Repeat radiation to the liver

[IRattending2021]

One of my buddy and I were discuss treatment options for someone with slowly reprogressing neuroendocrine mets of the liver. He could either give Y90 or bland embolization. The pt had Lutathera maybe 2-3 years back.

I argued for bland embo to those mets because that’s a pretty proven technique for us and I think Y90 plus Lutathera increase the risk of radiation induced liver disease (mets are extensive with a significant part of the liver replaced by met on both lobe).

I am not a radonc but reading this board it seems like re-irradation of the same location is high risk and requires expertise. What are you guy’s thoughts?

---

Members don't see this ad.

 

[ramsesthenice]

One of my buddy and I were discuss treatment options for someone with slowly reprogressing neuroendocrine mets of the liver. He could either give Y90 or bland embolization. The pt had Lutathera maybe 2-3 years back.

I argued for bland embo to those mets because that’s a pretty proven technique for us and I think Y90 plus Lutathera increase the risk of radiation induced liver disease (mets are extensive with a significant part of the liver replaced by met on both lobe).

I am not a radonc but reading this board it seems like re-irradation of the same location is high risk and requires expertise. What are you guy’s thoughts?

Yikes. Honestly if the disease is as extensive as you have hinted at I am not sure how optimistic I am that either would do a whole lot of good. If the lutathera was 2-3 years ago I actually don't think the risk of RILD with Y90 would be that high. That said, I don't think it would be any better than bland embolization so that would probably be my vote as well.

Regarding re-irradiation in the liver, you just have to be thoughtful about it. How long ago was it done? If they used Y90 did it localize well to a segment or 2 or was it more of a pharmacologic lobectomy? If its a peripheral lesion is it near a luminal organ? It can be doable but the bigger question is always the same: did it even work the first time? In the case you described it sounds like yes (2-3 year interval). But if there is short interval progression, probably worth trying something different if for nothing else the biology has told you what it thinks of radiation.

 

[RickyScott]

Neuro endocrine are very sensitive to y90

 

[IRattending2021]

Yikes. Honestly if the disease is as extensive as you have hinted at I am not sure how optimistic I am that either would do a whole lot of good. If the lutathera was 2-3 years ago I actually don't think the risk of RILD with Y90 would be that high. That said, I don't think it would be any better than bland embolization so that would probably be my vote as well.

Regarding re-irradiation in the liver, you just have to be thoughtful about it. How long ago was it done? If they used Y90 did it localize well to a segment or 2 or was it more of a pharmacologic lobectomy? If its a peripheral lesion is it near a luminal organ? It can be doable but the bigger question is always the same: did it even work the first time? In the case you described it sounds like yes (2-3 year interval). But if there is short interval progression, probably worth trying something different if for nothing else the biology has told you what it thinks of radiation.

thank you for the detailed reply! This pt never had Y90, just Lutathera. I certainly havent had enough rad bio training to know when can you retreat the liver.