- Email: [email protected]
29
266
Journal of Gastrointestinal Surgery
Abstracts
26 Outcomes of Hepatic Resection for Breast Cancer Metastases Juan M Sarmiento, Florencia G Que, David M Nagorney, Mayo Clinic, Rochester, MN Introduction: Hepatic resection is not a standard of care to treat patients with metastases from breast cancer. However, it has been suggested a possible a role for selected patients with no other sign of cancer recurrence. More information is necessary to define the potential benefit of partial hepatectomy in this setting. Methods: The records of all consecutive patients undergoing hepatic resection for breast cancer metastases between 1980-2001 were reviewed. Patients were offered a surgical resection when an R0 resection was anticipated preoperatively and extrahepatic disease was ruled out by imaging studies. Follow-up was complete by outpatient visits or mail correspondence. The Kaplan-Meier method was used to generate overall and recurrence-free survival. Results: Fourteen patients underwent partial hepatectomy to treat breast cancer metastases; mean age was 57 yr (SD 12). The liver was the first site of metastases in 10 patients. The median interval-free period (prior to hepatectomy) was 57 months (range 10-106) and in 9 patients was more than 24 months. An R0 resection was achieved in 10 patients, and extrahepatic disease was found intraoperatively in 3 (peritoneal implants, portal nodes). Median operative time was 165 minutes (120-250), transfusion requirement was 0 units (0-5), and length of stay was 6 days (4-8). Two patients experienced postoperative complications; there was no mortality. Median overall survival was 70 months (5-yr:63%) and recurrence-free survival was 28 months (5-yr:34%). In patients with intervalfree period greater than 24 months, they were 70 months (5-yr:63%) and 32 months (5-yr:44%), respectively. Most recurrences were located in the liver (4 out of 8). Conclusions: Partial hepatectomy offers an extended survival in very selected patients with metastatic breast cancer if the liver is the only site of disease. An extended preoperative interval-free period appears to select the best candidates for surgical therapy.
(14.7%) have died, one having an aggressive recurrence of HCC two months following transplant. Survival in the non-ablation cohort was 20.7 months. Conclusions: Radiographic assessment of tumor recurrence appears to underestimate residual disease and the completeness of tumor ablation. These findings challenge the concept that current ablative techniques achieve complete eradication of tumor and are curative. The patients in this analysis, however, represent the early experience with PEI or RFA as a bridge to transplantation. Although residual tumor was identified, it is of unknown clinical significance. Long-term followup is needed to assess value of ablation for HCC.
28 Hepatic Artery Infusion - Pitfalls and Benefits Harold J Wanebo, Charu Taneja, Giovanni Begossi, Audrey Levy, Roger Williams Medical Center, Providence, RI Introduction: Hepatic artery infusion provides a major method of controlling hepatic metastases in patients with non-resectable disease either as a singular technique or to supplement RFA or cryo-ablation. It also has suggested benefit as adjuvant therapy for patients with resectable disease. There are problems with pump management, but the benefit appears to outweigh the pitfalls. Material Methods: We have evolved a technique of HAI catheter placement with the goal to maximize the efficiency of the catheter placement. Patients are monitored with arteriography, magnetic resonance arteriography and dye distribution status by methylene blue injection or on-table arteriography coupled with ultrasound tumor localization and measurement and measurement of post therapy targeted liver lesions to define anti tumor response. Results—Outcome Survival Outcome Measureable Antitumor Response Patients Response Median 2-year 5-year
