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Riad Salem - One of the best experts on this subject based on the ideXlab platform.
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Pretransplant Intra-arterial Liver-Directed Therapy Does Not Increase the Risk of Hepatic Arterial Complications in Liver Transplantation: A Single-Center 10-Year Experience
CardioVascular and Interventional Radiology, 2018Co-Authors: Joseph R. Kallini, Riad Salem, Laura Kulik, Ahsun Riaz, Ahmed Gabr, Rehan Ali, Nadine Abouchaleh, Talia Baker, Juan Caicedo, Robert J LewandowskiAbstract:Purpose To investigate the association between pretransplant intra-arterial liver-directed therapy (IAT) for hepatocellular carcinoma (HCC) and hepatic arterial complications (HAC) in orthotopic liver transplantation (OLT) [namely hepatic artery thrombosis (HAT) and/or the need for hepatic arterial conduit]. Methods A total of 175 HCC patients (mean age: 60 years) underwent IAT with either transarterial chemoembolization or yttrium-90 (90Y) transarterial Radioembolization prior to OLT between 2003 and 2013. A matched control cohort of 159 HCC patients who underwent OLT without prior IAT was selected. Incidence of HAC in both cohorts was investigated. The categorical differences between both cohorts were calculated by chi-square test. Results Among the 175 patients (chemoembolization, n = 82; Radioembolization, n = 93), 8 (5%) required conduits due to HA disease (chemoembolization, n = 6; Radioembolization, n = 2), 3 (2%) developed HAT (chemoembolization, n = 2; Radioembolization, n = 1). Eleven of 175 patients (6.7%) had HAC. Of the 159 control patients, 6 (4%) needed conduits for HA disease and 3 (2%) developed HAT. Nine of 159 patients (5.7%) had HAC. Chi-square analysis between the IAT cohort and the control group yielded a p value of 0.810. When comparing chemoembolization to Radioembolization, p = 0.076 (not significant at p
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long term hepatotoxicity of yttrium 90 Radioembolization as treatment of metastatic neuroendocrine tumor to the liver
Journal of Vascular and Interventional Radiology, 2017Co-Authors: Rosewell V Mackey, Riad Salem, Vanessa L Gates, Ahsun Riaz, Frank H Miller, Al B Benson, Vahid Yaghmai, A Gabr, Robert J LewandowskiAbstract:Abstract Purpose To determine long-term hepatotoxicity of yttrium-90 ( 90 Y) Radioembolization in patients treated for metastatic neuroendocrine tumor (mNET) and evaluate if imaging and laboratory findings of cirrhosis-like morphology are associated with clinical symptoms. Materials and Methods Retrospective review from 2003 to 2016 was performed for patients with mNET treated with 90 Y glass microspheres. Fifty-four patients with > 2 year follow-up were stratified into unilobar (n = 15) vs whole-liver (n = 39) treatment. The most common primary mNET sites were small bowel (19 of 54), pancreas (19 of 54), and unknown (8 of 54). PreRadioembolization imaging and laboratory findings were compared with most recent follow-up for indications of worsening portal hypertension and decline in hepatic function. Results Among patients who underwent unilobar Radioembolization, imaging follow-up at a mean of 4.1 years (range, 2.0–15.2 y) revealed cirrhosis-like morphology in 26.7% (4 of 15), ascites in 13.3% (2 of 15), varices in 6.7% (1 of 15), and a 21.9% increase in splenic volume. The respective incidences in patients treated with whole-liver 90 Y Radioembolization were 56.4% (22 of 39), 41.0% (16 of 39), and 15.4% (6 of 39), with a 64.7% increase in splenic volume. Patients treated with whole-liver Radioembolization exhibited significantly decreased platelet counts ( P = .023) and lower albumin levels ( P = .0002). Eight patients (20.5%) treated with whole-liver Radioembolization who exhibited cirrhosis-like morphology showed clinical signs of hepatic decompensation; only 2 of 39 patients (5.1%) had no other causes of hepatotoxicity. Conclusions Whole-liver 90 Y Radioembolization for patients with mNET results in long-term imaging findings of cirrhosis-like morphology and portal hypertension in > 50% of treated patients, but the majority remain clinically asymptomatic. Long-term hepatotoxicity solely attributable to 90 Y develops in a small percentage of patients.
