Incidence and risk factors for sustained hepatic function toxicity 6 months after radioembolization: Analysis of the radiation-emitting sir-spheres in non-resectable liver tumor (RESIN) registry

Daniel Brown; Henry Krebs; Jayson Brower; Ryan O'Hara; Eric Wang; Kirubahara Vaheesan; Liping Du; Lea Matsuoka; Donna D'Souza; Daniel Y. Sze; Jafar Golzarian; Ripal Gandhi; Andrew Kennedy

doi:10.21037/jgo-20-346

Incidence and risk factors for sustained hepatic function toxicity 6 months after radioembolization: Analysis of the radiation-emitting sir-spheres in non-resectable liver tumor (RESIN) registry

Daniel Brown, Henry Krebs, Jayson Brower, Ryan O'Hara, Eric Wang, Kirubahara Vaheesan, Liping Du, Lea Matsuoka, Donna D'Souza, Daniel Y. Sze, Jafar Golzarian, Ripal Gandhi, Andrew Kennedy

Radiology

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

Background: To quantify rates and risk factors for toxicity after hepatic radioembolization using resin yttrium-90 microspheres.

Methods: Radiation-Emitting SIR-Spheres in Non-resectable liver tumor (RESIN) registry enrollees were reviewed with 614 patients included. Mean patient age was 63.1±12.5 years. The majority of patients were male (n=375, 61%) and white (n=490, 80%). Common tumor types were hepatocellular (n=197, 32%), colorectal (n=187, 30%) and neuroendocrine (n=56, 9%). Hepatotoxicity was measured using the Common Terminology Criteria for Adverse Events (CTCAE v 5). Potential risk factors for hepatotoxicity were tested using the Kruskal-Wallis or Pearson Chi-squared tests, and multivariate linear regressions.

Results: At 6 months, 115 patients (18.7%) died (n=91, 14.8%), entered hospice (n=20, 3.3%) or sought treatment elsewhere (n=4, 4%). Seven (1.1%) deaths were from liver decompensation. Grade 3 toxicity rates were: bilirubin (n=85, 13.8%), albumin (n=28, 4.6%), ALT (n=26, 4.2%) and AST (n=37, 6.0%). For each of these liver function test components, baseline abnormal labs predicted Grade 3 toxicity at follow-up by Kruskal-Wallis test (P<0.001) and linear regression (all P<0.03). Other significant factors predicting toxicity at regression included elevated Body-Mass Index (albumin P=0.0056), whole liver treatment (bilirubin P=0.046), and lower tumor volume (ALT and INR, P<0.035 for both).

Conclusions: Baseline liver function abnormalities prior to radioembolization is the strongest predictor of post-treatment Grade 3 toxicity with rates as high as 13.8%. Toxicity rates for specific lab values are affected by large volume treatments especially with low tumor volumes.

Original language	English (US)
Pages (from-to)	639-657
Number of pages	19
Journal	Journal of Gastrointestinal Oncology
Volume	12
Issue number	2
DOIs	https://doi.org/10.21037/jgo-20-346
State	Published - Apr 2021

Bibliographical note

Funding Information:
The authors would like to acknowledge Zachary Collins, MD; Suvranu Ganguli, MD; Christopher Grilli, DO;Shannon Peck, MD; Nabeel Akhter, MD; Charles Hennemeyer, MD; Nicholas Fidelman, MD; Marc Matrana, MD; Alexander Kim, MD; Cliff Davis, MD; Navesh Sharma, DO, PhD; Khashayar Farsad, MD, PhD; Nima Kokabi, MD; Prasoon Mohan, MD; Charles Martin, MD; Jon Davidson, MD; Gary Siskin, MD; Islam Shahin, MD; Michael Petroziello, MD; Ricky Tong, MD; James Meek, MD; Anthony Brown, MD; Robert K. Ryu, MD; Ahmed Kamel Abdel Aal, MD; and Mark Westcott, MD Funding: This work was supported by Sirtex Medical.

