Yttrium-90 for colorectal liver metastasis - the promising role of radiation segmentectomy as an alternative local cure

Figures & data

Figure 1. (a) Lobar Y90 administration in multifocal lesions. (b) Segmental Y90 administration in lesions confined to two or fewer hepatic segments.

Figure 2. A 86 year-old male CRC patient with metastatic lesion in the left lobe (a) Pretreatment MRI showing baseline low-attenuation lesion in segment II/III measuring 6.3 × 3.2 cm (arrow). Radiation segmentectomy was performed for the patient and a dose of 235 Gy was administered. (b) MRI at one-year follow-up shows a shrunken non-enhancing tumor (3.6 × 1.9 cm, arrow) with retraction and atrophy of the treated segments (arrowhead).

Table 1. Outcomes of trials evaluating the efficacy of radiation segmentectomy in colorectal liver metastasis.

Study	Primary tumor origin (n)	Intraprocedural technical success	outcome (number of patients)	Adverse events (number of patients/procedures)
Meiers et al. [54]	Colorectal (7)	9/10	Stable disease (4)	Phrenic nerve irritation (1)
	Breast (1)		Out-of-field progression (2)
	Carcinoid (1)		Complete response (2)
	Leiomyosarcoma (1)		Disease progression (2)
Padia et al. [55]	Colorectal (11) Neuroendocrine (10) Sarcoma (7) Other (8)	10/10	Stable disease (23) Partial response (10) Progressive disease (3) Complete response (0)	Fatigue (7)
				Post-embolization syndrome (6)
				Significant laboratory toxicity (3)
				Abscess (3)
				Biloma (1)
				Pain (1)
Kurilova et al. [57]	Colorectal (2)	12/12^a	Partial response (7) Complete response (2)^b Stable disease (1)	Fatigue (4)
	GI-related (3)			Abdominal Pain (3)
	Breast (1)			Nausea (1)
	Ovarian (1)			Dyspnea (1)
	Lung (1)			Weight loss (1)
	Pancreatic (1)			Elevation of diaphragm (1)
	Gallbladder (1)

GI: Gastrointestinal.

^aOne procedure was aborted due to development of anaphylaxis to the prophylactic antibiotic. The treatment session was successfully performed later.

^bUsing a combination of Choi and RECIST criteria.

Meiers C, Taylor A, Geller B, et al. Safety and initial efficacy of radiation segmentectomy for the treatment of hepatic metastases. J Gastrointest Oncol. 2018;9(2):311–315.

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Padia SA, Johnson GE, Agopian VG, et al. Yttrium-90 radiation segmentectomy for hepatic metastases: a multi-institutional study of safety and efficacy. J Surg Oncol. 2021;123(1):172–178.

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Kurilova I, Bendet A, Fung EK, et al. Radiation segmentectomy of hepatic metastases with Y-90 glass microspheres. Abdomin Radiol. 2021. DOI: 10.1007/s00261-021-02956-6

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