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Radioembolization as a Treatment Strategy for Metastatic Colorectal Cancer to the Liver: What Can We Learn from the SIRFLOX Trial?
Current Treatment Options in Oncology, 2016Co-Authors: Bippan Singh Sangha, Riad Salem, Halla Nimeiri, Ryan Hickey, Robert J LewandowskiAbstract:In the setting of liver metastases from colorectal cancer (CRC), Radioembolization with yttrium-90 has been used to treat chemotherapy refractory disease with a growing interest to establish its efficacy in prospective trials combined with first- and second-line chemotherapy. SIRFLOX is an ongoing, multi-center, phase 3 randomized trial comparing first-line chemotherapy alone or in combination with yttrium-90 Radioembolization in patients with CRC who have isolated liver metastases or liver-dominant metastases. Preliminary results from SIRFLOX demonstrate that Radioembolization combined with first-line chemotherapy is safe and feasible. There was no significant difference in median overall progression-free survival (PFS) between the combined Radioembolization-chemotherapy and chemotherapy-only arms (10.7 versus 10.2 months). Although the trial did not meet its primary endpoint of improved median PFS, there was a significant increase in the median hepatic PFS (20.5 versus 12.6 months; p = 0.02) favoring the combination arm. Thus, combining Radioembolization with chemotherapy in the first-line setting may be most effective for liver-limited metastatic CRC. Since Radioembolization targets liver disease, it is plausible that the trial failed to achieve an improvement in PFS given that 40 % of the SIRFLOX population had extra-hepatic disease. It is also possible that the overall median PFS may be a poor surrogate endpoint, and other endpoints like overall survival still needs to be delineated in this setting. In addition, it is crucial to document improvement or delay in time to deterioration in quality of life symptom endpoints in this population. SIRFLOX is the first of three prospective studies that assess the efficacy of adding Radioembolization to first-line chemotherapy, and the combined data from these trials will provide the necessary power for an overall survival analysis. The final results of SIRFLOX will be eagerly awaited to determine if the increased hepatic PFS in preliminary data will translate to increased overall survival benefit.
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Yttrium-90 Radioembolization for Hepatocellular Carcinoma
Seminars in nuclear medicine, 2016Co-Authors: Ryan Hickey, Robert J Lewandowski, Riad SalemAbstract:90 Y Radioembolization refers to the selective, transcatheter, and intra-arterial injection of micrometer-sized particles loaded with the radioisotope yttrium-90 for the treatment of primary and metastatic hepatic malignancies. In the treatment of intermediate- and advanced-stage hepatocellular carcinoma, 90 Y Radioembolization provides favorable outcomes with minimal side effects, offering an alternative treatment option to other transarterial therapies, such as bland embolization and chemoembolization. This review provides an overview of the use of 90 Y Radioembolization in the treatment of hepatocellular carcinoma, including patient selection criteria, dosimetry, and clinical outcomes.