27 Ablation of Hepatocellular Carcinoma (HCC) Prior to Transplantation — Pathologic Analysis of the Explant Charles M Vollmer Jr, Elijah Dixon, Maha Guindi, David R Grant, Mark S Cattral, Steven Gallinger, Paul D Greig, University of Toronto, Toronto, ON, Canada Background: Radiofrequency Ablation (RFA) and Percutaneous Ethanol Injection (PEI) ablation techniques have found utility for treatment of HCC. Transplantation has become the preferred treatment for patients with HCCs that lie within size and multiplicity criteria; however, the donor shortage has limited its widespread application. Since 1999, PEI and RFA have been used to control tumor progression in selected patients prior to hepatic transplantation for HCC. Pathologic analysis of the explanted liver in those transplanted provides a unique opportunity for the assessment of the oncologic effects of ablation. Methods: From Jan 1999 to Sept 2002, 37 cirrhotic patients were transplanted for known HCC. 14 patients (38%) underwent ablative procedures on 15 lesions prior to transplantation. PEI was performed on 6, RFA on 8, and one patient had both. Two patients had repeated ablations for recurrence. Ablated lesions were surveilled radiologically q3-monthly until transplantation. Mean interval between last imaging and transplant was 2.2 months. Hepatectomy explants were thoroughly analyzed for evidence of residual tumor at the site of ablation, as well as other findings. Results: Mean size of lesions pre-ablation was 29 mm (range 10 to 51 mm). Mean interval between ablation and transplant was 6.5 months. Seven patients had apparent radiographic control of their tumors, 6 suggested residual or recurrent tumor, and one was transplanted prior to post-ablative imaging. Pathologically, gross residual tumor, with varying degrees of necrosis or hemorrhage, was evident in all 15 ablation sites. Other incidental foci of cancer, or satellite lesions were identified in 7 (50%) patients. Mean post-transplant survival is 22.5 months for the ablation cohort: 2 patients
HAI (only) RFA Resection Vs. resection alone Systemic RX Historic control*
26 8 13
67% 60–80% 100%
17 mo 31 mo Not reached
23% 52% 66%
4% 28% 55%
87 139
100% 15–20%
35 mo 11 mo
73% 13%
21% 1%
136
Unknown
6 mo
8%
1%
*Kaplan-Meier Historic
Complications include misperfusion in 4 patients (all with negative nuclear scan) consisting of catheter migration with alteration of liver perfusion to the tumor ( 2 pts) and fracture of catheter in 1 patient. Conclude: HAI provides an important strategy to control hepatic metastases. Although complications occur, most are manageable with close attention to details. HAI has potential to significantly augment survival after resection or tumor ablation and, when used alone in advanced disease, may provide meaningful disease control and prolong overall survival.
29 Radiofrequency Ablation for Hepatocellular Carcinoma David A Iannitti, Damian Dupuy, William Mayo-Smith, Brown Medical School, Providence, RI Hepatocellular carcinoma (HCC) is a world-wide disease usually associated with poor outcomes. Systemic chemotherapy is ineffective. Hepatic artery chemoinfusion or chemoembolization has had mixed
Vol. 7, No. 2 2003
results. Hepatic resection continues to be the treatment of choice for this disease. Unfortunatley many patients because of poor liver function or significant co-morbidities are not candidates for hepatic resection. Radiofrequency ablation has become an increasing treatment modality for unresectable hepatic tumors. This study retrospectivley reviews 36 patients with unresectable hepatocellular carcinoma from 8/98 to 9/02. Mean follow up is 25 months (1 to 50 mo) All patients were treated with a cooled-tip cluster radiofrequency probe to achieve tumor margin temperatures of 70C. Patients were treated via percutaneous or operative approaches. 46 lesions were treated in 36 patients. Mean tumor size was 5.3 cm (6 mm to 15 cm). There were two mortalities within 30 days of ablation (CVA, cardiac arrhythmia). Morbidities included 2 patients with hepatic abcess, 2 transient liver dysfunction, 1 hepatic artery to portal venous fistula, and 2 segmental hepatic infarcts. Overall survival was 1 yr 76.7% (23/30), 2 yr 70.6% (12/17), 3 yr 50% (6/12), 4 yr 50% (1/2), 5 yr. NA. Two patients underwent orthotopic liver transplant following ablation with no viable tumor of the explanted specimen. Conclusion: Hepatic radiofrequency ablation is a treatment option which offers improved survival for patients with unresectable hepatocellular carcinoma.
