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Reuters Health Information (2013-07-30): High LFTs common after intra-arterial radioembolization for liver metastases


High LFTs common after intra-arterial radioembolization for liver metastases

Last Updated: 2013-07-30 11:20:02 -0400 (Reuters Health)

NEW YORK (Reuters Health) - More than a third of patients have abnormal liver function tests (LFTs) after intra-arterial radioembolization of unresectable liver metastases with 90Y microspheres, although severe clinical complications are uncommon, researchers from the Netherlands report.

Post-embolization syndrome (fatigue, nausea, vomiting, abdominal pain, loss of appetite and fever) and radiation-induced liver disease (RILD) can occur after radioembolization with 90Y microspheres. But relatively little is known about the expected range of lab toxicities in patients who do not develop RILD.

Dr. Maurice van den Bosch and colleagues from University Medical Center Utrecht reviewed data on 59 patients treated with 90Y radioembolization outside of clinical trials.

Most patients (30/59, 51%) had colorectal cancer liver metastases, six (10%) had neuroendocrine tumor liver metastases and 23 (39%) had metastases from various other primary tumors, according to the report online July 24 in PLoS ONE.

Thirty-eight patients (64%) received a whole liver treatment in one session, 10 patients (17%) received whole liver treatment in sequential sessions, and 11 patients (19%) received unilobar treatment.

There were 11 periprocedural complications (six allergic reactions, two arterial dissections, one nausea/vomiting, one delayed hemostasis at the access site, and one inguinal hematoma at the access site), but none of them prevented patients from receiving therapy.

Most patients had grade 1-2 clinical symptoms associated with post-embolization syndrome, but there were no reports of grade 3-4 toxicity and no serious treatment-related complications (duodenal or gastric ulceration, radiation pneumonitis or RILD).

Eleven patients were excluded from the lab analysis due to missing baseline or follow-up investigations. More than a third of the remaining patients (18/47, 38%) experienced new-onset grade 3-4 lab toxicity, including significant elevations in gamma-glutamyl transferase (27%), alkaline phosphatase (21%), bilirubin, aspartate aminotransferase, alanine aminotransferase, and albumin (2% each).

Grade 3-4 laboratory toxicity affected 10 of 28 patients who received whole liver treatment in one session, five of 10 patients who received whole liver treatment in sequential sessions, and three of 10 patients who received unilobar treatment.

At three months post-treatment, target lesion, whole liver and overall disease control rates were 35%, 21%, and 19%, respectively, and median overall survival for the entire group was 8.9 months.

Median time to progression was 6.2 months for target lesions, 3.3 months for the whole liver, and 3 months overall.

Because of the study's retrospective design and the lack of standardization of lab investigations and reporting of clinical symptoms during physical examination, the researchers say, "our results in terms of the incidence of laboratory or clinical toxicity are likely to be underestimations of the real incidence of toxicity."

Dr. van den Bosch was unavailable for comments on the findings.


PLoS ONE 2013.

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