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yttrium 90 Radioembolization is a viable treatment option for unresectable chemorefractory colorectal cancer liver metastases further evidence in support of a new treatment paradigm
Annals of Surgical Oncology, 2015Co-Authors: Ryan Hickey, Robert J Lewandowski, Riad SalemAbstract:Saxena et al. provide further evidence of the safety and efficacy of yttrium 90 Radioembolization for the treatment of chemorefractory colorectal liver metastases with the publication of outcomes in more than 300 patients treated during a 7-year period. The reported survival rates and low grade of toxicities complement a growing body of evidence in favor of transarterial Radioembolization for the treatment of a disease with an otherwise dismal prognosis. Saxena et al. joins a series of recent publications that are helping to define a new and promising treatment paradigm for colorectal liver metastases, which remains one of the most common causes of cancer-related mortality. The authors add to a worldwide experience of reproducible outcomes with Radioembolization for colorectal liver metastases. They remind us that patients with chemorefractory colorectal liver metastases have a median survival of only 4–6 months with best supportive care. In the setting of such chemorefractory disease, Saxena et al. report a median overall survival of 10.5 months from first Y90 Radioembolization, which is nearly identical to the 10.6-month median survival most recently reported by Lewandowski et al. in a study of 214 patients treated with glass Y90 microspheres over 12 years, and a median survival of 10.5 months reported by Kennedy et al. among responders in a multi-institutional review of 208 patients treated with resin Y90 microspheres. The study confirms that Y90 Radioembolization is safe in patients who have received multiple lines of chemotherapy, with the vast majority of clinical toxicities being low-grade and self-limited. Indeed, recent phase 1 studies indicate that Y90 Radioembolization can be safely combined with the radiosensitizing oral chemotherapeutic capecitabine, establishing a new front against colorectal liver metastases utilizing the synergistic effects of chemoradiation. Our group performed a dose-escalation study of Y90 Radioembolization with capecitabine in which Y90 doses were escalated in the setting of full-dose capecitabine. We reported that the maximum-tolerated dose of glass Y90 microspheres in conjunction with capecitabine exceeds 170 Gy for the treatment of hepatic metastases, the majority of which were colorectal metastases. Cohen et al. reported the safety of Y90 Radioembolization administered during escalating doses of capecitabine and found that resin Y90 microspheres could be safely administered with the maximum standard dose of capecitabine (1,000 mg/m b.i.d.) for patients with hepatic metastases, more than 70 % of whom had colorectal metastases. Given the limitations of external beam radiation in the treatment of hepatic metastases, Y90 Radioembolization provides the critical radiation component of chemoradiation. Whereas the incidence of radiation-induced liver disease is unacceptably high following external beam radiation at tumoricidal doses, Y90 Radioembolization offers high-dose treatment of multiple lesions in a single setting. The initial foundation has been established for incorporating Y90 into the standard treatment regimen of chemorefractory liver metastases of colorectal cancer. Nonetheless, several questions remain to be answered. In order to determine the most effective time at which Radioembolization should be performed, the imprecise term ‘‘line of chemotherapy’’ needs to be clarified. Investigators must try to separate patients who have discontinued a chemotherapeutic regimen and started another due to Society of Surgical Oncology 2014
Robert J Lewandowski - One of the best experts on this subject based on the ideXlab platform.
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Role of Y90 Radioembolization in Hepatic Metastatic Colorectal Carcinoma
Colorectal Cancer Liver Metastases, 2019Co-Authors: R. Ali, Ahmed Gabr, Ahsun Riaz, R. Mora, Robert J LewandowskiAbstract:Radioembolization is a treatment option for select patients with hepatic metastases from colorectal cancer in the salvage setting. These patients with liver-dominant or liver-only metastatic disease who have failed standard-of-care first- and second-line systemic therapies have clear and consistent objective response rates and survival outcomes from this outpatient procedure. While there is interest in combining systemic and locoregional therapies to benefit from chemoradiation principles as well as treat patients earlier in their disease course, current evidence to support this practice is lacking. Prospective randomized trials employing Radioembolization in combination with first-line chemotherapy have been negative to date. Most recently, a clinical trial of second-line chemotherapy with/without Radioembolization has completed enrollment in October 2018, and the study results are yet to be published.
