Purpose: To investigate survival after Y90 radioembolization of metastatic liver tumors in salvage setting and comparison of survival in different types of cancer.
Material and Methods: From 1/2012 to 2/2019, retrospective review was performed of all patients undergoing first time Y90 radioembolization of metastatic liver tumors at a single institution. All Y90 embolizations at this institution were applied in salvage setting only after failure of systemic chemotherapies. Demographics, medical history, procedural details, and outcomes including all-cause mortality were collected using electronic medical records, SSN Death Index, and online obituaries. For obituaries, identity was confirmed by at least two personal identifiers. Kaplan-Meier survival analyses and log rank tests were performed for the whole group and primary cancer subgroups.
Results: 103 patients (42 M, 61 F; mean age 61.6 years, SD 12.7) had a mean follow-up period of 400 days (SD 421), with 69 confirmed deceased, 20 confirmed alive to date, and 14 lost to follow-up (67%, 19%, and 14% respectively). Most common primary cancers were colorectal (n=34) and neuroendocrine (n=22), followed by 10 cholangiocarcinoma, 9 breast, 5 lung, 5 pancreatic adenocarcinoma, and 18 other (defined as any type with n of 3 or fewer). Kaplan-Meier survival curves of all metastatic patients and subgroups of colorectal, neuroendocrine, cholangiocarcinoma, and breast (Fig. 1) demonstrated that the greatest survival was associated with neuroendocrine (74%, 59%, 31% survival at 1, 2, and 3 years) and worst survival was associated with colorectal (30%, 4%, 0% survival at 1, 2, 3 years). Neuroendocrine survival advantage was statistically significant compared to colorectal, all metastatic patients, and breast groups (p<0.01, p=0.039, and p=0.037 respectively).
Conclusions: As a salvage therapy, Y90 radioembolization of metastatic neuroendocrine tumors are associated with a significant survival advantage at 1, 2, and 3 years follow-up vs. metastatic colorectal or breast tumors, with colorectal associated with the worst survival.