Efficacy and Prognostic Factors for Y-90 Radioembolization (Y-90)‎ in Metastatic Neuroendocrine Tumors with Liver Metastases

الملخص EN

Background.

Yttrium-90 (Y-90) can be an effective liver-directed therapy for patients with metastatic neuroendocrine tumors (NETs), but population-based data are limited.

We characterized the use of Y-90 in NET patients and identified factors associated with response.

Methods.

We identified 49 patients with metastatic liver-dominant NETs across BC Cancer’s six regional centres who received Y-90 between June 2011 and January 2017 in British Columbia, Canada.

Baseline characteristics, radiographic responses, and outcomes were summarized.

Results.

Of the 49 patients who received Y-90, the median age was 56 years (range 21–78), 49% were male, and 94% had an ECOG performance status of 0–1.

The primary location of the NET included pancreas (31%), small bowel (41%), large bowel (6%), unknown (14%), and others (12%).

69% of these patients had liver metastases alone, and tumors were graded as G1 (61%), G2 (25%), G3 (2%), and unknown (12%).

Prior therapies included surgery (63%), local ablative therapy (25%), somatostatin analogue (69%), and systemic therapy (35%).

The median Y-90 dose was 2.2 GBq (range 0.8–3.6), as SIR-spheres (69%) or TheraSpheres (29%).

Median time to Y-90 from diagnosis of metastases measured 1.54 years.

88% received segmental Y-90, with 1 (69%), 2 (29%), and 3 (2%) treatments.

Y-90 resulted in partial response (53%), stable disease (33%), and progressive disease (12%).

Y-90 was well-tolerated, with infrequent grade 3-4 biochemical toxicities (2%) and grade 3 abdominal pain (6%).

Longer overall survival (OS) was associated with resection of primary tumor, well-differentiated histology, and low Ki-67.

Median OS was 27.2 months (95% CI 8.0–46.5).Conclusions.

In our population-based cohort, Y-90 was well-tolerated in patients with metastatic liver-dominant NETs.

Prior surgical resection was an important predictor of OS.