30 Treatment Of Unresectable Primary Hepatic Malignancies Using Hyperthermic Isolated Hepatic Perfusion (IHP). Elizabeth D Feldman, Peter C Wu, Michael X Gnant, David L Bartlett, Steven K Libutti, James F Pingpank Jr, H. Richard Alexander Jr, Surgery Branch, NCI, NIH, Bethesda, MD Background: Primary hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. Isolated hepatic perfusion (IHP) is a locoregional treatment technique that isolates the liver in order to deliver high dose chemotherapy, biologic agents, and hyperthermia directly to hepatic parenchyma. This study presents our experience using IHP with melphalan with or without tumor necrosis factor (TNF) to treat nine patients with hepatocellular carcinoma or adenocarcinoma of hepatobiliary origin. Methods: Nine patients with unresectable primary hepatic malignancies underwent a 60-minute IHP with 1.5 mg/kg melphalan with or without 1.0 mg/ kg TNF. Four patients failed one or more previous treatment regimens and the mean hepatic replacement was 41% (range 10-75%). Patients were monitored for response, toxicity, time to recurrence, and survival. Results: Six of nine patients (67%) experienced a 50% regression of tumor on objective radiographic imaging with an additional patient having a 45% reduction in tumor burden. Mean time to recurrence was 6.6 months for those who responded to treatment. Patients who had a response to therapy had an average overall survival of 16.3 months. In five patients hepatic progression was the only sight of disease at death. In three of the remaining four patients, progressive hepatic disease accompanied systemic metastases. A single patient died of progressive pulmonary metastases, without evidence of liver progression. Conclusions: IHP can be performed safely and has significant anti-tumor activity in patients with unresectable primary hepatic malignancies. Hepatic progression continues to be the dominant factor influencing survival in this group of patients.
31 Hepatic Artery Chemoembolization for Isolated Colorectal Metastases to the Liver Paul E Wise, Steve S Liou, Paulgun Sulur, J. K Wright, William C Chapman, Steven G Meranze, Murray J Mazer, C. W Pinson, Vanderbilt University Medical Center, Nashville, TN; Washington University, St. Louis, MO
Abstracts
267
Introduction: Surgical resection is the preferred treatment for most hepatic malignancies, but is an option in only 25% of patients due to tumor characteristics or patient comorbidities. Hepatic artery chemoembolization (HACE) is an alternative therapy for these more advanced tumors, but its safety and efficacy for isolated hepatic colorectal metastases (CRM) has not been proven. We reviewed patients with isolated hepatic CRM who underwent HACE at our institution and compared their survival with both surgery for CRM and HACE for other malignancies. Methods: Data evaluated from CRM patients who underwent HACE between 1992 and 1999 included demographics, treatment details, and length of survival (LOS). These survival data were compared to LOS after surgical resection for CRM (n135) as well as LOS after HACE for hepatocellular carcinoma (HCC) (n40) and metastatic carcinoid (n16). These data were analyzed using Kaplan-Meier and log rank methods. Results: Twentythree patients with isolated hepatic CRM having an average age of 59.8 12.1 years (57% male) underwent 44 HACE treatments. Length of hospital stay after HACE ranged from 1-15 days with an average stay of 2.9 days. Minor morbidities (nausea/vomiting, abdominal pain, fever) were reported in 21 patients (91%). Major morbidities included access site hematomas (n3) and neutropenia (n2). There was one mortality secondary to sepsis and multi-system organ failure. LOS after the initial HACE treatment for CRM was significantly shorter than after surgery for CRM (median 9.3 vs. 36.2 months; p0.001). LOS after HACE for CRM was significantly shorter than after HACE for carcinoid (median 9.3 vs. 14.3 months; p0.05), but was equivalent to LOS after HACE for HCC (median 9.3 vs. 7.9 months; n.s.). Conclusions: HACE for CRM is safe and well-tolerated, but survival after HACE was worse than survival after surgical resection for CRM. Results from HACE for CRM are comparable to those for HCC but worse than for carcinoid.
