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Abstract No. 166: Isolated Limb Infusion with Cytotoxic Agents: A Simplified Approach for Venous Access
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Abstract No. 164
Partially PTFE-Covered Stent for Palliative Treatment of Malignant Biliary Obstruction. D. Gwon, G. Ko, K. Sung, H. Yoon, J. Kim, J. Shin, H. Song; Asan Medical Center, Seoul, South Korea. PURPOSE: To investigate the efficacy and safely of partially polytetrafluoroethylene (PTFE)-covered stents in patients with unresectable malignant biliary obstruction. MATERIALS & METHODS: From March 2006 to Jun 2008, 33 patients were treated by placement of partially PTFEcovered stents. The stent was available in lengths of 1, 2 or 3 cm for proximal bare extension which provides intrahepatic overstenting, and in a length of 1 or 1.5 cm for distal bare extension which can preserve the orifice of the pancreatic duct. The stricture was located in common hepatic duct (CHD) in eight patients, upper common bile duct (CBD) in 10 patients, and the lower CBD in 15 patients. RESULTS: In all cases, the partially PTFE-covered stents were successfully placed. The bilirubin level decrease was statistically significant before and after stent placement (p ⬍ 0.001), and all patients showed clinical improvement. The thirty-day mortality rate was 9% (three of 33 patients). The mean survival and stent patency times were 251.3 days (range, 102—289 days) and 260 days (range, 165—289 days), respectively. Cumulative stent patency rate were 95.8%, 95.8%, 86.3%, and 64.7% at three, six, nine, and 12 months, respectively. Three patients (9%) presented with stent occlusion and required repeat intervention. Acute cholecystitis and pancreatitis were not observed in any of the patients. Stent migration occurred in on patient (3%). CONCLUSION: Partially PTFE-covered stents are effective and safe for palliative treatment of malignant biliary obstructions. 4:36 PM
Abstract No. 165
Combined Regional Chemotherapy Versus Chemoembolization in Hepatic Tumor Model. S. Shin, Y. Do, S. Choo, K. Park, S. Cho, H. Park, I. Choo; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. PURPOSE: Transarterial chemotherapy alone has been considered less effective than transarterial chemoembolization (TACE) for treatment of hepatocellular carcinoma. We wanted to know that the addition of transportal chemotherapy to transarterial chemotherapy may exert any synergistic antitumor effects in the rabbit liver tumor model when compared with TACE. MATERIALS & METHODS: A total of 21 New Zealand white rabbits bearing VX2 liver tumors were divided into four groups: (a) transarterial group (TA, n⫽6) received a transarterial injection of doxorubicin (1 mg/body weight kg); (b) transarterial and transportal group (TAP, n⫽6) received injections of doxorubicin through both the hepatic artery (1 mg/kg) and the portal vein (1 mg/kg), thus receiving a total of 2 mg/kg of doxorubicin; (c) TACE group (n⫽6) received a transarterial injection of doxorubicin (1 mg/kg) followed by gelatin sponge embolization; (d) Control group (n⫽3) received no treatment. With the use of CT, tumor growth rates were calculated by comparing the tumor volumes before and at 7 days after each treatment. Microscopic exams were performed to evaluate the extent of tumor necrosis. S64
RESULTS: 7 days after treatment, tumor growth rates in each group were as follows: (1) 1.1%-349.8% (127.6% ⫾ 123.2, mean ⫾ SD) in TA group; (2) 46.8%-2841.8% (670.8% ⫾ 1076.9) in TAP group; (3) 0% in TACE group; (4) 72.9%-717.9% (432.9% ⫾ 329.0) in control group. Tumor growth of the TACE group was significantly prohibited than those of other groups (P⫽0.004 vs. the TA group, P⫽0.004 vs. the TAP group, and P⫽0.036 vs. the control group, respectively; Mann-Whitney U test) and there were no statistical differences in tumor growth between the TA, the TAP, and the control group (P⫽0.283, Kruskal-Wallis test). Tumors treated with TACE revealed massive necrosis involving both the peripheral and central regions of the tumors. In contrast, tumors of other groups consisted of numerous viable tumor cells and only partial necrosis after treatment. CONCLUSION: Transarterial chemotherapy, even combined with transportal chemotherapy appeared to be less effective than TACE in the rabbit liver VX2 tumor, in terms of tumor growth suppression and the induction of tumor necrosis. 4:48 PM
