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

Research output: Contribution to journalArticlepeer-review

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 languageEnglish (US)
Pages (from-to)639-657
Number of pages19
JournalJournal of Gastrointestinal Oncology
Volume12
Issue number2
DOIs
StatePublished - 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

PubMed: MeSH publication types

  • Journal Article

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