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Pretransplant Intra-arterial Liver-Directed Therapy Does Not Increase the Risk of Hepatic Arterial Complications in Liver Transplantation: A Single-Center 10-Year Experience
CardioVascular and Interventional Radiology, 2018Co-Authors: Joseph R. Kallini, Riad Salem, Laura Kulik, Ahsun Riaz, Ahmed Gabr, Rehan Ali, Nadine Abouchaleh, Talia Baker, Juan Caicedo, Robert J LewandowskiAbstract:Purpose To investigate the association between pretransplant intra-arterial liver-directed therapy (IAT) for hepatocellular carcinoma (HCC) and hepatic arterial complications (HAC) in orthotopic liver transplantation (OLT) [namely hepatic artery thrombosis (HAT) and/or the need for hepatic arterial conduit]. Methods A total of 175 HCC patients (mean age: 60 years) underwent IAT with either transarterial chemoembolization or yttrium-90 (90Y) transarterial Radioembolization prior to OLT between 2003 and 2013. A matched control cohort of 159 HCC patients who underwent OLT without prior IAT was selected. Incidence of HAC in both cohorts was investigated. The categorical differences between both cohorts were calculated by chi-square test. Results Among the 175 patients (chemoembolization, n = 82; Radioembolization, n = 93), 8 (5%) required conduits due to HA disease (chemoembolization, n = 6; Radioembolization, n = 2), 3 (2%) developed HAT (chemoembolization, n = 2; Radioembolization, n = 1). Eleven of 175 patients (6.7%) had HAC. Of the 159 control patients, 6 (4%) needed conduits for HA disease and 3 (2%) developed HAT. Nine of 159 patients (5.7%) had HAC. Chi-square analysis between the IAT cohort and the control group yielded a p value of 0.810. When comparing chemoembolization to Radioembolization, p = 0.076 (not significant at p
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long term hepatotoxicity of yttrium 90 Radioembolization as treatment of metastatic neuroendocrine tumor to the liver
Journal of Vascular and Interventional Radiology, 2017Co-Authors: Rosewell V Mackey, Riad Salem, Vanessa L Gates, Ahsun Riaz, Frank H Miller, Al B Benson, Vahid Yaghmai, A Gabr, Robert J LewandowskiAbstract:Abstract Purpose To determine long-term hepatotoxicity of yttrium-90 ( 90 Y) Radioembolization in patients treated for metastatic neuroendocrine tumor (mNET) and evaluate if imaging and laboratory findings of cirrhosis-like morphology are associated with clinical symptoms. Materials and Methods Retrospective review from 2003 to 2016 was performed for patients with mNET treated with 90 Y glass microspheres. Fifty-four patients with > 2 year follow-up were stratified into unilobar (n = 15) vs whole-liver (n = 39) treatment. The most common primary mNET sites were small bowel (19 of 54), pancreas (19 of 54), and unknown (8 of 54). PreRadioembolization imaging and laboratory findings were compared with most recent follow-up for indications of worsening portal hypertension and decline in hepatic function. Results Among patients who underwent unilobar Radioembolization, imaging follow-up at a mean of 4.1 years (range, 2.0–15.2 y) revealed cirrhosis-like morphology in 26.7% (4 of 15), ascites in 13.3% (2 of 15), varices in 6.7% (1 of 15), and a 21.9% increase in splenic volume. The respective incidences in patients treated with whole-liver 90 Y Radioembolization were 56.4% (22 of 39), 41.0% (16 of 39), and 15.4% (6 of 39), with a 64.7% increase in splenic volume. Patients treated with whole-liver Radioembolization exhibited significantly decreased platelet counts ( P = .023) and lower albumin levels ( P = .0002). Eight patients (20.5%) treated with whole-liver Radioembolization who exhibited cirrhosis-like morphology showed clinical signs of hepatic decompensation; only 2 of 39 patients (5.1%) had no other causes of hepatotoxicity. Conclusions Whole-liver 90 Y Radioembolization for patients with mNET results in long-term imaging findings of cirrhosis-like morphology and portal hypertension in > 50% of treated patients, but the majority remain clinically asymptomatic. Long-term hepatotoxicity solely attributable to 90 Y develops in a small percentage of patients.
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Radioembolization as a Treatment Strategy for Metastatic Colorectal Cancer to the Liver: What Can We Learn from the SIRFLOX Trial?
