International Journal of Radiation Oncology * Biology * Physics
Volume 74, Issue 5 , Pages 1494-1500 , 1 August 2009

Treatment Parameters and Outcome in 680 Treatments of Internal Radiation With Resin 90Y-Microspheres for Unresectable Hepatic Tumors

  • Andrew S. Kennedy, M.D., F.A.C.R.

      Affiliations

    • Wake Radiology Oncology, Cary, NC
    • Corresponding Author InformationReprint requests to: Andrew S. Kennedy, M.D., F.A.C.R.O., Wake Radiology Oncology, 300 Ashville Ave., Suite 110, Cary, NC 27518. Tel: (919) 854-4588; Fax: (919) 854-9950
  • ,
  • Patrick McNeillie, M.S.3

      Affiliations

    • University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
  • ,
  • William A. Dezarn, Ph.D., D.A.B.R.

      Affiliations

    • Wake Radiology Oncology, Cary, NC
  • ,
  • Charles Nutting, D.O., F.S.I.R.

      Affiliations

    • Skyridge Medical Center, Denver, CO
  • ,
  • Bruno Sangro, M.D.

      Affiliations

    • Universidad de Navarra and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Pamplona, Spain
  • ,
  • Dan Wertman, M.D.

      Affiliations

    • Durham Regional Medical Center, Durham, NC
  • ,
  • Michael Garafalo, M.D.

      Affiliations

    • University of Maryland School of Medicine, Baltimore, MD
  • ,
  • David Liu, M.D.

      Affiliations

    • St. Vincent's Hospital, Portland, OR
  • ,
  • Douglas Coldwell, Ph.D., M.D., F.S.I.R., F.A.C.R.

      Affiliations

    • University of Texas, Dallas, TX
  • ,
  • Michael Savin, M.D.

      Affiliations

    • Wm. Beaumont Hospital, Royal Oak, MI
  • ,
  • Tobias Jakobs, M.D.

      Affiliations

    • University of Munich–Grosshadern Campus, Munich, Germany
  • ,
  • Steven Rose, M.D.

      Affiliations

    • University of California, San Diego, San Diego, CA
  • ,
  • Richard Warner, M.D.

      Affiliations

    • Mt. Sinai Medical Center, New York, NY
  • ,
  • Dennis Carter, M.D.

      Affiliations

    • Skyridge Medical Center, Denver, CO
  • ,
  • Stephen Sapareto, Ph.D.

      Affiliations

    • Banner Good Samaritan Medical Center, Phoenix, AZ
  • ,
  • Subir Nag, M.D., F.A.C.R., F.A.C.R.O.

      Affiliations

    • The Ohio State University Medical Center, Columbus, OH
  • ,
  • Seza Gulec, M.D.

      Affiliations

    • Goshen Medical Center, Goshen, IN
  • ,
  • Allison Calkins, M.D.

      Affiliations

    • St. Joseph's Hospital Cancer Institute, Tampa, FL
  • ,
  • Vanessa L. Gates, M.S.

      Affiliations

    • Northwestern Medical Center, Chicago, IL
  • ,
  • Riad Salem, M.D., M.B.A.

      Affiliations

    • Northwestern Medical Center, Chicago, IL

Received 24 April 2007 ,Revised 5 September 2008 ,Accepted 8 October 2008.