Abstract No. 166
Isolated Limb Infusion with Cytotoxic Agents: A Simplified Approach for Venous Access. A. Vyas2, R. Avritscher1, M. Ross1, M.J. Wallace1; 1University of Texas MD Anderson Cancer Center, Houston, TX; 2 Baylor College of Medicine, Houston, TX. PURPOSE: To report our experience with isolated limb infusion (ILI) using an original simplified ipsilateral venous access approach compared to the conventional contralateral approach. ILI is a technique, developed in the last 15 years, to treat cutaneous malignancy involving a single extremity. This regional therapy is predominantly used to treat advanced melanoma with in-transit metastases. MATERIALS & METHODS: Patients undergoing lower extremity ILI between October 2005 and June 2008 were retrospectively reviewed. The procedure entails percutaneous insertion of an arterial and venous catheter into the affected limb to allow for circulation of chemotherapeutic agent under ischemic, conditions. The originally reported technique involves the insertion of both arterial and venous catheters from the contralateral approach. A simplified ipsilateral popliteal venous access approach was compared to the original contralateral femoral venous approach with regards to overall fluoroscopy time and the number of callbacks to the operating room for flow related issues. All arterial catheters were inserted from the contralateral common femoral arterial approach. Adverse events were also recorded with particular attention to venous thrombosis of the treated limb. RESULTS: The study included 67 lower extremity ILI procedures in 62 patients (28 males and 34 females; aged 31-82 years). Fifty-nine patients had a history of melanoma. The contralateral and ipsilateral venous approaches were performed in 15 and 52 ILI procedures with mean fluoroscopy times of 17.9 and 8.3 minutes (p⫽0.0019), respectively. This difference was statistically significant, favoring the ipsilateral approach. There was no significant difference in the number of call backs to the operating room for flow related issues or the incidence of venous thrombosis in the treated limb. CONCLUSION: ILI using ipsilateral popliteal venous access approach represents a simplified approach as exempli-
fied by a significant reduction in fluoroscopy time required for catheter insertion. The procedure modification is safe without an increase in adverse events. 5:00 PM
Abstract No. 167
Survival Benefits of Yttrium-90 Radioembolization (SIR-Spheres) for Hepatic Metastasis from Melanoma: Preliminary Study. R. Dhanasekaran1, V. Khanna1, D. Lawson2, K.A. Delman3, H.S. Kim1; 1Emory University School of Medicine - Division of Interventional Radiology and Image Guided Medicine, Department of Radiology, Atlanta, GA; 2 Emory University School of Medicine - Department of Hematology and Medical Oncology, Atlanta, GA; 3Emory University School of Medicine - Division of Surgical Oncology, Department of Surgery, Atlanta, GA. PURPOSE: To evaluate the clinical and radiological outcomes of transcatheter Yttrium-90 (Y-90) radioembolization in unresectable metastatic melanoma to liver.
CONCLUSION: Our preliminary study shows that Y-90 radioembolization for hepatic metastases of melanoma is feasible and may be associated with prolonged survival and longer progression free duration when compared to other transcatheter therapies. A significant positive correlation exists between progression-free duration and survival. 5:12 PM
Abstract No. 168
Treatment of Metastatic Neuroendocrine Tumors to the Liver with Yttrium-90 (Y90) Microspheres. R.J. Lewandowski1, M.F. Mulcahy2, A. Riaz1, R.K. Ryu1, K.T. Sato1, R. Omary1, R. Salem1,2; 1Northwestern University - Radiology, Chicago, IL; 2Northwestern University - Medicine, Chicago, IL.
