Is TARE an Effective Palliative Treatment for Hepatic Soft Tissue Sarcoma?
When treated with yttrium-90 (Y90) transarterial radioembolization (TARE), patients with hepatic soft tissue sarcoma (STS) of the liver had high rates of demonstrated disease control, as well as a median overall survival of 30 months.
Although Y-90 TARE is accepted as an effective treatment for hepatocellular carcinoma and for metastatic disease of the liver, little research has thus far been conducted on the potential of TARE for treatment of hepatic STS. To investigate further, the researchers undertook a multicenter, retrospective study that reviewed data from 39 patients with primary (2 patients) and metastatic (37 patients) hepatic STS who were treated with TARE. The study included 4 institutions and 14 subtypes of STS, though leiomyosarcoma was the subtype in 51% of the study patients.
There were 22 patients who received TARE with glass microspheres and 17 with resin microspheres. Seventeen patients received single-lobe treatment and 22 patients received bilobar disease treatment.
Results showed a complete or partial response to therapy in 14 patients, with an objective response rate of 36%. Disease control was defined as either stable disease or response to treatment, and 30 patients were found to be in that category. For all patients, there was a median overall survival of 30 months.
Additionally, there was an association with disease control at 3 months with an increased overall survival (44 months) compared with progressive disease (5 months). This was similarly seen in patients with disease control at 6 months, as they had an increased median overall survival (38 months) compared with patients with progressive disease (17 months).
Reported adverse events included 1 liver abscess, 1 gastric ulceration, and 1 pneumonitis.
“The difference in median overall survival in patients treated with glass microspheres compared to patients treated with resin microspheres is of uncertain clinical implication,” the researchers commented. “Although the results suggest that glass microspheres are superior to resin microspheres for treatment of STS metastatic to the liver, given the small size of the patient cohort, this study is likely statistically underpowered to make definitive conclusions.”
They concluded that “patients with hepatic STS demonstrated a median 30-month overall survival after TARE, with a favorable side effect profile and a 36% response rate. These results suggest that TARE can be considered as a possible palliative treatment for patients with liver-dominant disease.”
Response and overall survival for yttrium-90 radioembolization of hepatic sarcoma: a multicenter retrospective study. J Vasc Intervent Radiol. 30 April 2018. Epub ahead of print. doi: https://doi.org/10.1016/j.jvir.2018.01.775.