References 

  1. World Health Organization. Cancer Fact Sheets. Available at: http://www.who.int/mediacentre/factsheets/fs297/en/index.html. Accessed December 8, 2008.
  2. Ariel IM. Radioactive isotopes for adjuvant cancer therapy. Arch Surg. 1964;89:244–249
  3. Breedis C, Young G. The blood supply of neoplasms in the liver. Am J Pathol. 1954;30:969–984
  4. Gray B, Van Hazel G, Hope M, et al. Randomised trial of SIR-Spheres plus chemotherapy vs. chemotherapy alone for treating patients with liver metastases from primary large bowel cancer. Ann Oncol. 2001;12:1711–1720
  5. Kennedy AS, Coldwell D, Nutting C, et al. Resin 90Y-microsphere brachytherapy for unresectable colorectal liver metastases: Modern USA experience. Int J Radiat Oncol Biol Phys. 2006;65:412–425
  6. Salem R, Thurston KG. Radioembolization with yttrium-90 microspheres: A state-of-the-art brachytherapy treatment for primary and secondary liver malignancies: Part 3: Comprehensive literature review and future direction. J Vasc Interv Radiol. 2006;17:1571–1593
  7. Sato KT, Lewandowski RJ, Mulcahy MF, et al. Unresectable chemorefractory liver metastases: Radioembolization with 90Y microspheres—Safety, efficacy, and survival. Radiology. 2008;247:507–515
  8. Sharma RA, Van Hazel GA, Morgan B, et al. Radioembolization of liver metastases from colorectal cancer using yttrium-90 microspheres with concomitant systemic oxaliplatin, fluorouracil, and leucovorin chemotherapy. J Clin Oncol. 2007;25:1099–1106
  9. Stubbs RS, O'Brien I, Correia MM. Selective internal radiation therapy with 90Y microspheres for colorectal liver metastases: Single-centre experience with 100 patients. ANZ J Surg. 2006;76:696–703
  10. Geschwind JF, Salem R, Carr BI, et al. Yttrium-90 microspheres for the treatment of hepatocellular carcinoma. Gastroenterology. 2004;127(Suppl.):S194–S205
  11. Lau WY, Ho S, Leung TW, et al. Selective internal radiation therapy for nonresectable hepatocellular carcinoma with intraarterial infusion of 90yttrium microspheres. Int J Radiat Oncol Biol Phys. 1998;40:583–592
  12. Kennedy AS, Dezarn WA, McNeillie P, et al. Radioembolization for unresectable neuroendocrine hepatic metastases using resin 90Y-microspheres: Early results in 148 patients. Am J Clin Oncol. 2008;31:271–279
  13. King J, Quinn R, Glenn DM, et al. Radioembolization with selective internal radiation microspheres for neuroendocrine liver metastases. Cancer. 2008;113:921–929
  14. Rhee TK, Lewandowski RJ, Liu DM, et al. 90Y Radioembolization for metastatic neuroendocrine liver tumors: Preliminary results from a multi-institutional experience. Ann Surg. 2008;247:1029–1035
  15. Bangash AK, Atassi B, Kaklamani V, et al. 90Y Radioembolization of metastatic breast cancer to the liver: Toxicity, imaging response, survival. J Vasc Interv Radiol. 2007;18:621–628
  16. Coldwell DM, Kennedy AS, Nutting CW. Use of yttrium-90 microspheres in the treatment of unresectable hepatic metastases from breast cancer. Int J Radiat Oncol Biol Phys. 2007;69:800–804
  17. Jakobs TF, Hoffmann RT, Fischer T, et al. Radioembolization in patients with hepatic metastases from breast cancer. J Vasc Interv Radiol. 2008;19:683–690
  18. Kennedy AS, Murthy R, Sarfaraz M, et al. Outpatient hepatic artery brachytherapy for primary and secondary hepatic malignancies. [Abstract] Radiology. 2001;221P:468
  19. Lawrence TS, Robertson JM, Anscher MS, et al. Hepatic toxicity resulting from cancer treatment. Int J Radiat Oncol Biol Phys. 1995;31:1237–1248
  20. Fajardo LF, Berthrong M, Liver Anderson RE. Radiation pathology. 1st ed.. New York: Oxford University; 2001;pp. 249–257
  21. Reed G, Cox A. The human liver after radiation injury. Am J Pathol. 1966;48:597–612