RESULTS: The baseline demographics (n⫽40) and treatment characteristics are presented in the table below. At the patient level, 24 (68.6%) of 35 patients demonstrated partial response by WHO criteria. The median time to WHO response was 73 days (range: 24-264). Two (35%) patients had lesions that progressed after treatment and the estimated probability of progressing after treatment was 5.7%. 25 (71.4%) of the patients (n⫽35) showed partial response using the EASL criteria in the treated lesions and 10 (28.6%) showed complete response. Median hepatic progression-free survival (PFS) was not reached (95% CI: 34.4 mo, -). One year hepatic progression free survival was 78% (CI: 59%-89%). One year overall survival was 80.4% (CI: 61.2%-90.7%). CONCLUSION: The treatment of liver metastases from a primary NET using Y90 has favorable response rates and survivals. Randomized studies with TACE are warranted. Baseline Demographics of 40 Neuroendocrine Patients Median Age (Range) Gender N(%) Male Female ECOG N(%) 0 ⬎0 Extrahepatic Metastases Yes N(%) No ⬎4 Lesions N(%) Yes No Median Number of Treatments Median Dose to Treated Site (Gy) Median Dose to Lung (Gy)
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57.5 (27-85) 22 (55) 18 (45) 30 (75) 10 (25) 13 (32.5) 27 (67.5) 37 (92.5) 3 (7.5) 2 125 5.9
Abstract No. 169
Combined Sorafenib and Yttrium-90 Radioembolization in the Treatment of Advanced HCC: Preliminary Results. D.A. Valenti2, T. Cabrera2, A. Khankan2, M. Hassanain1, J. Bouteaud1, C. Nudo1, P. Chaudhury1, H. St-Amand2, P. Metrakos1; 1McGill University - HPB surgery, Montreal, QC, Canada; 2McGill University Radiology, Montreal, QC, Canada. PURPOSE: To evaluate the safety and tolerability of combining sorafenib with Yttrium-90 TheraSphere radio-embolisation (Y-90) in the treatment of unresctable hepato-cellular carcinoma (HCC). MATERIALS & METHODS: Consecutive eligible patients were enrolled from the McGill University Health Centre HCC Clinic from March 2008 to September 2008. Patients with HCC who were candidates for Y-90 therapy were eligible for the study. Patients began sorafenib (400 mg po BID) 6-8 weeks prior to Y-90 treatment. Sorafenib was continued post Y-90. The dose was adjusted if toxicity occurred. As per our standard protocol, all patients underwent diagnostic CT/MRI, hepatic arterial CT angiography, mesenteric angiography & Tc99m lung shunt study. Radiation dose was calculated according to the manufacturer’s guidelines, based on CT volume data of the S65
TUESDAY
RESULTS: Overall median survivals from the diagnosis of primary melanoma and from the diagnosis of liver metastases were 101.6 months (66.9-139.2) and 13.9 months (6.2-21.6). Median survival since the first transcatheter therapy was 8.1 months (0.0-20.63). Mean progression-free duration after the first embolization was 7.7 months (SD10.6). Mean and median survivals in patients treated with Y-90 radioembolization vs. transcatheter therapies from the diagnosis of metastases were 43.8 months (15.5 months) vs. 9.3 months (5.9 months) (p⫽0.04); from the transcatheter therapy were 27.3 months (10.9 months) vs. 6.1 months (2.1 months) (p⫽0.10). The duration of stable disease by RECIST criteria in patients treated with Y-90 vs. other-modes were 10.10 months vs. 2.30 months (p⫽0.04). Mean number of sessions of transcatheter therapy per person was 2.22 (range 1-9). Patients who received multiple treatment sessions showed significantly increased survival when compared to those who received single session (p⬍0.001). A positive correlation existed between progression-free duration and survival (p⫽0.05).
MATERIALS & METHODS: 40 patients with progressing liver disease on standard of care therapy (i.e.: Sandostatin) underwent radioembolization with Y90 for metastatic NET to the liver under an open label protocol. 35 patients (83 target lesions), had imaging prior to and following treatment. Response was determined using WHO size and EASL necrosis criteria. Kaplan-Meier was used to calculate the time to WHO response, hepatic time to progression (TTP) and hepatic progression-free survival (PFS).
Scientific Sessions
MATERIALS & METHODS: 18 patients with melanoma, who failed systemic therapy, were treated with transcatheter therapy for liver metastasis from 1998 to 2008. Among them 12 patients received Y-90 microspheres (SIR-Spheres) and 6 received conventional transcatheter chemoembolization and/or immunoembolization (GMCSF). The mean dose of Y-90 delivered was 57.58 mCi (SD 26.73).The patients were followed up clinically and with imaging (CT or MRI). RECIST criteria were used to assess the treatment response. Kaplan Meir estimator by log rank test and Cox Proportional Hazard model were used for survival analysis.
PURPOSE: To study Y90 radioembolization as a treatment in patients with metastatic neuroendocrine (NET) tumors to the liver.
