• breast cancer
• disease control rate
• glass
• objective response rate
• prognosis
• radioembolization
• resin
• survival

• Humans
• Liver Neoplasms/secondary
• Liver Neoplasms/radiotherapy
• Breast Neoplasms/pathology
• Breast Neoplasms/radiotherapy
• Female
• Embolization, Therapeutic/methods
• Treatment Outcome
• Yttrium Radioisotopes/therapeutic use

• Female
• Humans
• Breast Neoplasms/pathology
• Nuclear Medicine
• Positron Emission Tomography Computed Tomography/methods
• Radiopharmaceuticals/therapeutic use
• Radionuclide Imaging

• RECIST
• breast cancer
• interventional radiology
• liver metastases
• radioembolization
• yttrium

Our purpose was to retrospectively evaluate the safety and efficacy of transarterial hepatic radioembolization (TARE) treatment with yttrium-90 labeled glass microspheres in patients with chemotherapy-refractory breast cancer with liver-dominant metastatic disease.

This retrospective single-institution study evaluated 31 female patients (mean age of 59.6 ± 13.2 years) who were treated with TARE. All patients received and progressed on systemic chemotherapy before TARE. Twenty-one patients also had extrahepatic metastases, including 13 patients who had metastases in bones only besides the liver. Survival data were analyzed by Kaplan-Meier method and compared using log-rank test. Imaging response to treatment was determined by Response Evaluation Criteria in Solid Tumors.

Median overall survival (OS) from the TARE was 13 months (95% confidence interval, 9.1-16.9 months). The survival probability at 1, 2, and 3 years was 60.1%, 36.7%, and 24.5%, respectively. The median hepatic progression-free survival was 7 months (95% confidence interval, 6.1-7.9 months). There was no 30-day mortality and 3 patients (9.4%) had grade 3 toxicity. Estrogen receptor (ER) positive status predicted prolonged survival (14 months for ER+ vs 9 months for ER-; P = .028). Patients who had bone-only extrahepatic disease had higher OS than patients with extraosseous metastases (23 vs 8 months, P = .02). At the 3-month follow-up the radiographic objective response rate was 46.6% and disease control rate was 70%.

The treatment of patients with liver-dominant chemotherapy-refractory breast cancer metastases with TARE using yttrium-90 labeled glass microspheres is safe and led to promising hepatic disease control and OS especially in patients with ER+ tumors and in patients without extrahepatic extraosseous metastases.

The liver is the second most common site of breast cancer metastasis. Liver directed therapies including hepatic resection, radiofrequency ablation (RFA), transarterial chemo- and radioembolization (TACE/TARE), and hepatic arterial infusion (HAI) have been scarcely researched for breast cancer liver metastasis (BCLM). The purpose of this review is to present the known body of literature on these therapies for BCLM.

A systematic review was performed with pre-specified search terms using PubMed, MEDLINE, EMBASE, and Cochrane Review resulting in 9,957 results. After review of abstracts and application of exclusion criteria, 51 studies were included in this review.

Hepatic resection afforded the longest median overall survival (mOS) and 5-year survival (45 mo, 41%) across 23 studies. RFA was presented in six studies with pooled mOS and 5-year survival of 38 mo and 11–33%. Disease burden and tumor size was lower amongst hepatic resection and RFA patients. TACE was presented in eight studies with pooled mOS and 1-year survival of 19.6 mo and 32–88.8%. TARE was presented in 10 studies with pooled mOS and 1-year survival of 11.5 mo and 34.5–86%. TACE and TARE populations were selected for chemo-resistant, unresectable disease. Hepatic arterial infusion was presented in five studies with pooled mOS of 11.3 months.

Although further studies are necessary to delineate appropriate usage of liver directed therapies in BCLM, small studies suggest hepatic resection and RFA, in well selected patients, can result in prolonged survival. Longitudinal studies with larger cohorts are warranted to further investigate the effectiveness of each modality.

