Purpose: To assess toxicity and efficacy of yttrium-90 microsphere hepatic artery embolization in the treatment of nonresectable hepatic malignancy.
Methods and Materials: Patients were selected using inclusion criteria which included nonresectable biopsy proven primary or secondary hepatic malignancy, no significant extra-hepatic disease, portal vein patency and <15% breakthrough to the pulmonary parenchyma of Tc-MAA injected to simulate yttrium-90 delivery. Yttrium-90 microspheres were infused into the hepatic artery circulation using superselective catheters to avoid non-target gastrointestinal embolization. Toxicity was assessed at 1 day, 1 week and 1 month following treatment using an established subjective & objective grading system. Efficacy of tumor response at 3 months was assessed and categorized as partial response (PR), complete response (CR), progressive disease (PD) or stable disease (SD) using accepted CT criteria. Biochemical markers were also used where available.
Results: Twenty patients (12 men, 8 women) were treated over a 6 month period. Fourteen patients had metastatic colorectal carcinoma (CRC), 3 had HCC, 1 had cholangiocarcinoma, 1 had adenocarcinoma of unknown primary and 1 had metastatic prostate cancer. Eight patients had a PR at 3 months following therapy. One patient with PR at 3 months became a CR at 6 months. Four patients had SD. Eight patients were assessed as PD. The most common side effects were transient right upper quadrant pain and nausea. Toxicity was assessed as mild in 14 patients, moderate in 5 patients and severe in 1 patient.
Conclusion: Early experience with yttrium-90 microsphere hepatic artery embolization suggests it has acceptable toxicity and promising efficacy in the management of nonresectable primary & secondary hepatic malignancy.
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