32 Intra-Arterial Yttrium-90 Sir-Spheres for Metastatic Disease to the Liver Riad Salem, Daniel Williams, Vanessa L Gates, Beth Oman, Michelle Beauvais, Jeffrey Margolis, Beaumont Hospital, Royal Oak, MI; Beaumont Hospital, Royal Oak, MI Purpose: To evaluate the safety and efficacy of Yttrium-90 SirSpheres resin for the treatment of metastatic liver disease. Materials and Methods: 24 patients were treated with intra-arterial Yttrium-90 Sir-Spheres. All patients received 2 treatments on a lobar basis at 2835 day intervals. Indications for treatment included metastatic liver cancer from the pancreas (n2), colon (n14), breast (n3), carcinoid (n1) and unknown primary (n4). The average lobar volume was 1163 cc; the average dose of Y90 was 1.1 GBq. Patients had baseline liver function tests, tumor markers, CT and PET scans on or before on the day of treatment. Clinical follow-up, liver functions, CT scans were obtained at 30, as well as PET at 90 days. All patients were off chemotherapy at the time of treatment. Results: 22 of 24 patients received treatment on an outpatient basis and were discharged 6 hours after catheterization. 30 and 90 day clinical, laboratory, and CT follow-up was available in 18 of 24 patients. PET follow-up was available in 16 patients. 21 of 24 (88%) patients complained of fatigue for 7-14 days. 4 patients experienced transient but very severe burning in the area of treatment during the injection of Y90. On CT imaging, 15 of 18 patients had an average decrease in tumor size of 33%. 3 of 18 showed no change on CT. PET showed complete, partial and no response in 7, 7 and 2 patients respectively. Average tumour marker drop (CEA, CA19-9, CA15-3) in the 18 patients was 51% at day 90 following 1st treatment. The patient with carcinoid syndrome had complete resolution of symptoms. Conclusions: SirSpheres hepatic unilobar infusion for metastatic liver disease appears to represent a new and efficacious therapy with mild toxicity in a
Journal of Gastrointestinal Surgery
Abstracts
26 Outcomes of Hepatic Resection for Breast Cancer Metastases Juan M Sarmiento, Florencia G Que, David M Nagorney, Mayo Clinic, Rochester, MN Introduction: Hepatic resection is not a standard of care to treat patients with metastases from breast cancer. However, it has been suggested a possible a role for selected patients with no other sign of cancer recurrence. More information is necessary to define the potential benefit of partial hepatectomy in this setting. Methods: The records of all consecutive patients undergoing hepatic resection for breast cancer metastases between 1980-2001 were reviewed. Patients were offered a surgical resection when an R0 resection was anticipated preoperatively and extrahepatic disease was ruled out by imaging studies. Follow-up was complete by outpatient visits or mail correspondence. The Kaplan-Meier method was used to generate overall and recurrence-free survival. Results: Fourteen patients underwent partial hepatectomy to treat breast cancer metastases; mean age was 57 yr (SD 12). The liver was the first site of metastases in 10 patients. The median interval-free period (prior to hepatectomy) was 57 months (range 10-106) and in 9 patients was more than 24 months. An R0 resection was achieved in 10 patients, and extrahepatic disease was found intraoperatively in 3 (peritoneal implants, portal nodes). Median operative time was 165 minutes (120-250), transfusion requirement was 0 units (0-5), and length of stay was 6 days (4-8). Two patients experienced postoperative complications; there was no mortality. Median overall survival was 70 months (5-yr:63%) and recurrence-free survival was 28 months (5-yr:34%). In patients with intervalfree period greater than 24 months, they were 70 months (5-yr:63%) and 32 months (5-yr:44%), respectively. Most recurrences were located in the liver (4 out of 8). Conclusions: Partial hepatectomy offers an extended survival in very selected patients with metastatic breast cancer if the liver is the only site of disease. An extended preoperative interval-free period appears to select the best candidates for surgical therapy.