Publisher Copyright:
© Journal of Gastrointestinal Oncology. All rights reserved.

Keywords

Brachytherapy
Colorectal carcinoma
Hepatocellular carcinoma (HCC)
Liver metastases
Radioembolization

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10.21037/jgo-20-346

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Brown, D., Krebs, H., Brower, J., O'Hara, R., Wang, E., Vaheesan, K., Du, L., Matsuoka, L., D'Souza, D., Sze, D. Y., Golzarian, J., Gandhi, R., & Kennedy, A. (2021). Incidence and risk factors for sustained hepatic function toxicity 6 months after radioembolization: Analysis of the radiation-emitting sir-spheres in non-resectable liver tumor (RESIN) registry. Journal of Gastrointestinal Oncology, 12(2), 639-657. https://doi.org/10.21037/jgo-20-346

Incidence and risk factors for sustained hepatic function toxicity 6 months after radioembolization: Analysis of the radiation-emitting sir-spheres in non-resectable liver tumor (RESIN) registry. / Brown, Daniel; Krebs, Henry; Brower, Jayson et al.
In: Journal of Gastrointestinal Oncology, Vol. 12, No. 2, 04.2021, p. 639-657.

Research output: Contribution to journal › Article › peer-review

Brown, D, Krebs, H, Brower, J, O'Hara, R, Wang, E, Vaheesan, K, Du, L, Matsuoka, L, D'Souza, D, Sze, DY, Golzarian, J, Gandhi, R & Kennedy, A 2021, 'Incidence and risk factors for sustained hepatic function toxicity 6 months after radioembolization: Analysis of the radiation-emitting sir-spheres in non-resectable liver tumor (RESIN) registry', Journal of Gastrointestinal Oncology, vol. 12, no. 2, pp. 639-657. https://doi.org/10.21037/jgo-20-346

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title = "Incidence and risk factors for sustained hepatic function toxicity 6 months after radioembolization: Analysis of the radiation-emitting sir-spheres in non-resectable liver tumor (RESIN) registry",

abstract = "Background: To quantify rates and risk factors for toxicity after hepatic radioembolization using resin yttrium-90 microspheres.Methods: Radiation-Emitting SIR-Spheres in Non-resectable liver tumor (RESIN) registry enrollees were reviewed with 614 patients included. Mean patient age was 63.1±12.5 years. The majority of patients were male (n=375, 61%) and white (n=490, 80%). Common tumor types were hepatocellular (n=197, 32%), colorectal (n=187, 30%) and neuroendocrine (n=56, 9%). Hepatotoxicity was measured using the Common Terminology Criteria for Adverse Events (CTCAE v 5). Potential risk factors for hepatotoxicity were tested using the Kruskal-Wallis or Pearson Chi-squared tests, and multivariate linear regressions.Results: At 6 months, 115 patients (18.7%) died (n=91, 14.8%), entered hospice (n=20, 3.3%) or sought treatment elsewhere (n=4, 4%). Seven (1.1%) deaths were from liver decompensation. Grade 3 toxicity rates were: bilirubin (n=85, 13.8%), albumin (n=28, 4.6%), ALT (n=26, 4.2%) and AST (n=37, 6.0%). For each of these liver function test components, baseline abnormal labs predicted Grade 3 toxicity at follow-up by Kruskal-Wallis test (P<0.001) and linear regression (all P<0.03). Other significant factors predicting toxicity at regression included elevated Body-Mass Index (albumin P=0.0056), whole liver treatment (bilirubin P=0.046), and lower tumor volume (ALT and INR, P<0.035 for both).Conclusions: Baseline liver function abnormalities prior to radioembolization is the strongest predictor of post-treatment Grade 3 toxicity with rates as high as 13.8%. Toxicity rates for specific lab values are affected by large volume treatments especially with low tumor volumes.",

