13th Annual Global Embolization Symposium & Technologies
Purpose : Selective internal radiation therapy (SIRT) with Yttrium-90 (Y-90) has been used to treat primary and secondary hepatic malignancies. The main goal of SIRT is local disease control with an associated survival benefit. We have also observed that several patients with cancer-related right upper quadrant abdominal pain (RUQAP) have experienced significant pain relief after SIRT, leading to the hypothesis that SIRT may provide pain palliation for painful liver masses in similar fashion to external beam radiation for painful bone lesions. The goal of this study was to evaluate the effect of SIRT on cancer related RUQAP.
Material and Methods : The electronic medical records of 181 patients who underwent SIRT between 6/20/2012 and 7/24/2018 were retrospectively reviewed. Data on patients’ cancer-related RUQAP was collected from pre-treatment and one-month, 3-month and 6-month post-treatment clinic visit notes. Patient baseline characteristics, treatment-related factors, disease burden, and post-treatment outcomes were also reviewed.
Results : Twenty-four (13 %) of 181 patients had documented cancer related RUQAP before SIRT treatment. Of the 24 patients, 10 (42 %) had hepatocellular carcinoma, 6 (25 %) had metastatic colorectal cancer, 3 (12 %) had cholangiocarcinoma, 2 (8 %) had metastatic neuroendocrine tumor, 2 (8 %) had metastatic breast cancer and 1 (4 %) had metastatic lung cancer. Post SIRT, 7/24 (29 %) patients had complete resolution of pain while 4/24 (17 %) had partial pain relief. Five of 7 patients had complete pain relief by one month without significant change in tumor size, while 2 had complete pain relief by 3 months with decreased tumor size. Four of 7 (57 %) patients with complete pain relief had hepatocellular carcinoma, 2/7 (28 %) had metastatic disease (1 colon and 1 breast cancer) and 1/7 (15 %) had cholangiocarcinoma. Two patients had partial pain relief by 3 months and 2 had partial pain relief by 6 months. Eleven of 24 (45 %) patients did not notice any change in pain after treatment while 2/24 (8 %) reported increased pain after treatment at one month follow-up visit and returned to baseline pain level at 3 month.
Conclusions : Our findings suggest that a potential benefit of SIRT is pain control for symptomatic liver malignancies. Therefore, Y-90 treatment may be considered for pain palliation in patients with significant RUQAP.