(14.7%) have died, one having an aggressive recurrence of HCC two months following transplant. Survival in the non-ablation cohort was 20.7 months. Conclusions: Radiographic assessment of tumor recurrence appears to underestimate residual disease and the completeness of tumor ablation. These findings challenge the concept that current ablative techniques achieve complete eradication of tumor and are curative. The patients in this analysis, however, represent the early experience with PEI or RFA as a bridge to transplantation. Although residual tumor was identified, it is of unknown clinical significance. Long-term followup is needed to assess value of ablation for HCC.
28 Hepatic Artery Infusion - Pitfalls and Benefits Harold J Wanebo, Charu Taneja, Giovanni Begossi, Audrey Levy, Roger Williams Medical Center, Providence, RI Introduction: Hepatic artery infusion provides a major method of controlling hepatic metastases in patients with non-resectable disease either as a singular technique or to supplement RFA or cryo-ablation. It also has suggested benefit as adjuvant therapy for patients with resectable disease. There are problems with pump management, but the benefit appears to outweigh the pitfalls. Material Methods: We have evolved a technique of HAI catheter placement with the goal to maximize the efficiency of the catheter placement. Patients are monitored with arteriography, magnetic resonance arteriography and dye distribution status by methylene blue injection or on-table arteriography coupled with ultrasound tumor localization and measurement and measurement of post therapy targeted liver lesions to define anti tumor response. Results—Outcome Survival Outcome Measureable Antitumor Response Patients Response Median 2-year 5-year
27 Ablation of Hepatocellular Carcinoma (HCC) Prior to Transplantation — Pathologic Analysis of the Explant Charles M Vollmer Jr, Elijah Dixon, Maha Guindi, David R Grant, Mark S Cattral, Steven Gallinger, Paul D Greig, University of Toronto, Toronto, ON, Canada Background: Radiofrequency Ablation (RFA) and Percutaneous Ethanol Injection (PEI) ablation techniques have found utility for treatment of HCC. Transplantation has become the preferred treatment for patients with HCCs that lie within size and multiplicity criteria; however, the donor shortage has limited its widespread application. Since 1999, PEI and RFA have been used to control tumor progression in selected patients prior to hepatic transplantation for HCC. Pathologic analysis of the explanted liver in those transplanted provides a unique opportunity for the assessment of the oncologic effects of ablation. Methods: From Jan 1999 to Sept 2002, 37 cirrhotic patients were transplanted for known HCC. 14 patients (38%) underwent ablative procedures on 15 lesions prior to transplantation. PEI was performed on 6, RFA on 8, and one patient had both. Two patients had repeated ablations for recurrence. Ablated lesions were surveilled radiologically q3-monthly until transplantation. Mean interval between last imaging and transplant was 2.2 months. Hepatectomy explants were thoroughly analyzed for evidence of residual tumor at the site of ablation, as well as other findings. Results: Mean size of lesions pre-ablation was 29 mm (range 10 to 51 mm). Mean interval between ablation and transplant was 6.5 months. Seven patients had apparent radiographic control of their tumors, 6 suggested residual or recurrent tumor, and one was transplanted prior to post-ablative imaging. Pathologically, gross residual tumor, with varying degrees of necrosis or hemorrhage, was evident in all 15 ablation sites. Other incidental foci of cancer, or satellite lesions were identified in 7 (50%) patients. Mean post-transplant survival is 22.5 months for the ablation cohort: 2 patients
HAI (only) RFA Resection Vs. resection alone Systemic RX Historic control*
26 8 13
67% 60–80% 100%
17 mo 31 mo Not reached
23% 52% 66%
4% 28% 55%
87 139
100% 15–20%
35 mo 11 mo
73% 13%
21% 1%
136
Unknown
6 mo
8%
1%
*Kaplan-Meier Historic
Complications include misperfusion in 4 patients (all with negative nuclear scan) consisting of catheter migration with alteration of liver perfusion to the tumor ( 2 pts) and fracture of catheter in 1 patient. Conclude: HAI provides an important strategy to control hepatic metastases. Although complications occur, most are manageable with close attention to details. HAI has potential to significantly augment survival after resection or tumor ablation and, when used alone in advanced disease, may provide meaningful disease control and prolong overall survival.