• breast cancer liver metastasis
• hepatic resection
• liver directed therapies
• radiofrequency ablation
• transarterial chemoembolization
• transarterial radioembolization

• ablation
• breast cancer
• chemoembolization
• hepatic metastasis
• locoregional
• radioembolization

Liver metastases secondary to breast cancer are associated with unfavourable prognosis. Radioembolization with ytrrium-90 is an emerging option for management of liver metastases of breast cancer when other systemic therapies have failed to achieve disease control. However, unlike the case of other liver tumours (colorectal/melanoma metastases/cholangiocarcinoma), its role in the management of breast liver metastases is yet to be elucidated.

The aims of this systematic review were to (1) assess the effect of radioembolization with yttrium-90 on tumour response; and (2) to estimate patient survival post radioembolization.

The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A systematic literature search was performed using the PubMed and EMBASE databases from January 2007 to December 2018. The initial search yielded 265 reports which were potentially suitable for inclusion in this review. Studies published in English reporting at least one outcome of interest were considered to be suitable for inclusion. Conference abstracts; case reports, animal studies and reports not published in English were excluded from this review. Data was retrieved from each individual report on the name of primary author, year of publication, patient demographics, type of microspheres used, radiation dose delivered to tumour, duration of follow-up, disease control rate (%), tumour response, and overall patient survival.

The final number of studies which met the inclusion criteria was 12 involving 452 patients. There were no randomized controlled trials identified after the literature search. The age of the patients included in this review ranged from 52 to 61 years. The duration of the follow up period post-radioembolization ranged from 6 to 15.7 mo. The total number of patients with breast metastases not confined to the liver was 236 (52.2%). Cumulative analysis revealed that radioembolization with yttrium-90 conferred tumour control rate in 81% of patients. Overall survival post-radioembolization ranged from 3.6 to 20.9 mo with an estimated mean survival of 11.3 mo.

Radioembolization with ytrrium-90 appears to confer control of tumour growth rate in most patients, however its effect on patient survival need to be elucidated further. Furthermore, quality evidence in the form of randomized trials is needed in order to assess the effect of radioembolization in more depth.

• Breast cancer
• Liver metastases
• Yttrium-90
• Radioembolization
• Survival

The aim of the study was to evaluate the safety and feasibility of intra-arterial mitomycin C (MMC) infusion after selective internal radiation therapy (SIRT) using Yttrium-90 (⁹⁰Y) resin microspheres in liver metastatic breast cancer (LMBC) patients.

The prospective pilot study included LMBC patients from 2012–2018. Patients first received infusion of ⁹⁰Y resin microspheres, after 6–8 weeks response to treatment was assessed by MRI, ¹⁸F-FDG PET/CT and laboratory tests. After exclusion of progressive disease, MMC infusion was administrated 8 weeks later in different dose cohorts; A: 6 mg in 1 cycle, B: 12 mg in 2 cycles, C: 24 mg in 2 cycles and D: maximum of 72 mg in 6 cycles. In cohort D the response was evaluated after every 2 cycles and continued after exclusion of progressive disease. Adverse events (AE) were reported according to CTCAE version 5.0.

Sixteen patients received ⁹⁰Y treatment. Four patients were excluded for MMC infusion, because of extra hepatic disease progression (n = 3) and clinical and biochemical instability (n = 1). That resulted in the following number of patient per cohort; A: 2, B: 1, C: 3 and D: 6. In 4 of the 12 patients (all cohort D) the maximum dose of MMC was adjusted due biochemical toxicities (n = 2) and progressive disease (n = 2). One grade 3 AE occurred after ⁹⁰Y treatment consisting of a gastrointestinal ulcer whereby prolonged hospitalization was needed.

Sequential treatment of intra-arterial infusion of MMC after ⁹⁰Y SIRT was feasible in 75% of the patients when MMC was administrated in different escalating dose cohorts. However, caution is needed to prevent reflux after ⁹⁰Y SIRT in LMBC patients.

