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Radiation segmentectomy of hepatic metastases with Y-90 glass microspheres
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Radiation segmentectomy of hepatic metastases with Y-90 glass microspheres
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Radiation segmentectomy of hepatic metastases with Y-90 glass microspheres
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Journal Article
Radiation segmentectomy of hepatic metastases with Y-90 glass microspheres
2021
Overview
Purpose
To evaluate safety and efficacy of radiation segmentectomy (RS) with
90
Y glass microspheres in patients with limited metastatic liver disease not amenable to resection or percutaneous ablation.
Methods
Patients with ≤ 3 tumors treated with RS from 6/2015 to 12/2017 were included. Target tumor radiation dose was > 190 Gy based on medical internal radiation dose (MIRD) dosimetry. Tumor response, local tumor progression (LTP), LTP-free survival (LTPFS) and disease progression rate in the treated segment were defined using Choi and RECIST 1.1 criteria. Toxicities were evaluated using modified SIR criteria.
Results
Ten patients with 14 tumors underwent 12 RS. Median tumor size was 3 cm (range 1.4–5.6). Median follow-up was 17.8 months (range 1.6–37.3). Response rates per Choi and RECIST 1.1 criteria were 8/8 (100%) and 4/9 (44%), respectively. Overall LTP rate was 3/14 (21%) during the study period. One-, two- and three-year LTPFS was 83%, 83% and 69%, respectively. Median LTPFS was not reached. Disease progression rate in the treated segment was 6/18 (33%). Median overall survival was 41.5 months (IQR 16.7–41.5). Median delivered tumor radiation dose was 293 Gy (range 163–1303). One major complication was recorded in a patient post-Whipple procedure who suffered anaphylactic reaction to prophylactic cefotetan and liver abscess in RS region 6.5 months post-RS. All patients were alive on last follow-up.
Conclusion
RS of ≤ 3 hepatic segments can safely provide a 2-year local tumor control rate of 83% in selected patients with limited metastatic liver disease and limited treatment options. Optimal dosimetry methodology requires further investigation.
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