  22. Lewandowski RJ, Sato KT, Atassi B, et al. Radioembolization with 90Y microspheres: Angiographic and technical considerations. Cardiovasc Intervent Radiol. 2007;30:571–592
  23. Murthy R, Nunez R, Szklaruk J, et al. Yttrium-90 microsphere therapy for hepatic malignancy: Devices, indications, technical considerations, and potential complications. Radiographics. 2005;25(Suppl. 1):S41–S55
  24. Kennedy A, Nag S, Salem R, et al. Recommendations for radioembolization of hepatic malignancies using yttrium-90 microsphere brachytherapy: A consensus panel report from the Radioembolization Brachytherapy Oncology Consortium. Int J Radiat Oncol Biol Phys. 2007;68:13–23
  25. Salem R, Lewandowski RJ, Atassi B, et al. Treatment of unresectable hepatocellular carcinoma with use of 90Y microspheres (TheraSphere): Safety, tumor response, and survival. J Vasc Interv Radiol. 2005;16:1627–1639
  26. Salem R, Thurston KG. Radioembolization with 90yttrium microspheres: A state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 2: Special topics. J Vasc Interv Radiol. 2006;17:1425–1439
  27. Salem R, Thurston KG. Radioembolization with 90yttrium microspheres: A state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 1: Technical and methodologic considerations. J Vasc Interv Radiol. 2006;17:1251–1278
  28. Kennedy AS, Nutting C, Coldwell D, et al. Pathologic response and microdosimetry of 90Y microspheres in man: Review of four explanted whole livers. Int J Radiat Oncol Biol Phys. 2004;60:1552–1563
  29. Ho S, Lau WY, Leung TW, et al. Clinical evaluation of the partition model for estimating radiation doses from yttrium-90 microspheres in the treatment of hepatic cancer. Eur J Nucl Med. 1997;24:293–298
  30. Ho S, Lau WY, Leung TW, et al. Partition model for estimating radiation doses from yttrium-90 microspheres in treating hepatic tumours. Eur J Nucl Med. 1996;23:947–952
  31. Sarfaraz M, Kennedy AS, Cao ZJ, et al. Physical aspects of yttrium-90 microsphere therapy for nonresectable hepatic tumors. Med Phys. 2003;30:199–203
  32. Sarfaraz M, Kennedy AS, Cao ZJ, et al. Radiation dose distribution in patients treated with Y-90 microspheres for non-resectable hepatic tumors. Int J Radiat Biol Phys. 2001;51:32–33
  33. Sarfaraz M, Kennedy AS, Lodge MA, et al. Radiation absorbed dose distribution in a patient treated with yttrium-90 microspheres for hepatocellular carcinoma. Med Phys. 2004;31:2449–2453
  34. Ingold J, Reed G, Kaplan H. Radiation hepatitis. AJR Am J Roentgenol. 1965;93:200–208
  35. Fajardo LF, Colby TV. Pathogenesis of veno-occlusive liver disease after radiation. Arch Pathol Lab Med. 1980;104:584–588
  36. Lawrence TS, Ten Haken RK, Kessler ML, et al. The use of 3-D dose volume analysis to predict radiation hepatitis. Int J Radiat Oncol Biol Phys. 1992;23:781–788
  37. Lawrence TS, Tesser RJ. Ten Haken RK. An application of dose volume histograms to the treatment of intrahepatic malignancies with radiation therapy. Int J Radiat Oncol Biol Phys. 1990;19:1041–1047
  38. Therasse P, Eisenhauer EA, Verweij J. RECIST revisited: A review of validation studies on tumour assessment. Eur J Cancer. 2006;42:1031–1039
  39. Lawrence TS, Davis MA, Maybaum J, et al. The potential superiority of bromodeoxyuridine to iododeoxyuridine as a radiation sensitizer in the treatment of colorectal cancer. Cancer Res. 1992;52:3698–3704
  40. Lawrence TS, Dworzanin LM, Walker-Andrews SC, et al. Treatment of cancers involving the liver and porta hepatis with external beam irradiation and intraarterial hepatic fluorodeoxyuridine. Int J Radiat Oncol Biol Phys. 1991;20:555–561
