CASE REPORT Superselective Internal Radiation With Yttrium-90 Microspheres in the Management of a Chemorefractory Testicular Liver Metastasis Panagiotis A. Sideras • Constantinos T. Sofocleous • Lynn A. Brody • Robert H. Siegelbaum • Rajesh P. Shah • Neeta-Pandit Taskar Received: 3 May 2011 / Accepted: 25 June 2011 / Published online: 20 July 2011 Ó Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2011 Abstract We treated a patient with biopsy-proven, che- motherapy-resistant testicular cancer liver metastasis using Y-90 selective internal radiation treatment. We chose yttrium-90 rather than surgery and ablation due to tumor location and size as well as the patient’s clinical history. The result was marked tumor response by positron emis- sion tomography and computed tomography as well as significant improvement of the patient’s quality of life accompanied by a substantial decrease of his tumor markers. Keywords Interventional Oncology Á Intraarterial Á Radioembolization Á Hepatic Á Urogenital Á Neoplasm Introduction Yttrium-90 (Y-90) selective internal radiation therapy can have a potential role in treatment of chemotherapy resistant nonseminomatous germ cell tumor (NSGCT) hepatic metastases. Case Report A 52-year-old man presented with persistent symptoms of upper-respiratory infection and severe fatigue. Routine laboratory work demonstrated a profound increase of his liver enzymes. Ultrasonography showed diffuse liver lesions, and fine-needle aspiration–diagnosed metastatic NSGCT composed primarily of choriocarcinoma with a minute focus of teratoma. Scrotal ultrasound identified a right testicular mass, and further staging with computed tomography (CT) found several subcentimeter lung lesions, splenic lesions, enlarged retroperitoneal lymph nodes, and multiple bilobar liver metastases. The patient’s serum a-fetoprotein (AFP) level was 86,000 ng/ml, and the human chorionic gonadotropin (b-hCG) level was 20,000 IU/l. The patient presented initially in 2001 and was treated with cisplatin-based chemotherapy and interim right orchiectomy, resulting in resolution of most metastases with the exception of few retroperitoneal lymph nodes and some of the liver metastases. Sequential follow-up with chemo- therapy treatments resulted in good response. He was fol- lowed-up with sequential imaging, which showed a residual small amount of hepatic disease. In 2009, after he had had three cisplatin-based chemotherapy cycle failures, sub- sequent chemotherapy with paclitaxel gemcitabine and oral etoposide successfully normalized tumor markers; there also was CT resolution of all previous disease sites with the exception of a solitary, peripheral lesion in hepatic segment VI that continued to progress. A multidisciplinary team consisting of the patient’s oncologist, a hepatobiliary sur- geon, and an interventional radiologist deemed the patient a poor candidate for metastasectomy due to his previous history of multifocal liver lesions and the high risk for the development of new metastases or progression of the pre- viously treated lesions. Ablation was considered, but the relatively large size (52 9 37 9 48 mm) and subcapsular location (Fig. 1A, B) of the metastasis made ablation with clear margins unlikely. Y-90 microsphere selective internal radiation therapy (SIRT) was considered and deemed as the best option for this patient. Angiography and mapping using C-arm CT and CT arteriography confirmed arterial supply P. A. Sideras Á C. T. Sofocleous (&) Á L. A. Brody Á R. H. Siegelbaum Á R. P. Shah Á N.-P. Taskar Memorial Sloan Kettering Cancer Center, 410, E68th Street, New York, NY 10065, USA e-mail: sofoclec@mskcc.org 123 Cardiovasc Intervent Radiol (2012) 35:426–429 DOI 10.1007/s00270-011-0226-7