keywords = "Brachytherapy, Colorectal carcinoma, Hepatocellular carcinoma (HCC), Liver metastases, Radioembolization",

author = "Daniel Brown and Henry Krebs and Jayson Brower and Ryan O'Hara and Eric Wang and Kirubahara Vaheesan and Liping Du and Lea Matsuoka and Donna D'Souza and Sze, {Daniel Y.} and Jafar Golzarian and Ripal Gandhi and Andrew Kennedy",

note = "Funding Information: The authors would like to acknowledge Zachary Collins, MD; Suvranu Ganguli, MD; Christopher Grilli, DO;Shannon Peck, MD; Nabeel Akhter, MD; Charles Hennemeyer, MD; Nicholas Fidelman, MD; Marc Matrana, MD; Alexander Kim, MD; Cliff Davis, MD; Navesh Sharma, DO, PhD; Khashayar Farsad, MD, PhD; Nima Kokabi, MD; Prasoon Mohan, MD; Charles Martin, MD; Jon Davidson, MD; Gary Siskin, MD; Islam Shahin, MD; Michael Petroziello, MD; Ricky Tong, MD; James Meek, MD; Anthony Brown, MD; Robert K. Ryu, MD; Ahmed Kamel Abdel Aal, MD; and Mark Westcott, MD Funding: This work was supported by Sirtex Medical. Publisher Copyright: {\textcopyright} Journal of Gastrointestinal Oncology. All rights reserved.",

year = "2021",

month = apr,

doi = "10.21037/jgo-20-346",

language = "English (US)",

volume = "12",

pages = "639--657",

journal = "Journal of Gastrointestinal Oncology",

issn = "2078-6891",

publisher = "Pioneer Bioscience Publishing Company (PBPC)",

number = "2",

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TY - JOUR

T1 - Incidence and risk factors for sustained hepatic function toxicity 6 months after radioembolization

T2 - Analysis of the radiation-emitting sir-spheres in non-resectable liver tumor (RESIN) registry

AU - Brown, Daniel

AU - Krebs, Henry

AU - Brower, Jayson

AU - O'Hara, Ryan

AU - Wang, Eric

AU - Vaheesan, Kirubahara

AU - Du, Liping

AU - Matsuoka, Lea

AU - D'Souza, Donna

AU - Sze, Daniel Y.

AU - Golzarian, Jafar

AU - Gandhi, Ripal

AU - Kennedy, Andrew

N1 - Funding Information: The authors would like to acknowledge Zachary Collins, MD; Suvranu Ganguli, MD; Christopher Grilli, DO;Shannon Peck, MD; Nabeel Akhter, MD; Charles Hennemeyer, MD; Nicholas Fidelman, MD; Marc Matrana, MD; Alexander Kim, MD; Cliff Davis, MD; Navesh Sharma, DO, PhD; Khashayar Farsad, MD, PhD; Nima Kokabi, MD; Prasoon Mohan, MD; Charles Martin, MD; Jon Davidson, MD; Gary Siskin, MD; Islam Shahin, MD; Michael Petroziello, MD; Ricky Tong, MD; James Meek, MD; Anthony Brown, MD; Robert K. Ryu, MD; Ahmed Kamel Abdel Aal, MD; and Mark Westcott, MD Funding: This work was supported by Sirtex Medical. Publisher Copyright: © Journal of Gastrointestinal Oncology. All rights reserved.

