Yttrium-90 transarterial radioembolization of primary lung cancer metastases to the liver

Purpose Assess if Yttrium-90 transarterial radioembolization (TARE) is safe and effective for primary lung cancer metastases to liver (LCML). Methods and methods Retrospective study included 57 patients with LCML, treated with 79 TARE treatments. Histology included non-small cell lung cancer (NSCLC) [n=27], small cell lung cancer (SCLC) [n=17], and lung carcinoid (LC) [n =13]. Adverse events were graded using Society of Interventional Radiology’s Adverse Events Classification. Survival was calculated by Kaplan-Meier method; differences between groups were estimated using logrank test. Cox proportional hazards model was used to determine factors influencing survival. Results There were 11/79 severe or life-threatening adverse events within 30 days (abdominal pain, altered mental status, nausea/vomiting, acalculous/aseptic cholecystitis, hyponatremia, pancreatitis, renal failure, death from pneumonia). Median overall survival (OS) was: NSCLC 8.3 (95% CI: 6.3-16.4) months; SCLC 4.1 (95% CI: 1.9-6.6) months; and LC 43.5 (95% CI: 7.8-61.4) months. For NSCLC, presence of bilobar vs unilobar disease [HR: 5.24 (95%CI:1.64-16.79); p=0.002], more tumors [2-5 vs 1 (HR: 4.88 [95%CI: 1.17-20.37]; p=0.003); >5 vs 1 (HR: 3.75 [95%CI: 0.95-6.92]; p=0.05)], and lobar vs segmental treatment [HR: 2.56 (95%CI: 0–NA); p=0.002] were negative predictors of OS. For SCLC, receipt of >2 lines of chemotherapy vs ≤2 [HR: 3.16 (95%CI: 0.95 – 10.47); p=0.05] was a negative predictor of OS. For LC, tumor involvement >50% was a negative predictor of OS [HR: 3.77e+15 (95%CI: 0–NA); p=0.002]. Conclusion TARE is safe for treatment of LCML with survival benefits best seen in LC tumors.