Clinical study
90Y Radioembolization of Metastatic Breast Cancer to the Liver: Toxicity, Imaging Response, Survival

https://doi.org/10.1016/j.jvir.2007.02.019Get rights and content

Purpose

To present data from patients with breast cancer liver metastases who underwent radioembolization with yttrium (90Y) microspheres.

Materials and Methods

Using standard 90Y lobar treatment protocol, 27 female patients with progressing liver metastases on standard of care polychemotherapy were treated under an open-label phase 2 protocol. After treatment, we assessed (a) tumor response using computed tomography and/or positron emission tomography, (b) biochemical toxicity, and (c) survival.

Results

The mean age of the patients was 52. Seventeen (63%) patients received 20 left lobe treatments (median radiation dose, 123 Gy; mean, 119 Gy), and 20 (74%) patients received 22 right lobe treatments (median radiation dose, 121 Gy; mean, 109 Gy) to the treatment site. No significant dose-difference was noted between the two lobes (P = .69). Tumor response on 90-day follow-up computed tomography showed (a) complete and partial response in nine (39.1%) patients, (b) stable disease in 12 (52.1%) patients, and (c) progressive disease in 2 (8.8%) patients. Positive tumor response on positron emission tomography was noted in 17 (63%) patients. Three of 27 (11%) patients (Eastern Cooperation Oncology Group 1, 2, or 3) showed bilirubin toxicity of grade 3, all of which were attributed to disease progression. Median survival for Eastern Cooperation Oncology Group 0 versus 1, 2, or 3 patients was 6.8 months and 2.6 months, respectively (P = .24) and for patients with tumor burden <25% versus >25% was 9.4 and 2.0 months, respectively (P = .46).

Conclusions

Radioembolization with 90Y brachytherapy device may be a viable therapeutic option for the treatment of breast cancer liver metastases in patients who have progressed or failed on standard of care polychemotherapy.

Section snippets

Patients

Our institutional review board approved this open-label phase 2 treatment protocol, and all patients signed informed consent allowing the use of their data. All patients were referred to the interventional radiology department for treatment by medical oncology. Patient selection criteria included (a) confirmed diagnosis of metastatic breast cancer to the liver on computed tomography (CT), tumor markers, or biopsy; (b) patients with Eastern Cooperation Oncology Group (ECOG) performance status of

Patient Cohort and Baseline Imaging

The mean age was 52 years. All patients received at least one 90Y treatment; nine patients received two treatments, and three patients received three total treatments. Three of the 27 patients had previous liver-directed therapy prior to 90Y treatment (one RFA, one hepatic resection, one received TACE). None of the patients were deemed candidates for RFA. A total of 46 separate 90Y therapies were performed on the 27 patients. Each treatment was given within 90 days from the previous 90Y

Discussion

In this study, 27 heavily pretreated patients with metastatic breast cancer to the liver successfully underwent 90Y radioembolization therapy. Median radiation doses of 122 Gy (left lobe) and 121 Gy (right lobe) were administered and resulted in greater than 90% treatment effect as measured by tumor response (stable disease or partial response) at 90 days after 90Y therapy. Serologic toxicity assessed using serum bilirubin was noted in three patients. Median survival rates from first treatment

Summary

We present treatment-related toxicity, tumor response, and survival from an open-label phase 2 study using 90Y microspheres for patients with breast cancer liver metastases. Patients with metastatic breast carcinoma to the liver treated with 90Y therapy showed imaging response in >90% of patients progressing on standard of care chemotherapy with minimal toxicity. Given the encouraging tumor response on CT and PET for the majority of patients, future studies assessing long-term efficacy of 90Y

References (41)

  • J.W. Zinser et al.

    Clinical course of breast cancer patients with liver metastases

    J Clin Oncol

    (1987)
  • J. Bucerius et al.

    (18F)-FDG PET and conventional imaging for assessment of Hodgkin’s disease and non Hodgkin’s lymphomaAn analysis of 193 patient studies

    Nuklearmedizin

    (2006)
  • F.B. Hagemeister et al.

    Causes of death in breast cancer: a clinicopathologic study

    Cancer

    (1980)
  • S. Schneebaum et al.

    The regional treatment of liver metastases from breast cancer

    J Surg Oncol

    (1994)
  • M. d’Annibale et al.

    Liver metastases from breast cancer: the role of surgical treatment

    Hepatogastroenterology

    (2005)
  • D. Elias et al.

    Surgical and chemotherapeutic treatment of hepatic metastases from carcinoma of the breast

    Surg Gynecol Obstet

    (1991)
  • M. Carlini et al.

    Liver metastases from breast cancerResults of surgical resection

    Hepatogastroenterology

    (2002)
  • K. Kogure et al.

    Long-term survival after hepatectomy for large metastatic breast cancer: a case report

    Hepatogastroenterology

    (2003)
  • Y.D. Podnos et al.

    Surgical management of hepatic breast cancer metastases

    Oncology (Williston Park)

    (2005)
  • G. Fraschini et al.

    Percutaneous hepatic arterial infusion of cisplatin-vinblastine for refractory breast carcinoma metastatic to the liver

    Am J Clin Oncol

    (1988)
  • Cited by (80)

    • Transarterial Yttrium-90 Glass Microsphere Radioembolization of Chemotherapy-Refractory Breast Cancer Liver Metastases: Results of a Single Institution Retrospective Study

      2022, Advances in Radiation Oncology
      Citation Excerpt :

      The current study on 31 patients with breast cancer with unresectable, chemotherapy-refractory liver metastases who underwent TARE with Y90-labeled glass microspheres demonstrated a median OS of 13 months and a HPFS of 7 months. These survival data are comparable to those reported in previous studies using Y90-labeled resin or a combination of resin and glass microspheres (Table 1).13,15–21,23–29 However, our results are different than the largest study on Y90-labeled glass microspheres where 75 patients with breast cancer were treated and reported 6.6 months median OS.22

    • Transcatheter Embolization of Liver Metastases

      2020, Image-Guided Interventions: Expert Radiology Series, Third Edition
    • Long-term radiological and histological outcomes following selective internal radiation therapy to liver metastases from breast cancer

      2018, Radiology Case Reports
      Citation Excerpt :

      Several retrospective studies have explored the use of SIRT in chemorefractory metastatic breast cancer to the liver. In 2007, Bangash et al demonstrated a complete or partial response at 90 days in 9/27 women with progressive breast cancer who had failed standard of care chemotherapy, whilst 2/27 progressed and the remainder were stable [26]. The same year Coldwell et al published series of 44 heavily pretreated women with breast liver metastasis, showing a 47% partial response rate by CT at 12 weeks, and higher response rate by PET [27].

    • Yttrium-90 Radioembolization for Breast Cancer Liver Metastases

      2016, Journal of Vascular and Interventional Radiology
    View all citing articles on Scopus
    1

    R.S. is a consultant for MDS Nordion.

    View full text