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. 2022 Oct 17;11(6):e220130.
doi: 10.1530/ETJ-22-0130. Print 2022 Dec 1.

Yttrium-90 transarterial radioembolization for liver metastases from medullary thyroid cancer

Luciana Puleo  1 , Laura Agate  1 , Irene Bargellini  2 , Giuseppe Boni  3 , Paolo Piaggi  1 , Claudio Traino  3 , Tommaso Depalo  3 , Giulia Lorenzoni  2 , Francesca Bianchi  3 , Duccio Volterrani  3 , Sandra Brogioni  1 , Valeria Bottici  1 , Maurizia Rossana Brunetto  4 , Barbara Coco  4 , Eleonora Molinaro  1 , Rossella Elisei  1
Affiliations

Yttrium-90 transarterial radioembolization for liver metastases from medullary thyroid cancer

Luciana Puleo et al. Eur Thyroid J. .

Abstract

Objectives: Liver metastases occur in 45% of patients with advanced metastatic medullary thyroid cancer (MTC). Transarterial radioembolization (TARE) has been proposed to treat liver metastases (LM), especially in neuroendocrine tumors. The aim of this study was to investigate the biochemical (calcitonin and carcino-embryonic antigen) and objective response of liver metastases from MTC to TARE.

Methods: TARE is an internal radiotherapy in which microspheres loaded with β-emitting yttrium-90 (90Y) are delivered into the hepatic arteries that supply blood to LM. Eight patients with progressive multiple LM underwent TARE and were followed prospectively. They were clinically, biochemically and radiologically evaluated at 1, 4, 12 and 18 months after TARE.

Results: Two patients were excluded from the analysis due to severe liver injury and death due to extrahepatic disease progression, respectively. One month after TARE, a statistically significant (P = 0.02) reduction of calcitonin was observed in all patients and remained clinically relevant during follow-up; reduction of CEA, although not significant, was found in all patients. Significant reduction of liver tumor mass was observed 1, 4 and 12 months after TARE (P = 0.007, P = 0.004, P = 0.002, respectively). After 1 month, three of six patients showed partial response (PR) and three of six stable disease (SD) according to RECIST 1.1, while five of six patients had a PR and one of six a SD according to mRECIST. The clinical response remained relevant 18 months after TARE. Excluding one patient, all others showed only a slight and transient increase in liver enzymes.

Conclusions: TARE is effective in LM treatment of MTC. The absence of severe complications and the good tolerability make TARE a valid therapeutic strategy when liver LM are multiple and progressive.

Keywords: SIRT; TARE; liver metastases; medullary thyroid cancer; yttrium-90.

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Figures

Figure 1
Figure 1
Trend of serum Ct before, 1 month (A) and 18 months (B) after TARE in six patients with an 18 months follow-up.
Figure 2
Figure 2
Trend of serum CEA before, 1 month (A) and 18 months (B) after TARE in six patients with an 18 months follow-up.
Figure 3
Figure 3
Trend of hepatic tumor volume (HTV) before and during the follow-up after TARE (error bars show geometric means with 95% CI).
Figure 4
Figure 4
Response of liver metastases to TARE treatment according to RECIST 1.1 (A) and mRECIST (B).
Figure 5
Figure 5
CT scan images of a patient with liver metastases of MTC in the right hepatic lobe before (A) and 1 month after TARE (B). CR was documented according to mRECIST.
See this image and copyright information in PMC

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