Beyond hepatocellular carcinoma and colorectal metastasis: the expanding applications of radioembolization

Yttrium-90 Radioembolization of Metastatic Adrenocortical Carcinoma to the Liver following Systemic Chemotherapy and Surgical Resection of the Primary Lesion

Use of yttrium-90 (Y-90) is used for primary liver tumors and a handful of liver metastatic lesions. Y-90 treatment for metastatic adrenocortical carcinoma (ACC) to the liver is currently off-label, with one previously documented case report. In this case report, we present a 52-year-old woman with ACC and extensive liver metastatic disease. After failed chemotherapy, multidisciplinary discussion suggested potential Y-90 treatment for palliative purposes. After undergoing Y-90 treatment separately to the right and then the left hepatic lobes, subsequent patient visits demonstrated significantly improved clinical function as well as complete radiographic resolution of liver metastatic disease mainly from ACC. This case report demonstrates the potential efficacy of Y-90 for off-label uses in liver metastatic disease. This case and similar cases may open the door to a wide variety of potential indications for Y-90 treatment.

Successful Yttrium-90 Microsphere Radioembolization for Hepatic Metastases of Prostate Cancer

Prostate cancer is the most common solid tumor malignancy worldwide with an estimated 180,000 new cases of prostate cancer and 26,000 deaths in the USA in 2016. Although significant advances in the treatment of prostate cancer have recently been made, the treatment of metastatic disease remains a challenge. With visceral metastases marking more advanced tumor stages, liver involvement is associated with the worst prognosis. So far, no locoregional treatment regimens for the management of liver metastases of prostatic cancer exist. Herein, we report for the first time a successful treatment of hepatic metastases of prostatic cancer using radioembolization with selective intra-arterial administration of Yttrium-90 resin microspheres.

Evaluation of Liver Biomarkers as Prognostic Factors for Outcomes to Yttrium-90 Radioembolization of Primary and Secondary Liver Malignancies

The objective of this study was to examine indicators of liver function and inflammation for prognostic value in predicting outcomes to yttrium-90 radioembolization (RE). In a retrospective analysis, markers of liver function and inflammation, biomarkers required to stage liver function and inflammation, and data regarding survival, tumor response, and progression after RE were recorded. Univariate regression models were used to investigate the prognostic value of liver biomarkers in predicting outcome to RE as measured by survival, tumor progression, and radiographic and biochemical tumor response. Markers from all malignancy types were analyzed together. A subgroup analysis was performed on markers from patients with metastatic colorectal cancer. A total of 31 patients received RE from 2004 to 2014. Median survival after RE for all malignancies combined was 13.6 months (95% CI: 6.7-17.6 months). Results from an exploratory analysis of patient data suggest that liver biomarkers, including albumin concentrations, international normalized ratio, bilirubin concentrations, and the model for end-stage liver disease score, possess prognostic value in predicting outcomes to RE.

JARID1B promotes metastasis and epithelial-mesenchymal transition via PTEN/AKT signaling in hepatocellular carcinoma cells

JARID1B is a member of the family of JmjC domain-containing proteins that removes methyl residues from methylated lysine 4 on histone H3 lysine 4 (H3K4). JARID1B has been proposed as an oncogene in many types of tumors; however, its role and underlying mechanisms in hepatocellular carcinoma (HCC) remain unknown. Here we show that JARID1B is elevated in HCC and its expression level is positively correlated with metastasis. In addition Kaplan-Meier survival analysis showed that high expression of JARID1B was associated with decreased overall survival of HCC patients. Overexpression of JARID1B in HCC cells increased proliferation, epithelial-mesenchymal transition, migration and invasion in vitro, and enhanced tumorigenic and metastatic capacities in vivo. In contrast, silencing JARID1B in aggressive and invasive HCC cells inhibited these processes. Mechanistically, we found JARID1B exerts its function through modulation of H3K4me3 at the PTEN gene promoter, which was associated with inactive PTEN transcription. PTEN overexpression blocked JARID1B-driven proliferation, EMT, and metastasis. Our results, for the first time, portray a pivotal role of JARID1B in stimulating metastatic behaviors of HCC cells. Targeting JARID1B may thus be a useful strategy to impede HCC cell invasion and metastasis.

Yttrium-90 hepatic radioembolization: clinical review and current techniques in interventional radiology and personalized dosimetry

In recent years, yttrium-90 ((90)Y) microsphere radioembolization has been establishing itself as a safe and efficacious treatment for both primary and metastatic liver cancers. This extends to both first-line therapies as well as in the salvage setting. In addition, radioembolization appears efficacious for patients with portal vein thrombosis, which is currently a contraindication for surgery, transplantation and transarterial chemoembolization. This article reviews the efficacy and expanding use of (90)Y microsphere radioembolization with an added emphasis on recent advances in personalized dosimetry and interventional radiology techniques. Directions for future research into combination therapies with radioembolization and expansion into sites other than the liver are also explored.