Current Treatment Options in Oncology, 2016Co-Authors: Bippan Singh Sangha, Riad Salem, Halla Nimeiri, Ryan Hickey, Robert J LewandowskiAbstract:In the setting of liver metastases from colorectal cancer (CRC), Radioembolization with yttrium-90 has been used to treat chemotherapy refractory disease with a growing interest to establish its efficacy in prospective trials combined with first- and second-line chemotherapy. SIRFLOX is an ongoing, multi-center, phase 3 randomized trial comparing first-line chemotherapy alone or in combination with yttrium-90 Radioembolization in patients with CRC who have isolated liver metastases or liver-dominant metastases. Preliminary results from SIRFLOX demonstrate that Radioembolization combined with first-line chemotherapy is safe and feasible. There was no significant difference in median overall progression-free survival (PFS) between the combined Radioembolization-chemotherapy and chemotherapy-only arms (10.7 versus 10.2 months). Although the trial did not meet its primary endpoint of improved median PFS, there was a significant increase in the median hepatic PFS (20.5 versus 12.6 months; p = 0.02) favoring the combination arm. Thus, combining Radioembolization with chemotherapy in the first-line setting may be most effective for liver-limited metastatic CRC. Since Radioembolization targets liver disease, it is plausible that the trial failed to achieve an improvement in PFS given that 40 % of the SIRFLOX population had extra-hepatic disease. It is also possible that the overall median PFS may be a poor surrogate endpoint, and other endpoints like overall survival still needs to be delineated in this setting. In addition, it is crucial to document improvement or delay in time to deterioration in quality of life symptom endpoints in this population. SIRFLOX is the first of three prospective studies that assess the efficacy of adding Radioembolization to first-line chemotherapy, and the combined data from these trials will provide the necessary power for an overall survival analysis. The final results of SIRFLOX will be eagerly awaited to determine if the increased hepatic PFS in preliminary data will translate to increased overall survival benefit.
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Yttrium-90 Radioembolization for Hepatocellular Carcinoma
Seminars in nuclear medicine, 2016Co-Authors: Ryan Hickey, Robert J Lewandowski, Riad SalemAbstract:90 Y Radioembolization refers to the selective, transcatheter, and intra-arterial injection of micrometer-sized particles loaded with the radioisotope yttrium-90 for the treatment of primary and metastatic hepatic malignancies. In the treatment of intermediate- and advanced-stage hepatocellular carcinoma, 90 Y Radioembolization provides favorable outcomes with minimal side effects, offering an alternative treatment option to other transarterial therapies, such as bland embolization and chemoembolization. This review provides an overview of the use of 90 Y Radioembolization in the treatment of hepatocellular carcinoma, including patient selection criteria, dosimetry, and clinical outcomes.
Maciej Pech - One of the best experts on this subject based on the ideXlab platform.
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Matched-Pair Comparison of Radioembolization Plus Best Supportive Care Versus Best Supportive Care Alone for Chemotherapy Refractory Liver-Dominant Colorectal Metastases
CardioVascular and Interventional Radiology, 2012Co-Authors: Ricarda Seidensticker, Timm Denecke, Patrick Kraus, Max Seidensticker, Konrad Mohnike, Jörg Fahlke, Erika Kettner, Bert Hildebrandt, Oliver Dudeck, Maciej PechAbstract:Purpose This study was designed to evaluate overall survival after Radioembolization or best supportive care (BSC) in patients with chemotherapy-refractory liver-dominant metastatic colorectal cancer (mCRC). Methods This was a matched-pair comparison of patients who received Radioembolization plus BSC or BSC alone for extensive liver disease. Twenty-nine patients who received Radioembolization were retrospectively matched with a contemporary cohort of >500 patients who received BSC from 3 centers in Germany. Using clinical databases, patients were initially matched for prior treatments and tumor burden and then 29 patients were consecutively identified with two or more of four matching criteria: synchronous/metachronous metastases, tumor burden, increased ALP, and/or CEA >200 U/ml. Survival was calculated from date of progression before Radioembolization or BSC by using Kaplan–Meier analysis. Results Of 29 patients in each study arm, 16 pairs (55.2%) matched for all four criteria, and 11 pairs (37.9%) matched three criteria. Patients in both groups had a similar performance status (Karnofsky index, median 80% [range, 60–100%]). Compared with BSC alone, Radioembolization prolonged survival (median, 8.3 vs. 3.5 months; P