• chemo resistant
• intra-arterial therapy
• liver metastatic breast cancer
• mitomycin C infusion
• radioembolization
• selective internal radiation therapy

• Liver-directed therapy
• SIRT
• Selective internal radiation therapy
• Transarterial radioembolization

• chemoembolization
• interventional radiology
• liver metastases
• locoregional therapy
• radioembolization
• thermal ablation

To evaluate prognostic values of clinical and diffusion-weighted magnetic resonance imaging-derived intravoxel incoherent motion (IVIM) parameters in patients undergoing primary radioembolization for metastatic breast cancer liver metastases.

A total of 21 females (mean age 54 years, range 43–72 years) with liver-dominant metastatic breast cancer underwent standard liver magnetic resonance imaging (1.5 T, diffusion-weighted imaging with b-values of 0, 50, and 800 s/mm²) before and 4–6 weeks after radioembolization. The IVIM model-derived estimated diffusion coefficient D’ and the perfusion fraction f’ were evaluated by averaging the values of the two largest treated metastases in each patient. Kaplan–Meier and Cox regression analyses for overall survival (OS) were performed. Investigated parameters were changes in f’- and D’-values after therapy, age, sex, Eastern Cooperative Oncology Group (ECOG) status, grading of primary tumor, hepatic tumor burden, presence of extrahepatic disease, baseline bilirubin, previous bevacizumab therapy, early stasis during radioembolization, chemotherapy after radioembolization, repeated radioembolization and Response Evaluation Criteria in Solid Tumors (RECIST) response at 6-week follow-up.

Median OS after radioembolization was 6 (range 1.5–54.9) months. In patients with therapy-induced decreasing or stable f’-values, median OS was significantly longer than in those with increased f’-values (7.6 [range 2.6–54.9] vs 2.6 [range 1.5–17.4] months, P<0.0001). Longer median OS was also seen in patients with increased D’-values (6 [range 1.6–54.9] vs 2.8 [range 1.5–17.4] months, P=0.008). Patients with remission or stable disease (responders) according to RECIST survived longer than nonresponders (7.2 [range 2.6–54.9] vs 2.6 [range 1.5–17.4] months, P<0.0001). An ECOG status ≤1 resulted in longer median OS than >1 (7.6 [range 2.6–54.9] vs 1.7 [range 1.5–4.5] months, P<0.0001). Pretreatment IVIM parameters and the other clinical characteristics were not associated with OS. Classification by f’-value changes and ECOG status remained as independent predictors of OS on multivariate analysis, while RECIST response and D’-value changes did not predict survival.

Following radioembolization of breast cancer liver metastases, early changes in the IVIM model-derived perfusion fraction f’ and baseline ECOG score were predictive of patient outcome, and may thus help to guide treatment strategy.

• DWI
• IVIM
• MRI
• breast cancer
• radioembolization
• selective internal radiation therapy

• breast cancer
• hepatic metastases
• radioembolization
• survival

• Breast cancer
• Embolization
• Intra-arterial therapy
• Liver
• Melanoma
• Neuroendocrine

• advanced
• liver
• metastases
• pancreas
• radioembolization
• sirt

• Aged
• Antimetabolites, Antineoplastic/therapeutic use
• Combined Modality Therapy/methods
• Female
• Fluorouracil/therapeutic use
• Humans
• Liver Neoplasms/diagnosis
• Liver Neoplasms/drug therapy
• Liver Neoplasms/radiotherapy
• Liver Neoplasms/secondary
• Male
• Middle Aged
• Pancreatic Neoplasms/diagnosis
• Pancreatic Neoplasms/drug therapy
• Pancreatic Neoplasms/radiotherapy
• Prospective Studies
• Yttrium Radioisotopes/administration & dosage
• Pancreatic Neoplasms

