A descriptive analysis of the characteristics, treatment response and prognosis of hepatic dominant solid tumors undergoing selective internal radiation therapy (SIRT)

Benedict Gosztonyi; Bernhard Pestalozzi; David Kenkel; Ivette Engel-Bicik; Philipp A Kaufmann; Valerie Treyer; Alexander R Siebenhüner

doi:10.21037/jgo-22-122

A descriptive analysis of the characteristics, treatment response and prognosis of hepatic dominant solid tumors undergoing selective internal radiation therapy (SIRT)

J Gastrointest Oncol. 2022 Dec;13(6):3240-3253. doi: 10.21037/jgo-22-122.

Authors

Benedict Gosztonyi^{1

2}, Bernhard Pestalozzi^{1

2}, David Kenkel³, Ivette Engel-Bicik³, Philipp A Kaufmann^{1

3}, Valerie Treyer^{1

3}, Alexander R Siebenhüner^{1

2

4}

Affiliations

¹ University of Zurich, Zurich, Switzerland.
² Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland.
³ Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.
⁴ Cantonal Hospital Schaffhausen, Schaffhausen, Switzerland.

Abstract

Background: Selective internal radiotherapy is widely used for liver dominant diseases of solid tumors. However, data about sequential treatment and prognostic factors are lacking.

Methods: We consecutively included all 209 patients who received a selective internal radiotherapy intervention between January 2015 and May 2019. A retrospective analysis of their electronic patient records was performed regarding diagnosis of cancer, previous therapies and applied radioactive activity. A multicenter follow-up at least 6 weeks after intervention to assess radiological response and irregular subsequent follow-ups to asses disease progression were conducted. In addition, subgroup analyses were carried out.

Results: The most frequently treated indications were hepatocellular carcinoma (37%), colorectal cancers (14%), neuroendocrine tumors (9%), and breast cancer (8%). In hepatocellular carcinoma, selective internal radiotherapy was most performed without prior systemic therapy (40%), and for the remaining indications, most often after surgery with systemic therapy in sequence. Local radiological response, defined as either regression or stable disease, was assessed at least 6 weeks after intervention and showed 52% across all indications. Hepatocellular carcinoma (59%) and breast cancer (67%) showed an excellent, colorectal cancers (29%) a particularly poor response rate. Neuroendocrine tumors showed the third longest median post-selective internal radiation therapy (SIRT) survival with 12.4 months and the second longest median progression-free time with 5.2 months. Hepatocellular carcinoma showed even better results with a post-SIRT survival of 15.7 months and a median progression-free time of 5.3 months. Pancreatic neuroendocrine tumors showed significantly worse outcomes than other neuroendocrine tumors, regarding median post-SIRT survival and median progression-free time. No relevant SIRT related differences among sexes were detected.

Conclusions: Patients with neuroendocrine tumors, breast cancer in late therapy lines and early-stage hepatocellular carcinoma seem to show better responses to SIRT than other entities. Colorectal cancers were mainly treated with SIRT in a second or third therapy line but with considerably weaker results than other entities.

Keywords: Selective internal radiation therapy (SIRT); liver metastases; primary liver tumors.