  41. Lawrence TS, Kessler ML, Robertson JM. Conformal high-dose radiation plus intraarterial floxuridine for hepatic cancer. Oncology (Huntingt). 1993;7:51–57discussion, 57–58, 63
  42. Dawson LA, Brock KK, Kazanjian S, et al. The reproducibility of organ position using active breathing control (ABC) during liver radiotherapy. Int J Radiat Oncol Biol Phys. 2001;51:1410–1421
  43. Dawson LA, McGinn CJ, Normolle D, et al. Escalated focal liver radiation and concurrent hepatic artery fluorodeoxyuridine for unresectable intrahepatic malignancies. J Clin Oncol. 2000;18:2210–2218
  44. Dawson LA. Ten Haken RK. Partial volume tolerance of the liver to radiation. Semin Radiat Oncol. 2005;15:279–283
  45. Dawson LA, Ten Haken RK, Lawrence TS. Partial irradiation of the liver. Semin Radiat Oncol. 2001;11:240–246
  46. Jackson A, Ten Haken RK, Robertson JM, et al. Analysis of clinical complication data for radiation hepatitis using a parallel architecture model. Int J Radiat Oncol Biol Phys. 1995;31:883–891
  47. McGinn CJ, Ten Haken RK, Ensminger WD, et al. Treatment of intrahepatic cancers with radiation doses based on a normal tissue complication probability model. J Clin Oncol. 1998;16:2246–2252
  48. Ten Haken RK, Lawrence TS, McShan DL, et al. Technical considerations in the use of 3-D beam arrangements in the abdomen. Radiother Oncol. 1991;22:19–28
  49. Ten Haken RK, Martel MK, Kessler ML, et al. Use of Veff and iso-NTCP in the implementation of dose escalation protocols. Int J Radiat Oncol Biol Phys. 1993;27:689–695
  50. Yorke ED, Jackson A, Fox RA, et al. Can current models explain the lack of liver complications in Y-90 microsphere therapy?. Clin Cancer Res. 1999;5(Suppl.):3024S–3030S
  51. Goin JE, Salem R, Carr BI, et al. Treatment of unresectable hepatocellular carcinoma with intrahepatic yttrium 90 microspheres: Factors associated with liver toxicities. J Vasc Interv Radiol. 2005;16:205–213
  52. Goin JE, Salem R, Carr BI, et al. Treatment of unresectable hepatocellular carcinoma with intrahepatic yttrium 90 microspheres: A risk-stratification analysis. J Vasc Interv Radiol. 2005;16:195–203
  53. Toohey RE, Stabin MG, Watson EE. The AAPM/RSNA physics tutorial for residents: Internal radiation dosimetry: Principles and applications. Radiographics. 2000;20:533–546quiz, 531–532
  54. Sato K, Lewandowski RJ, Bui JT, et al. Treatment of unresectable primary and metastatic liver cancer with yttrium-90 microspheres (TheraSphere®): Assessment of hepatic arterial embolization. Cardiovasc Intervent Radiol. 2006;29:522–529
  55. Dancey JE, Shepherd FA, Paul K, et al. Treatment of nonresectable hepatocellular carcinoma with intrahepatic 90Y-microspheres. J Nucl Med. 2000;41:1673–1681
  56. Sangro B, Gil-Alzugaray B, Rodriguez J, et al. Liver disease induced by radioembolization of liver tumors: Description and possible risk factors. Cancer. 2008;112:1538–1546
  57. Gulec SA, Mesoloras G, Dezarn WA, et al. Safety and efficacy evaluation of y-90 microsphere treatment using Medical Internal Radiation Dosimetry (MIRD) in patients with liver malignancies. [Abstract] J Nucl Med. 2006;47:493P

 Conflict of interest: The following authors have received honoraria as proctors for the resin microsphere product, but are not otherwise in any relationship with either Sirtex Medical or MDS Nordion, the manufacturers of resin and glass microspheres currently available for use: A.S. Kennedy, W.A. Dezarn, C. Nutting, D. Wertman, D. Liu, D. Coldwell, S. Rose, S. Nag, and S. Gulec. R. Salem has received honoraria from MDS Nordion for continuing medical education related activities.

PII: S0360-3016(08)03563-3

doi: 10.1016/j.ijrobp.2008.10.005

International Journal of Radiation Oncology * Biology * Physics
Volume 74, Issue 5 , Pages 1494-1500 , 1 August 2009