Role of resin microsphere y90 dosimetry in predicting objective tumor response, survival and treatment related toxicity in surgically unresectable colorectal liver metastasis: A retrospective single institution study

• Type of Material: Article
• Authors: Tina Sankhla, Emory University; Bernard Cheng, Morehouse School of Medicine; Nariman Nezami, Emory University; Minzhi Xing, Emory University; Ila Sethi, Emory University; Zachary L. Bercu, Emory University; David Brandon, Emory University; Bill Majdalany, Emory University; David Schuster, Emory University; Nima Kokabi, Emory University
• Language: English
• Date: 2021-10-01
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2021 by the authors
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/cancers13194908
• Title of Journal or Parent Work: Cancers
• Volume: 13
• Issue: 19
• Grant/Funding Information: This research received no external funding.
• Keywords: unresectable colorectal liver metastasis; objective tumor response; selective internal radiation therapy; overall survival; treatment related toxicity
• Research Categories: Health Sciences, Oncology; Health Sciences, Toxicology

Abstract

Purpose: To Evaluate the correlation between tumor dosimetric parameters with objective tumor response (OR) and overall survival (OS) in patients with surgically unresectable colorectal liver metastasis (CRLM) undergoing resin-based Ytrrium-90 selective internal radiation therapy (Y90 SIRT). Materials and Methods: 45 consecutive patients with CRLM underwent resin-based Y90 SIRT in one or both hepatic lobes (66 treated lobes total). Dose volume histograms were created with MIM Sureplan® v.6.9 using post-treatment SPECT/CT. Dosimetry analyses were based on the cumulative volume of the five largest tumors in each treatment session and non-tumoral liver (NTL) dose. Receiver operating characteristic (ROC) curve was used to evaluate tumor dosimetric factors in predicting OR by Response Evaluation Criteria for Solid Tumors at 3 months post-Y90. Additionally, ROC curve was used to evaluate non-tumoral liver dose as a predictor of grade ≥3 liver toxicity and radioembolization induced liver disease (REILD) 3 months post Y90. To minimize for potential confounding demographic and clinical factors, univariate and multivariate analysis of survival with mean tumor dose as one of the factors were also performed. Kaplan-Meier estimation was used for OS analysis from initial Y90 SIRT. Results: 26 out of 45 patients had OR with a median OS of 17.2 months versus 6.8 months for patients without OR (p < 0.001). Mean tumor dose (TD) of the five largest tumors was the strongest predictor of OR with an area under the curve of 0.73 (p < 0.001). Minimum TD, and TD to 30%, 50%, and 70% of tumor volume also predicted OR (p’s < 0.05). Mean TD ≥ 100 Gy predicted a significantly prolonged median OS of 19 vs. 11 months for those receiving.