29 Radiofrequency Ablation for Hepatocellular Carcinoma David A Iannitti, Damian Dupuy, William Mayo-Smith, Brown Medical School, Providence, RI Hepatocellular carcinoma (HCC) is a world-wide disease usually associated with poor outcomes. Systemic chemotherapy is ineffective. Hepatic artery chemoinfusion or chemoembolization has had mixed
Vol. 7, No. 2 2003
results. Hepatic resection continues to be the treatment of choice for this disease. Unfortunatley many patients because of poor liver function or significant co-morbidities are not candidates for hepatic resection. Radiofrequency ablation has become an increasing treatment modality for unresectable hepatic tumors. This study retrospectivley reviews 36 patients with unresectable hepatocellular carcinoma from 8/98 to 9/02. Mean follow up is 25 months (1 to 50 mo) All patients were treated with a cooled-tip cluster radiofrequency probe to achieve tumor margin temperatures of 70C. Patients were treated via percutaneous or operative approaches. 46 lesions were treated in 36 patients. Mean tumor size was 5.3 cm (6 mm to 15 cm). There were two mortalities within 30 days of ablation (CVA, cardiac arrhythmia). Morbidities included 2 patients with hepatic abcess, 2 transient liver dysfunction, 1 hepatic artery to portal venous fistula, and 2 segmental hepatic infarcts. Overall survival was 1 yr 76.7% (23/30), 2 yr 70.6% (12/17), 3 yr 50% (6/12), 4 yr 50% (1/2), 5 yr. NA. Two patients underwent orthotopic liver transplant following ablation with no viable tumor of the explanted specimen. Conclusion: Hepatic radiofrequency ablation is a treatment option which offers improved survival for patients with unresectable hepatocellular carcinoma.
30 Treatment Of Unresectable Primary Hepatic Malignancies Using Hyperthermic Isolated Hepatic Perfusion (IHP). Elizabeth D Feldman, Peter C Wu, Michael X Gnant, David L Bartlett, Steven K Libutti, James F Pingpank Jr, H. Richard Alexander Jr, Surgery Branch, NCI, NIH, Bethesda, MD Background: Primary hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. Isolated hepatic perfusion (IHP) is a locoregional treatment technique that isolates the liver in order to deliver high dose chemotherapy, biologic agents, and hyperthermia directly to hepatic parenchyma. This study presents our experience using IHP with melphalan with or without tumor necrosis factor (TNF) to treat nine patients with hepatocellular carcinoma or adenocarcinoma of hepatobiliary origin. Methods: Nine patients with unresectable primary hepatic malignancies underwent a 60-minute IHP with 1.5 mg/kg melphalan with or without 1.0 mg/ kg TNF. Four patients failed one or more previous treatment regimens and the mean hepatic replacement was 41% (range 10-75%). Patients were monitored for response, toxicity, time to recurrence, and survival. Results: Six of nine patients (67%) experienced a 50% regression of tumor on objective radiographic imaging with an additional patient having a 45% reduction in tumor burden. Mean time to recurrence was 6.6 months for those who responded to treatment. Patients who had a response to therapy had an average overall survival of 16.3 months. In five patients hepatic progression was the only sight of disease at death. In three of the remaining four patients, progressive hepatic disease accompanied systemic metastases. A single patient died of progressive pulmonary metastases, without evidence of liver progression. Conclusions: IHP can be performed safely and has significant anti-tumor activity in patients with unresectable primary hepatic malignancies. Hepatic progression continues to be the dominant factor influencing survival in this group of patients.