Abstract No. 164
Partially PTFE-Covered Stent for Palliative Treatment of Malignant Biliary Obstruction. D. Gwon, G. Ko, K. Sung, H. Yoon, J. Kim, J. Shin, H. Song; Asan Medical Center, Seoul, South Korea. PURPOSE: To investigate the efficacy and safely of partially polytetrafluoroethylene (PTFE)-covered stents in patients with unresectable malignant biliary obstruction. MATERIALS & METHODS: From March 2006 to Jun 2008, 33 patients were treated by placement of partially PTFEcovered stents. The stent was available in lengths of 1, 2 or 3 cm for proximal bare extension which provides intrahepatic overstenting, and in a length of 1 or 1.5 cm for distal bare extension which can preserve the orifice of the pancreatic duct. The stricture was located in common hepatic duct (CHD) in eight patients, upper common bile duct (CBD) in 10 patients, and the lower CBD in 15 patients. RESULTS: In all cases, the partially PTFE-covered stents were successfully placed. The bilirubin level decrease was statistically significant before and after stent placement (p ⬍ 0.001), and all patients showed clinical improvement. The thirty-day mortality rate was 9% (three of 33 patients). The mean survival and stent patency times were 251.3 days (range, 102—289 days) and 260 days (range, 165—289 days), respectively. Cumulative stent patency rate were 95.8%, 95.8%, 86.3%, and 64.7% at three, six, nine, and 12 months, respectively. Three patients (9%) presented with stent occlusion and required repeat intervention. Acute cholecystitis and pancreatitis were not observed in any of the patients. Stent migration occurred in on patient (3%). CONCLUSION: Partially PTFE-covered stents are effective and safe for palliative treatment of malignant biliary obstructions. 4:36 PM
Abstract No. 165
Combined Regional Chemotherapy Versus Chemoembolization in Hepatic Tumor Model. S. Shin, Y. Do, S. Choo, K. Park, S. Cho, H. Park, I. Choo; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. PURPOSE: Transarterial chemotherapy alone has been considered less effective than transarterial chemoembolization (TACE) for treatment of hepatocellular carcinoma. We wanted to know that the addition of transportal chemotherapy to transarterial chemotherapy may exert any synergistic antitumor effects in the rabbit liver tumor model when compared with TACE. MATERIALS & METHODS: A total of 21 New Zealand white rabbits bearing VX2 liver tumors were divided into four groups: (a) transarterial group (TA, n⫽6) received a transarterial injection of doxorubicin (1 mg/body weight kg); (b) transarterial and transportal group (TAP, n⫽6) received injections of doxorubicin through both the hepatic artery (1 mg/kg) and the portal vein (1 mg/kg), thus receiving a total of 2 mg/kg of doxorubicin; (c) TACE group (n⫽6) received a transarterial injection of doxorubicin (1 mg/kg) followed by gelatin sponge embolization; (d) Control group (n⫽3) received no treatment. With the use of CT, tumor growth rates were calculated by comparing the tumor volumes before and at 7 days after each treatment. Microscopic exams were performed to evaluate the extent of tumor necrosis. S64
RESULTS: 7 days after treatment, tumor growth rates in each group were as follows: (1) 1.1%-349.8% (127.6% ⫾ 123.2, mean ⫾ SD) in TA group; (2) 46.8%-2841.8% (670.8% ⫾ 1076.9) in TAP group; (3) 0% in TACE group; (4) 72.9%-717.9% (432.9% ⫾ 329.0) in control group. Tumor growth of the TACE group was significantly prohibited than those of other groups (P⫽0.004 vs. the TA group, P⫽0.004 vs. the TAP group, and P⫽0.036 vs. the control group, respectively; Mann-Whitney U test) and there were no statistical differences in tumor growth between the TA, the TAP, and the control group (P⫽0.283, Kruskal-Wallis test). Tumors treated with TACE revealed massive necrosis involving both the peripheral and central regions of the tumors. In contrast, tumors of other groups consisted of numerous viable tumor cells and only partial necrosis after treatment. CONCLUSION: Transarterial chemotherapy, even combined with transportal chemotherapy appeared to be less effective than TACE in the rabbit liver VX2 tumor, in terms of tumor growth suppression and the induction of tumor necrosis. 4:48 PM
