumor-to-liver ratio (B) and transaminase toxicity (C). Log-rank P is given. WNL = within normal limits.

TABLE 1

Baseline Characteristics of Study Cohort

Characteristic (n = 81)	Total or median
Age (y)	61 (15)
Time between diagnosis and radioembolization (y)	6.0 (7.3)
Prior local treatment	20 (25%)
Surgery	8 (10%)
RFA	9 (11%)
TACE	4 (5%)
LITT	1 (1%)
Multiple	2 (2%)
UICC stage at initial diagnosis
1	4 (5%)
2a	29 (36%)
2b	13 (16%)
3a	11 (14%)
3b	8 (10%)
4	16 (20%)
Tumor expression profile
PR+	40 (49%)
ER+	60 (74%)
Her2/neu+	28 (35%)
CA15-3 (U/mL)	137 (395)
Carcinoembryonic antigen (ng/mL)	12 (28)
Tumor-to-liver ratio
<25%	49 (60%)
25%–50%	24 (30%)
≥50%	8 (10%)
Radioactivity delivered (GBq)	1.6 (0.6)

RFA = radiofrequency ablation; TACE = transcatheter arterial chemoembolization; LITT = laser-induced thermotherapy; UICC = International Union Against Cancer; PR+ = progesterone receptor status positive; ER+ = estrogen receptor status positive; Her-2/neu+ = Her-2/neu status positive.
Given are total numbers (with percentages in parentheses) or median (with IQRs in parentheses).

TABLE 2

Adverse Events After Radioembolization

TABLE 3

Therapy-Associated Risk for SAE After Radioembolization

↵* Significant.
TAX = taxanes; ANT = anthracyclines; 5-FU = fluorouracil; MTX = methotrexate; PBA = platinum-based agents; CLA = DNA cross-link agents; mAb = monoclonal antibodies; CTx = chemotherapy; HTx = hormone therapy.

TABLE 4

OS, TTP_liver, and Response by ¹⁸F-FDG PET or CA15-3

Given are total numbers (with percentages in parentheses) or median (with IQRs in parentheses).

TABLE 5

Univariate Cox Regression Analysis for OS After Radioembolization

						95% confidence interval
Variable	Median	Subcategories based on rounded median	n	P	Hazard ratio	Lower bound	Upper bound
Prior local treatment		No	61		1.0
		Yes	20	0.152^*	0.66	0.38	1.16
Treatment group		SL	23		1.0
		WL	58	0.938	1.02	0.60	1.75
Tumor-to-liver ratio		<25%	49		1.0
		25%–50%	24	0.048^*	1.64	0.99	2.72
		≥50%	8	<0.001^*	6.36	2.74	14.79
Chemo < 3 mo before radioembolization		No	53		1.0
		Yes	28	0.186^*	1.39	0.85	2.25
Dose (GBq)	1.6	<1.6	40	0.352	1.25	0.78	1.98
		≥1.6	41		1.0
Baseline CA15-3	137	<137	40		1.0
		≥137	41	0.065^*	1.55	0.97	2.48
Baseline transaminase toxicity		WNL	61		1.0
		Grade ≥ 2	20	0.001^*	2.48	1.44	4.26
Baseline GGT toxicity		WNL	36		1.0
		Grade ≥ 2	45	0.008^*	1.89	1.18	3.03
Baseline bilirubin toxicity		WNL	73		1.0
		Any grade	8	0.279	1.51	1.72	3.16
Extrahepatic metastasis		No	27		1.0
		Yes	54	0.299	1.30	0.79	2.12