Published online Feb 15, 2020. doi: 10.4251/wjgo.v12.i2.228
Peer-review started: October 8, 2019
First decision: November 11, 2019
Revised: December 19, 2019
Accepted: January 6, 2020
Article in press: January 6, 2020
Published online: February 15, 2020
Breast cancer liver metastases are associated with dismal prognosis. Previous reports in the literature on liver metastases secondary to melanoma or colorectal origin have shown promising results with the use of transarterial embolization. The aim of this review was to consolidate the evidence available in the literature on the use of transarterial embolization for management of breast liver metastases.
The aim of this review was to consolidate the evidence currently available on transarterial embolization for breast liver metastases in a systematic fashion. This relatively new technique is not widely available and its role in the management pathway of breast metastases has not been clearly described before. Patients with breast liver metastases have poor prognosis despite advances in chemotherapy and therefore transarterial embolization could be of benefit for those patients with advanced disease.
The main outcomes of interest were tumour response and patient survival following radioembolization with ytrrium-90 spheres.
A systematic literature search was performed in PubMed and EMBASE databases from January 2007 to December 2018. The following search terms were used in order to identify the relevant studies of interest: “yttrium” or “yttrium-90” or “Y90” or “radio-embolization” and “breast”.
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 was ranged from 52-61 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. The effect on patient survival need to be elucidated further. The findings reported in this review are limited by the absence of randomized trials on the subject and the heterogeneity in the methodology of the studies included. It is therefore highly desirable for more quality evidence to be produced in order to assess mor accurately the role of radioembolization with yttrium-90.
The findings of this review highlight the need for more quality evidence to be produced in the form of randomized controlled trials. Standardisation of types of spheres used, timing of imaging modalities and criteria used in order to assess the effect of radioembolization is required. Furthermore, the potentially synergistic role of radioembolization for patients on palliative chemotherapy should be evaluated as it may confer a significant impact on survival.