Transarterial Radioembolization With Y90 in Pediatric Patients
Transarterial radioembolization with yttrium-90 (TARE-Y90) of unresectable primary liver malignancy demonstrates an anticancer effect and could be used as adjunctive therapy in pediatric patients with unresectable hepatic malignancies. A new study published in Pediatric Blood & Cancer found that TARE-Y90 could be used as a bridge to surgical resection or liver transplant in these patients although more research is required to determine how effective this treatment is in children.
The retrospective review included 10 pediatric patients with histologically confirmed primary liver malignancy who received treatment with TARE-Y90 between January 2011 and April 2017 at Cincinnati Children's Hospital. Inclusion criteria included ≤ 18 years of age at the time of initial consultation, had a histologically confirmed hepatic malignancy, and received treatment with TARE-Y90.
At the time of treatment median age was 5.5 years (range, 2-18 years). From initial diagnosis the median patient survival was 12.5 months (range, 10-28 months), and after treatment with TARE-Y90 the median patient survival was 4 months (range, 2-20 months).
In the 3 of 10 patients who tolerated retreatment, the longest survival times (range, 17-20 months) were demonstrated. One patient was transplanted 6 weeks after TARE-Y90. By RECIST 1.1, 8 of 9 patients had stable disease, and 1 of 9 had progressive disease. By mRECIST criteria (requiring postcontrast arterial phase imaging), 2 of 7 patients had a partial response, 4 of 7 had stable disease, and 1 of 7 had progressive disease.
“Management of pediatric primary liver tumors has advanced in recent years, but options are limited in children and adolescents with chemorefractory, unresectable tumors. TARE-Y90 offers the ability to provide radiation doses to the tumor that cannot be delivered with external beam radiation due to potential organ toxicity,” the authors said. “We have shown that TARE-Y90 of unresectable liver malignancy in children is both technically feasible and demonstrates an anticancer effect, and retreatment is well tolerated. The optimal defined uses remain unclear, but TARE-Y90 could be considered for palliation when other options are not available. For most pediatric patients, TARE-Y90 was safe and very well tolerated at full doses analogous to those used in adult patients.”
Aguado A, Ristagno R, Towbin AJ, et al. Transarterial radioembolization with yttrium-90 of unresectable primary hepatic malignancy in children. Pediatr Blood Cancer. 2018:e27510. doi: 10.1002/pbc.27510. [Epub ahead of print].