Transarterial radioembolization with yttrium-90 safely and effectively treated unresectable primary malignant liver tumors in pediatric patients as an alternative therapy bridge to surgical resection or liver transplant, according to data published in Pediatric Blood and Cancer.
Allison S. Aguado
“The therapy has been around for about 20 years in adults, but it has been seldomly used in children,” Allison S. Aguado, MD, from the Nemours Alfred I. duPont Hospital for Children in Delaware, told Healio Gastroenterology and Liver Disease. “We want to try and get more children able to have their tumor resected or liver transplanted. Resection is preferred to transplant, though, because they don’t have to go through life-long immunotherapy and care following the transplant and some transplant may fail during a child’s life.”
Yttrium-90 is a beta-emitting isotope with high-energy radiation that travels an average of 2.5 mm and a maximum of approximately 11 mm. In contrast with external beam radiation that is not typically used in children due to the damage it can cause to normal liver tissue, transarterial radioembolization with yttrium-90 (TARE-Y90) deposits the radiation in the target tissue and only a small amount of tissue around it, according to Aguado.
The study comprised 10 pediatric patients with a median age at treatment of 5.5 years (range, 2-18 years). At treatment baseline, all patients previously received chemotherapy and had either liver disease that was unresectable, metastatic or both.
Based on RECIST 1.1 criteria of all target lesions, eight patients had stable disease and one patient had progressive disease. Based on mRECIST criteria, two patients had a partial response, four had stable disease, and one had progressive disease. Overall, six patients had progressive disease, all of whom had pulmonary metastatic progression, two had progression of hepatic disease, and one had progression of nodal disease.
TARE-Y90 was well-tolerated with five patients experiencing no side effects. The most common side effect was fatigue and two patients experienced fevers with no evidence of infection. One patient who had near-complete replacement of the treated lobe by tumor experienced abdominal pain, elevated aspartate aminotransferase and lipase, and thrombocytopenia.
“The therapy is mostly performed as an outpatient procedure,” Aguado explained. “If patients have good liver function prior to the procedure, they’re usually able to maintain their liver function after. This is in comparison to adults who often have cirrhosis or underlying liver disease, whereas children typically do not have underlying liver complications.”
Median patient survival from initial diagnosis was 12.5 months (range, 10-28 months). Median patient survival after treatment with TARE-Y90 was 4 months (range, 2-20 months). Three patients whose retreatment was well-tolerated demonstrated the longest survival times (range, 17-20 months).
“Hepatoblastoma is becoming more common and we’re seeing an increased incidence related to premature birth and low birth weight,” Aguado said. “As we’re delivering children earlier and earlier, hepatoblastoma is becoming more common. It is still an uncommon tumor, but we’re seeing it more often than we did 20 years ago.”
Aguado explained that, while it’s fortunate that liver tumors are rare in children — about 1% to 2% per year — confirmation of TARE-Y90’s safety and efficacy will simply require time to increase case numbers. – by Talitha Bennett
Disclosure: The authors report no relevant financial disclosures.