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matched pair comparison of Radioembolization plus best supportive care versus best supportive care alone for chemotherapy refractory liver dominant colorectal metastases
CardioVascular and Interventional Radiology, 2012Co-Authors: Ricarda Seidensticker, Timm Denecke, Patrick Kraus, Max Seidensticker, Konrad Mohnike, Jörg Fahlke, Erika Kettner, Bert Hildebrandt, Oliver Dudeck, Maciej PechAbstract:This study was designed to evaluate overall survival after Radioembolization or best supportive care (BSC) in patients with chemotherapy-refractory liver-dominant metastatic colorectal cancer (mCRC). This was a matched-pair comparison of patients who received Radioembolization plus BSC or BSC alone for extensive liver disease. Twenty-nine patients who received Radioembolization were retrospectively matched with a contemporary cohort of >500 patients who received BSC from 3 centers in Germany. Using clinical databases, patients were initially matched for prior treatments and tumor burden and then 29 patients were consecutively identified with two or more of four matching criteria: synchronous/metachronous metastases, tumor burden, increased ALP, and/or CEA >200 U/ml. Survival was calculated from date of progression before Radioembolization or BSC by using Kaplan–Meier analysis. Of 29 patients in each study arm, 16 pairs (55.2%) matched for all four criteria, and 11 pairs (37.9%) matched three criteria. Patients in both groups had a similar performance status (Karnofsky index, median 80% [range, 60–100%]). Compared with BSC alone, Radioembolization prolonged survival (median, 8.3 vs. 3.5 months; P < 0.001) with a hazard ratio of 0.3 (95% confidence interval, 0.16–0.55; P < 0.001) in a multivariate Cox proportional hazard model. Treatment-related adverse events following Radioembolization included: grade 1–2 fatigue (n = 20, 69%), grade 1 abdominal pain/nausea (n = 14, 48.3%), and grade 2 gastrointestinal ulceration (n = 3, 10.3%). Three cases of grade 3 radiation-induced liver disease were symptomatically managed. Radioembolization offers a promising addition to BSC in treatment-refractory patients for whom there are limited options. Survival was prolonged and adverse events were generally mild-to-moderate in nature and manageable.
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Hepatic Toxicity After Radioembolization of the Liver Using ^90Y-Microspheres: Sequential Lobar Versus Whole Liver Approach
CardioVascular and Interventional Radiology, 2012Co-Authors: Ricarda Seidensticker, Max Seidensticker, Konrad Mohnike, Maciej Pech, Robert Damm, Kerstin Schütte, Peter Malfertheiner, Mark Buskirk, Holger Amthauer, Jens RickeAbstract:Purpose ^90Y-Radioembolization (RE) is a promising technique for delivering high doses of radiation to liver tumors but may result in compromise of liver function. To gain further perspective, we evaluated the toxicity rates of sequential lobar versus “whole liver” ^90Y-Radioembolization. Methods Thirty-four patients with liver malignancy in noncirrhotic livers were included; ^90Y-Radioembolization was performed as either whole liver or sequential lobar treatment in 17 patients each. Standard clinical and liver specific laboratory parameters as well as MR imaging before treatment and at follow-up (6 and 12 weeks) after Radioembolization were evaluated for toxicity using the Common Terminology Criteria for Adverse Events (CTCAE). Volumetry of the liver, tumor, and spleen and measurement of portal vein diameter also were performed. Results Three months after whole liver RE, 14 liver-related grade 3/4 events were recorded versus 2 events after sequential lobar treatment ( P
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hepatic toxicity after Radioembolization of the liver using 90 y microspheres sequential lobar versus whole liver approach
CardioVascular and Interventional Radiology, 2012Co-Authors: Ricarda Seidensticker, Max Seidensticker, Maciej Pech, Robert Damm, Kerstin Schütte, Peter Malfertheiner, Holger Amthauer, K Mohnike, Mark Van Buskirk, Jens RickeAbstract:Purpose 90Y-Radioembolization (RE) is a promising technique for delivering high doses of radiation to liver tumors but may result in compromise of liver function. To gain further perspective, we evaluated the toxicity rates of sequential lobar versus “whole liver” 90Y-Radioembolization.
Ricarda Seidensticker - One of the best experts on this subject based on the ideXlab platform.