The liver is a common site of metastasis, with essentially all metastatic malignancies having been known to spread to the liver. Nearly half of all patients with extrahepatic primary cancer have hepatic metastases. The severe prognostic implications of hepatic metastases have made surgical resection an important first line treatment in management. However, limitations such as the presence of extrahepatic spread or poor functional hepatic reserve exclude the majority of patients as surgical candidates, leaving chemotherapy and locoregional therapies as next best options. Selective internal radiation therapy (SIRT) is a form of catheter-based locoregional cancer treatment modality for unresectable tumors, involving trans-arterial injection of microspheres embedded with a radio-isotope Yttrium-90. The therapeutic radiation dose is selectively delivered as the microspheres permanently embed themselves within the tumor vascular bed. Use of SIRT has been conventionally aimed at treating primary hepatic tumors (hepatocellular carcinoma) or colorectal and neuroendocrine metastases. Numerous reviews are available for these tumor types. However, little is known or reviewed on non-colorectal or non-neuroendocrine primaries. Therefore, the aim of this paper is to systematically review the current literature to evaluate the effects of Yttrium-90 radioembolization on non-conventional liver tumors including those secondary to breast cancer, cholangiocarcinoma, ocular and percutaneous melanoma, pancreatic cancer, renal cell carcinoma, and lung cancer.

• Liver metastases
• Breast cancer
• Melanoma
• Cholangiocarcinoma
• Radioembolization
• Selective internal radiation therapy
• Selective internal radiation therapy
• Transarterial radioembolization
• Transarterial radioembolization
• Yttrium-90

• Embolization, Therapeutic/adverse effects
• Embolization, Therapeutic/methods
• Humans
• Liver Neoplasms/classification
• Liver Neoplasms/radiotherapy
• Liver Neoplasms/secondary
• Microspheres
• Radiopharmaceuticals/administration & dosage
• Radiopharmaceuticals/adverse effects
• Treatment Outcome
• Yttrium Radioisotopes/administration & dosage
• Yttrium Radioisotopes/adverse effects

• HCC
• liver
• metastasis
• neoplasm
• radioembolization

• colorectal cancer
• hepatocellular carcinoma
• liver metastases
• neuroendocrine tumors
• radioembolization
• yttrium-90

• Breast neoplasm
• RECIST
• Yttrium-90
• computed tomography
• liver metastasis

• Adult
• Aged
• Algorithms
• Breast Neoplasms/diagnostic imaging
• Breast Neoplasms/radiotherapy
• Female
• Humans
• Imaging, Three-Dimensional/methods
• Kinetics
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/radiotherapy
• Liver Neoplasms/secondary
• Middle Aged
• Multidetector Computed Tomography/methods
• Neoplasm Recurrence, Local/diagnostic imaging
• Neoplasm Recurrence, Local/radiotherapy
• Prognosis
• Radiographic Image Enhancement/methods
• Radiographic Image Interpretation, Computer-Assisted/methods
• Reproducibility of Results
• Response Evaluation Criteria in Solid Tumors
• Sensitivity and Specificity
• Subtraction Technique
• Treatment Outcome
• Tumor Burden

• Adult
• Aged
• Brachytherapy
• Breast Neoplasms/mortality
• Breast Neoplasms/pathology
• Breast Neoplasms/radiotherapy
• Breast Neoplasms/surgery
• Drug Resistance, Neoplasm
• Embolization, Therapeutic
• Female
• Follow-Up Studies
• Humans
• Liver Neoplasms/mortality
• Liver Neoplasms/radiotherapy
• Liver Neoplasms/secondary
• Liver Neoplasms/surgery
• Middle Aged
• Neoplasm Staging
• Prognosis
• Prospective Studies
• Retrospective Studies
• Survival Rate
• Yttrium Radioisotopes/therapeutic use

• chemoembolisation
• hepatic metastasis
• radioembolisation
• yttrium-90 microspheres

• Breast Neoplasms/pathology
• Chemoembolization, Therapeutic/methods
• Disease Progression
• Female
• Humans
• Liver Function Tests
• Liver Neoplasms/radiotherapy
• Liver Neoplasms/secondary
• Microspheres
• Middle Aged
• Survival Rate
• Treatment Outcome
• Yttrium Radioisotopes/therapeutic use