Abstract No. 166
Isolated Limb Infusion with Cytotoxic Agents: A Simplified Approach for Venous Access. A. Vyas2, R. Avritscher1, M. Ross1, M.J. Wallace1; 1University of Texas MD Anderson Cancer Center, Houston, TX; 2 Baylor College of Medicine, Houston, TX. PURPOSE: To report our experience with isolated limb infusion (ILI) using an original simplified ipsilateral venous access approach compared to the conventional contralateral approach. ILI is a technique, developed in the last 15 years, to treat cutaneous malignancy involving a single extremity. This regional therapy is predominantly used to treat advanced melanoma with in-transit metastases. MATERIALS & METHODS: Patients undergoing lower extremity ILI between October 2005 and June 2008 were retrospectively reviewed. The procedure entails percutaneous insertion of an arterial and venous catheter into the affected limb to allow for circulation of chemotherapeutic agent under ischemic, conditions. The originally reported technique involves the insertion of both arterial and venous catheters from the contralateral approach. A simplified ipsilateral popliteal venous access approach was compared to the original contralateral femoral venous approach with regards to overall fluoroscopy time and the number of callbacks to the operating room for flow related issues. All arterial catheters were inserted from the contralateral common femoral arterial approach. Adverse events were also recorded with particular attention to venous thrombosis of the treated limb. RESULTS: The study included 67 lower extremity ILI procedures in 62 patients (28 males and 34 females; aged 31-82 years). Fifty-nine patients had a history of melanoma. The contralateral and ipsilateral venous approaches were performed in 15 and 52 ILI procedures with mean fluoroscopy times of 17.9 and 8.3 minutes (p⫽0.0019), respectively. This difference was statistically significant, favoring the ipsilateral approach. There was no significant difference in the number of call backs to the operating room for flow related issues or the incidence of venous thrombosis in the treated limb. CONCLUSION: ILI using ipsilateral popliteal venous access approach represents a simplified approach as exempli-
fied by a significant reduction in fluoroscopy time required for catheter insertion. The procedure modification is safe without an increase in adverse events. 5:00 PM
Abstract No. 167
Survival Benefits of Yttrium-90 Radioembolization (SIR-Spheres) for Hepatic Metastasis from Melanoma: Preliminary Study. R. Dhanasekaran1, V. Khanna1, D. Lawson2, K.A. Delman3, H.S. Kim1; 1Emory University School of Medicine - Division of Interventional Radiology and Image Guided Medicine, Department of Radiology, Atlanta, GA; 2 Emory University School of Medicine - Department of Hematology and Medical Oncology, Atlanta, GA; 3Emory University School of Medicine - Division of Surgical Oncology, Department of Surgery, Atlanta, GA. PURPOSE: To evaluate the clinical and radiological outcomes of transcatheter Yttrium-90 (Y-90) radioembolization in unresectable metastatic melanoma to liver.
CONCLUSION: Our preliminary study shows that Y-90 radioembolization for hepatic metastases of melanoma is feasible and may be associated with prolonged survival and longer progression free duration when compared to other transcatheter therapies. A significant positive correlation exists between progression-free duration and survival. 5:12 PM
Abstract No. 168
Treatment of Metastatic Neuroendocrine Tumors to the Liver with Yttrium-90 (Y90) Microspheres. R.J. Lewandowski1, M.F. Mulcahy2, A. Riaz1, R.K. Ryu1, K.T. Sato1, R. Omary1, R. Salem1,2; 1Northwestern University - Radiology, Chicago, IL; 2Northwestern University - Medicine, Chicago, IL.
