Purpose
Intra-arterial hepatic tumour therapy using microspheres labelled with Yttrium-90, a pure beta-emitting isotope, is an effective palliative treatment option for some patients with non-resectable hypervascular hepatic malignancies. The aim of this study is to review its outcomes for unresectable hepatocellular carcinoma and hepatic metastases performed at our institution, a regional centre for such therapy.
Material and methods
60 consecutive yttrium-90 therapy cases, performed between March 2000 and December 2005, were reviewed retrospectively, using case histories and imaging. Cases with incomplete follow-up were excluded. These included international patients who could not be followed up as they had departed Singapore post-therapy. CT was used to assess treatment response. Results were compared with published literature.
Results
Complete follow-up (range 1-70 months) occurred in 34 cases. 74% (25/34) showed complete or partial response to therapy. 56% (19/34) had no immediate complications, 74% (25/34) had no delayed complications, 47% (16/34) had neither. Significant complications, gastritis (1), peptic ulceration (2) and radiation cholecystitis (1), occurred only in the 1.5 year. Since then, a policy of careful super-selective yttrium-90 delivery was adopted when required. No patients required pre-yttrium-90 vascular embolization. Average disease progression was 4 months in non-responders and 8 months in responders. Of the 16 deaths, non-responders survived an average of 7 months and responders an average of 16 months. In our series, the longest disease-free survival interval was 52 months.
Conclusion
Disease progression occurs more slowly and survival is more prolonged in responders. Results confirm Yttrium-90 is effective palliative therapy for responders with non-resectable hypervascular liver tumours. Most patients do not have significant delayed complications.