Efficacy and Prognostic Factors for Y-90 Radioembolization (Y-90) in Metastatic Neuroendocrine Tumors with Liver Metastases
Background. Yttrium-90 (Y-90) can be an effective liver-directed therapy for patients with metastatic neuroendocrine tumors (NETs), but population-based data are limited. We characterized the use of Y-90 in NET patients and identified factors associated with response. Methods. We identified 49 patie...
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doaj-e75bd44e074c4eabb4c291728536b4502020-12-07T09:08:22ZengHindawi LimitedCanadian Journal of Gastroenterology and Hepatology2291-27892291-27972020-01-01202010.1155/2020/51040825104082Efficacy and Prognostic Factors for Y-90 Radioembolization (Y-90) in Metastatic Neuroendocrine Tumors with Liver MetastasesErica S. Tsang0Jonathan M. Loree1Janine M. Davies2Sharlene Gill3David Liu4Stephen Ho5Daniel J. Renouf6Howard J. Lim7Hagen F. Kennecke8Division of Medical Oncology, BC Cancer, Vancouver, BC, CanadaDivision of Medical Oncology, BC Cancer, Vancouver, BC, CanadaDivision of Medical Oncology, BC Cancer, Vancouver, BC, CanadaDivision of Medical Oncology, BC Cancer, Vancouver, BC, CanadaDepartment of Radiology, Vancouver General Hospital, Vancouver, BC, CanadaDepartment of Radiology, Vancouver General Hospital, Vancouver, BC, CanadaDivision of Medical Oncology, BC Cancer, Vancouver, BC, CanadaDivision of Medical Oncology, BC Cancer, Vancouver, BC, CanadaFloyd and Delores Jones Cancer Institute, Virginia Mason Cancer Institute, Seattle, WA, USABackground. Yttrium-90 (Y-90) can be an effective liver-directed therapy for patients with metastatic neuroendocrine tumors (NETs), but population-based data are limited. We characterized the use of Y-90 in NET patients and identified factors associated with response. Methods. We identified 49 patients with metastatic liver-dominant NETs across BC Cancer’s six regional centres who received Y-90 between June 2011 and January 2017 in British Columbia, Canada. Baseline characteristics, radiographic responses, and outcomes were summarized. Results. Of the 49 patients who received Y-90, the median age was 56 years (range 21–78), 49% were male, and 94% had an ECOG performance status of 0–1. The primary location of the NET included pancreas (31%), small bowel (41%), large bowel (6%), unknown (14%), and others (12%). 69% of these patients had liver metastases alone, and tumors were graded as G1 (61%), G2 (25%), G3 (2%), and unknown (12%). Prior therapies included surgery (63%), local ablative therapy (25%), somatostatin analogue (69%), and systemic therapy (35%). The median Y-90 dose was 2.2 GBq (range 0.8–3.6), as SIR-spheres (69%) or TheraSpheres (29%). Median time to Y-90 from diagnosis of metastases measured 1.54 years. 88% received segmental Y-90, with 1 (69%), 2 (29%), and 3 (2%) treatments. Y-90 resulted in partial response (53%), stable disease (33%), and progressive disease (12%). Y-90 was well-tolerated, with infrequent grade 3-4 biochemical toxicities (2%) and grade 3 abdominal pain (6%). Longer overall survival (OS) was associated with resection of primary tumor, well-differentiated histology, and low Ki-67. Median OS was 27.2 months (95% CI 8.0–46.5).Conclusions. In our population-based cohort, Y-90 was well-tolerated in patients with metastatic liver-dominant NETs. Prior surgical resection was an important predictor of OS.http://dx.doi.org/10.1155/2020/5104082 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Erica S. Tsang Jonathan M. Loree Janine M. Davies Sharlene Gill David Liu Stephen Ho Daniel J. Renouf Howard J. Lim Hagen F. Kennecke |
spellingShingle |
Erica S. Tsang Jonathan M. Loree Janine M. Davies Sharlene Gill David Liu Stephen Ho Daniel J. Renouf Howard J. Lim Hagen F. Kennecke Efficacy and Prognostic Factors for Y-90 Radioembolization (Y-90) in Metastatic Neuroendocrine Tumors with Liver Metastases Canadian Journal of Gastroenterology and Hepatology |
author_facet |
Erica S. Tsang Jonathan M. Loree Janine M. Davies Sharlene Gill David Liu Stephen Ho Daniel J. Renouf Howard J. Lim Hagen F. Kennecke |
author_sort |
Erica S. Tsang |
title |
Efficacy and Prognostic Factors for Y-90 Radioembolization (Y-90) in Metastatic Neuroendocrine Tumors with Liver Metastases |
title_short |
Efficacy and Prognostic Factors for Y-90 Radioembolization (Y-90) in Metastatic Neuroendocrine Tumors with Liver Metastases |
title_full |
Efficacy and Prognostic Factors for Y-90 Radioembolization (Y-90) in Metastatic Neuroendocrine Tumors with Liver Metastases |
title_fullStr |
Efficacy and Prognostic Factors for Y-90 Radioembolization (Y-90) in Metastatic Neuroendocrine Tumors with Liver Metastases |
title_full_unstemmed |
Efficacy and Prognostic Factors for Y-90 Radioembolization (Y-90) in Metastatic Neuroendocrine Tumors with Liver Metastases |
title_sort |
efficacy and prognostic factors for y-90 radioembolization (y-90) in metastatic neuroendocrine tumors with liver metastases |
publisher |
Hindawi Limited |
series |
Canadian Journal of Gastroenterology and Hepatology |
issn |
2291-2789 2291-2797 |
publishDate |
2020-01-01 |
description |
Background. Yttrium-90 (Y-90) can be an effective liver-directed therapy for patients with metastatic neuroendocrine tumors (NETs), but population-based data are limited. We characterized the use of Y-90 in NET patients and identified factors associated with response. Methods. We identified 49 patients with metastatic liver-dominant NETs across BC Cancer’s six regional centres who received Y-90 between June 2011 and January 2017 in British Columbia, Canada. Baseline characteristics, radiographic responses, and outcomes were summarized. Results. Of the 49 patients who received Y-90, the median age was 56 years (range 21–78), 49% were male, and 94% had an ECOG performance status of 0–1. The primary location of the NET included pancreas (31%), small bowel (41%), large bowel (6%), unknown (14%), and others (12%). 69% of these patients had liver metastases alone, and tumors were graded as G1 (61%), G2 (25%), G3 (2%), and unknown (12%). Prior therapies included surgery (63%), local ablative therapy (25%), somatostatin analogue (69%), and systemic therapy (35%). The median Y-90 dose was 2.2 GBq (range 0.8–3.6), as SIR-spheres (69%) or TheraSpheres (29%). Median time to Y-90 from diagnosis of metastases measured 1.54 years. 88% received segmental Y-90, with 1 (69%), 2 (29%), and 3 (2%) treatments. Y-90 resulted in partial response (53%), stable disease (33%), and progressive disease (12%). Y-90 was well-tolerated, with infrequent grade 3-4 biochemical toxicities (2%) and grade 3 abdominal pain (6%). Longer overall survival (OS) was associated with resection of primary tumor, well-differentiated histology, and low Ki-67. Median OS was 27.2 months (95% CI 8.0–46.5).Conclusions. In our population-based cohort, Y-90 was well-tolerated in patients with metastatic liver-dominant NETs. Prior surgical resection was an important predictor of OS. |
url |
http://dx.doi.org/10.1155/2020/5104082 |
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