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.
Bibliographical noteFunding 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.
© Journal of Gastrointestinal Oncology. All rights reserved.
- Colorectal carcinoma
- Hepatocellular carcinoma (HCC)
- Liver metastases
PubMed: MeSH publication types
- Journal Article