SIR 2024
Interventional Oncology
Alex Arne, MD
Integrated Interventional Radiology Resident
University of Colorado Anschutz Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Katherine Marchak, MD (she/her/hers)
Interventional Radiologist
University of Colorado Health System
Disclosure information not submitted.
Mira Malavia, BA (she/her/hers)
Medical Student
University of Missouri-Kansas City School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Nicholas Pudar, BS, RT
Medical Student
Rutgers New Jersey Medical School
Financial relationships: Full list of relationships is listed on the CME information page.
Hannah R. Spears, MPH
Statistician
Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus
Disclosure information not submitted.
Robert K. Ryu, MD
Professor of Radiology
University of Colorado
Financial relationships: Full list of relationships is listed on the CME information page.
Ken Hirasaki, MD
Assistant Professor, Radiology-Interventional
University of Colorado
Disclosure information not submitted.
James Hart, MD
Assistant Professor, Radiology-Interventional
University of Colorado
Disclosure information not submitted.
Leigh Casadaban, MD, MS
Assistant Professor
University of Colorado
Financial relationships: Full list of relationships is listed on the CME information page.
Premal Trivedi, MD, MS
Associate Professor, Interventional Radiology
University of Colorado Anschutz Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Jonathan Lindquist, MD
Interim Vice Chair, Quality & Patient Safety and Clinical Operations
University of Colorado Department of Radiology
Financial relationships: Full list of relationships is listed on the CME information page.
Few studies have established the safety and toxicity of repeated radioembolization in the same arterial territory. Cumulative radiation exposure can lead to liver toxicity, particularly in patients with limited functional hepatic reserve. The risk of complications such as vascular injury and liver fibrosis has been suggested to be higher with retreatment {1-3}. We aim to describe efficacy and safety in a cohort of patients that received multiple radioembolization procedures to the same vascular territory.
Materials and Methods:
Review of a prospectively acquired database was performed. The inclusion criterion was patients who underwent multiple radioembolization treatments in the same vascular territory. Imaging response was measured according to mRECIST on contrast-enhanced cross-sectional imaging at 1-3 month intervals. Liver function tests, platelet count, INR, and tumor markers were recorded at baseline, 1, 3, 6, 9 and 12 months. Chemotherapy prior to the re-irradiation procedure was documented. Toxicity was calculated using CTCAE v5.0 criteria for liver function tests, with a grade 3 toxicity or higher being deemed clinically significant. Progression free survival (PFS) following retreatment procedure was calculated and patients with missing follow up data were censored.
Results:
41 patients met the inclusion criterion. Prior to re-irradiation 34 (83%) patients were Child-Pugh A and 7 (17%) were Child-Pugh B. Performance status was ECOG 0 in 21 (51%), ECOG 1 in 13 (32%), ECOG 2 in 5 (12%), and unknown in 2 cases. Most tumors were hepatocellular carcinoma (32, 78%), with the remainder comprised of metastatic uveal melanoma (4, 10%), intrahepatic cholangiocarcinoma (3, 7%), and metastatic neuroendocrine tumor (2, 5%). Chemotherapy had been administered to 18 (44%) patients prior to the re-irradiation procedure. Following retreatment 40 (98%) of 41 patients had an objective response by mRECIST [25 (61%) complete response, 15 (37%) partial response, 1 (2%) progressive disease]. Median PFS was 328 days. Liver function test toxicity grade 3 or greater was identified in 2 (5%) of 41 patients.
Conclusion: Re-irradiation with Y90 microspheres was effective and safe in this cohort with PFS of 10.9 months and minimal toxicity. Retreatment of previously irradiated liver can be performed in appropriately selected patients.