PY - 2021/4

Y1 - 2021/4

N2 - Background: To quantify rates and risk factors for toxicity after hepatic radioembolization using resin yttrium-90 microspheres.Methods: Radiation-Emitting SIR-Spheres in Non-resectable liver tumor (RESIN) registry enrollees were reviewed with 614 patients included. Mean patient age was 63.1±12.5 years. The majority of patients were male (n=375, 61%) and white (n=490, 80%). Common tumor types were hepatocellular (n=197, 32%), colorectal (n=187, 30%) and neuroendocrine (n=56, 9%). Hepatotoxicity was measured using the Common Terminology Criteria for Adverse Events (CTCAE v 5). Potential risk factors for hepatotoxicity were tested using the Kruskal-Wallis or Pearson Chi-squared tests, and multivariate linear regressions.Results: At 6 months, 115 patients (18.7%) died (n=91, 14.8%), entered hospice (n=20, 3.3%) or sought treatment elsewhere (n=4, 4%). Seven (1.1%) deaths were from liver decompensation. Grade 3 toxicity rates were: bilirubin (n=85, 13.8%), albumin (n=28, 4.6%), ALT (n=26, 4.2%) and AST (n=37, 6.0%). For each of these liver function test components, baseline abnormal labs predicted Grade 3 toxicity at follow-up by Kruskal-Wallis test (P<0.001) and linear regression (all P<0.03). Other significant factors predicting toxicity at regression included elevated Body-Mass Index (albumin P=0.0056), whole liver treatment (bilirubin P=0.046), and lower tumor volume (ALT and INR, P<0.035 for both).Conclusions: Baseline liver function abnormalities prior to radioembolization is the strongest predictor of post-treatment Grade 3 toxicity with rates as high as 13.8%. Toxicity rates for specific lab values are affected by large volume treatments especially with low tumor volumes.

AB - Background: To quantify rates and risk factors for toxicity after hepatic radioembolization using resin yttrium-90 microspheres.Methods: Radiation-Emitting SIR-Spheres in Non-resectable liver tumor (RESIN) registry enrollees were reviewed with 614 patients included. Mean patient age was 63.1±12.5 years. The majority of patients were male (n=375, 61%) and white (n=490, 80%). Common tumor types were hepatocellular (n=197, 32%), colorectal (n=187, 30%) and neuroendocrine (n=56, 9%). Hepatotoxicity was measured using the Common Terminology Criteria for Adverse Events (CTCAE v 5). Potential risk factors for hepatotoxicity were tested using the Kruskal-Wallis or Pearson Chi-squared tests, and multivariate linear regressions.Results: At 6 months, 115 patients (18.7%) died (n=91, 14.8%), entered hospice (n=20, 3.3%) or sought treatment elsewhere (n=4, 4%). Seven (1.1%) deaths were from liver decompensation. Grade 3 toxicity rates were: bilirubin (n=85, 13.8%), albumin (n=28, 4.6%), ALT (n=26, 4.2%) and AST (n=37, 6.0%). For each of these liver function test components, baseline abnormal labs predicted Grade 3 toxicity at follow-up by Kruskal-Wallis test (P<0.001) and linear regression (all P<0.03). Other significant factors predicting toxicity at regression included elevated Body-Mass Index (albumin P=0.0056), whole liver treatment (bilirubin P=0.046), and lower tumor volume (ALT and INR, P<0.035 for both).Conclusions: Baseline liver function abnormalities prior to radioembolization is the strongest predictor of post-treatment Grade 3 toxicity with rates as high as 13.8%. Toxicity rates for specific lab values are affected by large volume treatments especially with low tumor volumes.

KW - Brachytherapy

KW - Colorectal carcinoma

KW - Hepatocellular carcinoma (HCC)

KW - Liver metastases

KW - Radioembolization

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U2 - 10.21037/jgo-20-346

DO - 10.21037/jgo-20-346

M3 - Article

C2 - 34012656

AN - SCOPUS:85105268940

SN - 2078-6891

VL - 12

SP - 639

EP - 657

JO - Journal of Gastrointestinal Oncology

JF - Journal of Gastrointestinal Oncology

IS - 2

ER -

Incidence and risk factors for sustained hepatic function toxicity 6 months after radioembolization: Analysis of the radiation-emitting sir-spheres in non-resectable liver tumor (RESIN) registry

Abstract

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