Salvage Radioembolization of Liver-dominant Metastases with a Resin-based Microsphere: Initial Outcomes Jourdan E. Stuart, BS, Benjamin Tan, MD, Robert J. Myerson, MD, PhD, Jose Garcia-Ramirez, PhD, Sreekrishna M. Goddu, PhD, Thomas K. Pilgram, PhD, and Daniel B. Brown, MD PURPOSE: The use of radioembolization of hepatic metastases with yttrium-90 ( 90 Y) microspheres is increasing. The present report describes the outcomes in a cohort of patients with metastatic liver tumors treated with a resin-based microsphere agent. MATERIALS AND METHODS: Thirty patients with colon (n  13), breast (n  7), and other primary cancers (n  10) were treated after the failure of first- and second-line therapy. Overall survival (OS), time to progression (TTP), and time to treatment failure (TTTF) were calculated from the first treatment. Response was measured according to Response Evaluation Criteria In Solid Tumors at interval follow-up imaging. RESULTS: Thirty patients underwent 56 infusions of 90 Y, and 18 remained alive at the end of the study. Fourteen patients (47%) had a partial response or stable disease. OS (604 vs 251 days), TTP (223 vs 87 days), and TTTF (363 vs 87 days) were all significantly longer for patients who had a partial response or stable disease (P < .05). Median OS, TTP, and TTTF for patients with colorectal carcinoma were 357, 112, and 107 days, respectively, versus 638, 118, and 363 days in patients with other metastatic sources. Median survival was not reached for patients with breast carcinoma, and the TTP and TTTF were each 282 days. One patient (3%) experienced grade 3 toxicity (gastrointestinal ulceration). CONCLUSIONS: 90 Y microsphere therapy produced promising survival rates compared with systemic salvage options, with minimal toxicity. J Vasc Interv Radiol 2008; 19:1427–1433 Abbreviations: OS = overall survival, TTTF = time to treatment failure, TTP = time to progression MORE than 60% of patients with meta- static breast or colorectal cancer will de- velop hepatic metastases (1,2). Although outcomes with newer chemotherapeutic and targeted antineoplastic regimens for patients with unresectable metastatic disease have improved during the past decade, long-term survival with these treatments remains poor. Disease pro- gression after salvage therapy confers a dismal prognosis. Hepatic failure sec- ondary to metastatic disease is the cause of death in 20% of all patients with breast cancer and 60% of patients with breast cancer with metastatic disease (3– 5). The reported median survival times for patients with breast cancer with liver metastases vary widely, ranging from 3 to 16 months (6). Liver metastases from colon cancer are an even greater source of morbidity and mortality. Tumor-re- lated liver failure causes as many as 90% of all deaths from metastatic colorectal cancer (7). First-line treatment of meta- static colorectal cancer has shown re- sponse rates between 30 and 55%, with rates precipitously decreasing for sec- ond-line therapy (5%–25%) (8). Median survival times for patients receiving sec- ond-line regimens with irinotecan or oxaliplatin for colorectal cancer are only 8 –12 months (9 –14). In patients with liver-dominant disease who have un- dergone failed polychemotherapy with or without targeted agents, therapies re- sulting in local control of liver disease may be the only option to provide symptomatic relief and potentially pro- long survival (15). Interventional radiology techniques such as hepatic artery chemoemboliza- tion and chemotherapeutic agent infu- sion have historically been used for salvage therapy in this patient group. These methods have demonstrated control of liver disease by limiting pro- From the Department of Medicine, Division of On- cology (B.T., J.G.R., S.M.G.), Department of Radia- tion Oncology (R.J.M.), Mallinckrodt Institute of Ra- diology (T.K.P., D.B.B.), and Siteman Cancer Center (B.T., R.J.M., J.G.R., S.M.G., D.B.B.), Washington University School of Medicine (J.E.S.), St. Louis, Missouri. Received December 20, 2007; final revision received July 3, 2008; accepted July 14, 2008. Ad- dress correspondence to D.B.B., Interventional Ra- diology, Thomas Jefferson University Hospital, 132 S. 10th St., Suite 766 Main Building, Philadelphia, PA 19107; E-mail: daniel.brown@jefferson.edu None of the authors have identified a conflict of interest. © SIR, 2008 DOI: 10.1016/j.jvir.2008.07.009 1427