Yttrium-90 microsphere radioembolization for the treatment of liver malignancies: a structured meta-analysis

Radioembolization with yttrium-90 microspheres (Y-90-RE), either glass- or resin-based, is increasingly applied in patients with unresectable liver malignancies. Clinical results are promising but overall response and survival are not yet known. Therefore a meta-analysis on tumor response and survival in patients who underwent Y-90-RE was conducted. Based on an extensive literature search, six groups were formed. Determinants were cancer type, microsphere type, chemotherapy protocol used, and stage (deployment in first-line or as salvage therapy). For colorectal liver metastases (mCRC), in a salvage setting, response was 79% for Y-90-RE combined with 5-fluorouracil/leucovorin (5-FU/LV), and 79% when combined with 5-FU/LV/oxaliplatin or 5-FU/LV/irinotecan, and in a first-line setting 91% and 91%, respectively. For hepatocellular carcinoma (HCC), response was 89% for resin microspheres and 78% for glass microspheres. No statistical method is available to assess median survival based on data presented in the literature. In mCRC, Y-90-RE delivers high response rates, especially if used neoadjuvant to chemotherapy. In HCC, Y-90-RE with resin microspheres is significantly more effective than Y-90-RE with glass microspheres. The impact on survival will become known only when the results of phase III studies are published.