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Matched-Pair Comparison of Radioembolization Plus Best Supportive Care Versus Best Supportive Care Alone for Chemotherapy Refractory Liver-Dominant Colorectal Metastases
CardioVascular and Interventional Radiology, 2012Co-Authors: Ricarda Seidensticker, Timm Denecke, Patrick Kraus, Max Seidensticker, Konrad Mohnike, Jörg Fahlke, Erika Kettner, Bert Hildebrandt, Oliver Dudeck, Maciej PechAbstract:Purpose This study was designed to evaluate overall survival after Radioembolization or best supportive care (BSC) in patients with chemotherapy-refractory liver-dominant metastatic colorectal cancer (mCRC). Methods This was a matched-pair comparison of patients who received Radioembolization plus BSC or BSC alone for extensive liver disease. Twenty-nine patients who received Radioembolization were retrospectively matched with a contemporary cohort of >500 patients who received BSC from 3 centers in Germany. Using clinical databases, patients were initially matched for prior treatments and tumor burden and then 29 patients were consecutively identified with two or more of four matching criteria: synchronous/metachronous metastases, tumor burden, increased ALP, and/or CEA >200 U/ml. Survival was calculated from date of progression before Radioembolization or BSC by using Kaplan–Meier analysis. Results Of 29 patients in each study arm, 16 pairs (55.2%) matched for all four criteria, and 11 pairs (37.9%) matched three criteria. Patients in both groups had a similar performance status (Karnofsky index, median 80% [range, 60–100%]). Compared with BSC alone, Radioembolization prolonged survival (median, 8.3 vs. 3.5 months; P
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matched pair comparison of Radioembolization plus best supportive care versus best supportive care alone for chemotherapy refractory liver dominant colorectal metastases
CardioVascular and Interventional Radiology, 2012Co-Authors: Ricarda Seidensticker, Timm Denecke, Patrick Kraus, Max Seidensticker, Konrad Mohnike, Jörg Fahlke, Erika Kettner, Bert Hildebrandt, Oliver Dudeck, Maciej PechAbstract:This study was designed to evaluate overall survival after Radioembolization or best supportive care (BSC) in patients with chemotherapy-refractory liver-dominant metastatic colorectal cancer (mCRC). This was a matched-pair comparison of patients who received Radioembolization plus BSC or BSC alone for extensive liver disease. Twenty-nine patients who received Radioembolization were retrospectively matched with a contemporary cohort of >500 patients who received BSC from 3 centers in Germany. Using clinical databases, patients were initially matched for prior treatments and tumor burden and then 29 patients were consecutively identified with two or more of four matching criteria: synchronous/metachronous metastases, tumor burden, increased ALP, and/or CEA >200 U/ml. Survival was calculated from date of progression before Radioembolization or BSC by using Kaplan–Meier analysis. Of 29 patients in each study arm, 16 pairs (55.2%) matched for all four criteria, and 11 pairs (37.9%) matched three criteria. Patients in both groups had a similar performance status (Karnofsky index, median 80% [range, 60–100%]). Compared with BSC alone, Radioembolization prolonged survival (median, 8.3 vs. 3.5 months; P < 0.001) with a hazard ratio of 0.3 (95% confidence interval, 0.16–0.55; P < 0.001) in a multivariate Cox proportional hazard model. Treatment-related adverse events following Radioembolization included: grade 1–2 fatigue (n = 20, 69%), grade 1 abdominal pain/nausea (n = 14, 48.3%), and grade 2 gastrointestinal ulceration (n = 3, 10.3%). Three cases of grade 3 radiation-induced liver disease were symptomatically managed. Radioembolization offers a promising addition to BSC in treatment-refractory patients for whom there are limited options. Survival was prolonged and adverse events were generally mild-to-moderate in nature and manageable.
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Hepatic Toxicity After Radioembolization of the Liver Using ^90Y-Microspheres: Sequential Lobar Versus Whole Liver Approach
CardioVascular and Interventional Radiology, 2012Co-Authors: Ricarda Seidensticker, Max Seidensticker, Konrad Mohnike, Maciej Pech, Robert Damm, Kerstin Schütte, Peter Malfertheiner, Mark Buskirk, Holger Amthauer, Jens RickeAbstract:Purpose ^90Y-Radioembolization (RE) is a promising technique for delivering high doses of radiation to liver tumors but may result in compromise of liver function. To gain further perspective, we evaluated the toxicity rates of sequential lobar versus “whole liver” ^90Y-Radioembolization. Methods Thirty-four patients with liver malignancy in noncirrhotic livers were included; ^90Y-Radioembolization was performed as either whole liver or sequential lobar treatment in 17 patients each. Standard clinical and liver specific laboratory parameters as well as MR imaging before treatment and at follow-up (6 and 12 weeks) after Radioembolization were evaluated for toxicity using the Common Terminology Criteria for Adverse Events (CTCAE). Volumetry of the liver, tumor, and spleen and measurement of portal vein diameter also were performed. Results Three months after whole liver RE, 14 liver-related grade 3/4 events were recorded versus 2 events after sequential lobar treatment ( P
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hepatic toxicity after Radioembolization of the liver using 90 y microspheres sequential lobar versus whole liver approach
CardioVascular and Interventional Radiology, 2012Co-Authors: Ricarda Seidensticker, Max Seidensticker, Maciej Pech, Robert Damm, Kerstin Schütte, Peter Malfertheiner, Holger Amthauer, K Mohnike, Mark Van Buskirk, Jens RickeAbstract:Purpose 90Y-Radioembolization (RE) is a promising technique for delivering high doses of radiation to liver tumors but may result in compromise of liver function. To gain further perspective, we evaluated the toxicity rates of sequential lobar versus “whole liver” 90Y-Radioembolization.