31 Hepatic Artery Chemoembolization for Isolated Colorectal Metastases to the Liver Paul E Wise, Steve S Liou, Paulgun Sulur, J. K Wright, William C Chapman, Steven G Meranze, Murray J Mazer, C. W Pinson, Vanderbilt University Medical Center, Nashville, TN; Washington University, St. Louis, MO
Abstracts
267
Introduction: Surgical resection is the preferred treatment for most hepatic malignancies, but is an option in only 25% of patients due to tumor characteristics or patient comorbidities. Hepatic artery chemoembolization (HACE) is an alternative therapy for these more advanced tumors, but its safety and efficacy for isolated hepatic colorectal metastases (CRM) has not been proven. We reviewed patients with isolated hepatic CRM who underwent HACE at our institution and compared their survival with both surgery for CRM and HACE for other malignancies. Methods: Data evaluated from CRM patients who underwent HACE between 1992 and 1999 included demographics, treatment details, and length of survival (LOS). These survival data were compared to LOS after surgical resection for CRM (n135) as well as LOS after HACE for hepatocellular carcinoma (HCC) (n40) and metastatic carcinoid (n16). These data were analyzed using Kaplan-Meier and log rank methods. Results: Twentythree patients with isolated hepatic CRM having an average age of 59.8 12.1 years (57% male) underwent 44 HACE treatments. Length of hospital stay after HACE ranged from 1-15 days with an average stay of 2.9 days. Minor morbidities (nausea/vomiting, abdominal pain, fever) were reported in 21 patients (91%). Major morbidities included access site hematomas (n3) and neutropenia (n2). There was one mortality secondary to sepsis and multi-system organ failure. LOS after the initial HACE treatment for CRM was significantly shorter than after surgery for CRM (median 9.3 vs. 36.2 months; p0.001). LOS after HACE for CRM was significantly shorter than after HACE for carcinoid (median 9.3 vs. 14.3 months; p0.05), but was equivalent to LOS after HACE for HCC (median 9.3 vs. 7.9 months; n.s.). Conclusions: HACE for CRM is safe and well-tolerated, but survival after HACE was worse than survival after surgical resection for CRM. Results from HACE for CRM are comparable to those for HCC but worse than for carcinoid.
32 Intra-Arterial Yttrium-90 Sir-Spheres for Metastatic Disease to the Liver Riad Salem, Daniel Williams, Vanessa L Gates, Beth Oman, Michelle Beauvais, Jeffrey Margolis, Beaumont Hospital, Royal Oak, MI; Beaumont Hospital, Royal Oak, MI Purpose: To evaluate the safety and efficacy of Yttrium-90 SirSpheres resin for the treatment of metastatic liver disease. Materials and Methods: 24 patients were treated with intra-arterial Yttrium-90 Sir-Spheres. All patients received 2 treatments on a lobar basis at 2835 day intervals. Indications for treatment included metastatic liver cancer from the pancreas (n2), colon (n14), breast (n3), carcinoid (n1) and unknown primary (n4). The average lobar volume was 1163 cc; the average dose of Y90 was 1.1 GBq. Patients had baseline liver function tests, tumor markers, CT and PET scans on or before on the day of treatment. Clinical follow-up, liver functions, CT scans were obtained at 30, as well as PET at 90 days. All patients were off chemotherapy at the time of treatment. Results: 22 of 24 patients received treatment on an outpatient basis and were discharged 6 hours after catheterization. 30 and 90 day clinical, laboratory, and CT follow-up was available in 18 of 24 patients. PET follow-up was available in 16 patients. 21 of 24 (88%) patients complained of fatigue for 7-14 days. 4 patients experienced transient but very severe burning in the area of treatment during the injection of Y90. On CT imaging, 15 of 18 patients had an average decrease in tumor size of 33%. 3 of 18 showed no change on CT. PET showed complete, partial and no response in 7, 7 and 2 patients respectively. Average tumour marker drop (CEA, CA19-9, CA15-3) in the 18 patients was 51% at day 90 following 1st treatment. The patient with carcinoid syndrome had complete resolution of symptoms. Conclusions: SirSpheres hepatic unilobar infusion for metastatic liver disease appears to represent a new and efficacious therapy with mild toxicity in a