RESULTS: The baseline demographics (n⫽40) and treatment characteristics are presented in the table below. At the patient level, 24 (68.6%) of 35 patients demonstrated partial response by WHO criteria. The median time to WHO response was 73 days (range: 24-264). Two (35%) patients had lesions that progressed after treatment and the estimated probability of progressing after treatment was 5.7%. 25 (71.4%) of the patients (n⫽35) showed partial response using the EASL criteria in the treated lesions and 10 (28.6%) showed complete response. Median hepatic progression-free survival (PFS) was not reached (95% CI: 34.4 mo, -). One year hepatic progression free survival was 78% (CI: 59%-89%). One year overall survival was 80.4% (CI: 61.2%-90.7%). CONCLUSION: The treatment of liver metastases from a primary NET using Y90 has favorable response rates and survivals. Randomized studies with TACE are warranted. Baseline Demographics of 40 Neuroendocrine Patients Median Age (Range) Gender N(%) Male Female ECOG N(%) 0 ⬎0 Extrahepatic Metastases Yes N(%) No ⬎4 Lesions N(%) Yes No Median Number of Treatments Median Dose to Treated Site (Gy) Median Dose to Lung (Gy)
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57.5 (27-85) 22 (55) 18 (45) 30 (75) 10 (25) 13 (32.5) 27 (67.5) 37 (92.5) 3 (7.5) 2 125 5.9
Abstract No. 169
Combined Sorafenib and Yttrium-90 Radioembolization in the Treatment of Advanced HCC: Preliminary Results. D.A. Valenti2, T. Cabrera2, A. Khankan2, M. Hassanain1, J. Bouteaud1, C. Nudo1, P. Chaudhury1, H. St-Amand2, P. Metrakos1; 1McGill University - HPB surgery, Montreal, QC, Canada; 2McGill University Radiology, Montreal, QC, Canada. PURPOSE: To evaluate the safety and tolerability of combining sorafenib with Yttrium-90 TheraSphere radio-embolisation (Y-90) in the treatment of unresctable hepato-cellular carcinoma (HCC). MATERIALS & METHODS: Consecutive eligible patients were enrolled from the McGill University Health Centre HCC Clinic from March 2008 to September 2008. Patients with HCC who were candidates for Y-90 therapy were eligible for the study. Patients began sorafenib (400 mg po BID) 6-8 weeks prior to Y-90 treatment. Sorafenib was continued post Y-90. The dose was adjusted if toxicity occurred. As per our standard protocol, all patients underwent diagnostic CT/MRI, hepatic arterial CT angiography, mesenteric angiography & Tc99m lung shunt study. Radiation dose was calculated according to the manufacturer’s guidelines, based on CT volume data of the S65
TUESDAY
RESULTS: Overall median survivals from the diagnosis of primary melanoma and from the diagnosis of liver metastases were 101.6 months (66.9-139.2) and 13.9 months (6.2-21.6). Median survival since the first transcatheter therapy was 8.1 months (0.0-20.63). Mean progression-free duration after the first embolization was 7.7 months (SD10.6). Mean and median survivals in patients treated with Y-90 radioembolization vs. transcatheter therapies from the diagnosis of metastases were 43.8 months (15.5 months) vs. 9.3 months (5.9 months) (p⫽0.04); from the transcatheter therapy were 27.3 months (10.9 months) vs. 6.1 months (2.1 months) (p⫽0.10). The duration of stable disease by RECIST criteria in patients treated with Y-90 vs. other-modes were 10.10 months vs. 2.30 months (p⫽0.04). Mean number of sessions of transcatheter therapy per person was 2.22 (range 1-9). Patients who received multiple treatment sessions showed significantly increased survival when compared to those who received single session (p⬍0.001). A positive correlation existed between progression-free duration and survival (p⫽0.05).
MATERIALS & METHODS: 40 patients with progressing liver disease on standard of care therapy (i.e.: Sandostatin) underwent radioembolization with Y90 for metastatic NET to the liver under an open label protocol. 35 patients (83 target lesions), had imaging prior to and following treatment. Response was determined using WHO size and EASL necrosis criteria. Kaplan-Meier was used to calculate the time to WHO response, hepatic time to progression (TTP) and hepatic progression-free survival (PFS).
Scientific Sessions
MATERIALS & METHODS: 18 patients with melanoma, who failed systemic therapy, were treated with transcatheter therapy for liver metastasis from 1998 to 2008. Among them 12 patients received Y-90 microspheres (SIR-Spheres) and 6 received conventional transcatheter chemoembolization and/or immunoembolization (GMCSF). The mean dose of Y-90 delivered was 57.58 mCi (SD 26.73).The patients were followed up clinically and with imaging (CT or MRI). RECIST criteria were used to assess the treatment response. Kaplan Meir estimator by log rank test and Cox Proportional Hazard model were used for survival analysis.
PURPOSE: To study Y90 radioembolization as a treatment in patients with metastatic neuroendocrine (NET) tumors to the liver.