Peter Gunvén - One of the best experts on this subject based on the ideXlab platform.
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Liver Embolizations in Oncology. A Review. Part II. Arterial Radioembolizations, Portal Venous Embolizations, Experimental Arterial Embolization Procedures
Medical Oncology, 2007Co-Authors: Peter GunvénAbstract:Arterial embolization of the liver may temporarily retard the growth of its primary and secondary tumors which are both mainly nourished arterially. Addition of radioisotopes, mostly 131I or 90Y, results in Radioembolizations which predominantly act by radiation and less by ischemia. They may therefore be utilized in the absence of portal venous flow when conventional embolization is hazardous. 131I-oily Radioembolization seems to prolong short-term survival in such patients with unresectable hepatocellular cancers, and to improve the prognosis after resection of hepatocellular cancer. The procedure does however not palliate better than “cold” chemoembolization in patients with preserved portal flow, except for having milder side effects. Embolization with 90Y-coupled microspheres may shrink primary and secondary liver tumors but has so far unproven effects on survival. Embolization of portal venous branches gives compensatory hypertrophy of the non-embolized liver and can increase the volume of the future remnant liver before resection. This diminishes the risk for postoperative liver failure after extensive resection and/or in the presence of chronic liver disease, and permits wider surgical indications. Tumor growth may however be accelerated, and the hypertrophy is inhibited by severe liver parenchymal disease in which situation the method would be most needed. Experimental use of liver arterial embolizations includes combined arterial and portal embolizations, i.e. “chemical hepatectomy,” arterial embolizations before external radiotherapy, administration of boron for neutron capture therapy, immunoembolizations, and future gene therapy.
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Liver Embolizations in Oncology. A Review. Part II. Arterial Radioembolizations, Portal Venous Embolizations, Experimental Arterial Embolization Procedures
Medical Oncology, 2007Co-Authors: Peter GunvénAbstract:Arterial embolization of the liver may temporarily retard the growth of its primary and secondary tumors which are both mainly nourished arterially. Addition of radioisotopes, mostly 131I or 90Y, results in Radioembolizations which predominantly act by radiation and less by ischemia. They may therefore be utilized in the absence of portal venous flow when conventional embolization is hazardous. 131I-oily Radioembolization seems to prolong short-term survival in such patients with unresectable hepatocellular cancers, and to improve the prognosis after resection of hepatocellular cancer. The procedure does however not palliate better than “cold” chemoembolization in patients with preserved portal flow, except for having milder side effects. Embolization with 90Y-coupled microspheres may shrink primary and secondary liver tumors but has so far unproven effects on survival. Embolization of portal venous branches gives compensatory hypertrophy of the non-embolized liver and can increase the volume of the future remnant liver before resection. This diminishes the risk for postoperative liver failure after extensive resection and/or in the presence of chronic liver disease, and permits wider surgical indications. Tumor growth may however be accelerated, and the hypertrophy is inhibited by severe liver parenchymal disease in which situation the method would be most needed. Experimental use of liver arterial embolizations includes combined arterial and portal embolizations, i.e. “chemical hepatectomy,” arterial embolizations before external radiotherapy, administration of boron for neutron capture therapy, immunoembolizations, and future gene therapy.