Clinical study90Y Radioembolization of Metastatic Breast Cancer to the Liver: Toxicity, Imaging Response, Survival
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)
- et al.
Liver metastases from breast cancer: the relationship between clinical, biochemical and pathological features and survival
Eur J Cancer
(1990) - et al.
Clinical outcome of breast cancer patients with liver metastases alone in the anthracycline-taxane era: a retrospective analysis of two prospective, randomised metastatic breast cancer trials
Eur J Cancer
(2003) - et al.
Chemoembolization of liver metastasis from breast carcinoma
J Vasc Interv Radiol
(2004) - et al.
90Y microsphere (TheraSphere) treatment for unresectable colorectal cancer metastases of the liver: response to treatment at targeted doses of 135-150 Gy as measured by [18F]fluorodeoxyglucose positron emission tomography and computed tomographic imaging
J Vasc Interv Radiol
(2005) - et al.
Treatment of unresectable hepatocellular carcinoma with use of 90Y microspheres (TheraSphere): safety, tumor response, and survival
J Vasc Interv Radiol
(2005) - et al.
Radioembolization with 90yttrium microspheres: a state-of-the-art brachytherapy Treatment for primary and secondary liver malignancies: part 1: technical and methodologic considerations
J Vasc Interv Radiol
(2006) - et al.
Feasibility of blood oxygenation level-dependent MR imaging to monitor hepatic transcatheter arterial embolization in rabbits
J Vasc Interv Radiol
(2005) - et al.
Randomised trial of SIR-Spheres plus chemotherapy vs. chemotherapy alone for treating patients with liver metastases from primary large bowel cancer
Ann Oncol
(2001) - American Cancer Society, Breast Cancer Facts & Figures 2005–2006. Atlanta: American Cancer Society,...
- et al.
Recurrent breast cancer: presentation, diagnosis, and treatment
Semin Oncol
(1993)
Clinical course of breast cancer patients with liver metastases
J Clin Oncol
(18F)-FDG PET and conventional imaging for assessment of Hodgkin’s disease and non Hodgkin’s lymphomaAn analysis of 193 patient studies
Nuklearmedizin
Causes of death in breast cancer: a clinicopathologic study
Cancer
The regional treatment of liver metastases from breast cancer
J Surg Oncol
Liver metastases from breast cancer: the role of surgical treatment
Hepatogastroenterology
Surgical and chemotherapeutic treatment of hepatic metastases from carcinoma of the breast
Surg Gynecol Obstet
Liver metastases from breast cancerResults of surgical resection
Hepatogastroenterology
Long-term survival after hepatectomy for large metastatic breast cancer: a case report
Hepatogastroenterology
Surgical management of hepatic breast cancer metastases
Oncology (Williston Park)
Percutaneous hepatic arterial infusion of cisplatin-vinblastine for refractory breast carcinoma metastatic to the liver
Am J Clin Oncol
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R.S. is a consultant for MDS Nordion.