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TARE-Y90 safe, effective for unresectable pediatric liver tumors



Transarterial radioembolization with yttrium-90 treated safely and effectively primary malignant tumors not operable in pediatric patients as an alternative therapy to surgical resection or liver transplantation, according to data published on Pediatric blood and cancer . [19659002] Allison S. Aguado, MD "style =" height: 106px; width: 80px; "/>

Allison S. Aguado

"Therapy has existed for about 20 years in adults, but has rarely been used in children" Allison S. Aguado MD, by 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 resected tumor or liver transplantation.Resection is preferable to transplantation, however, because they do not have to go through immunotherapy for life and care after transplantation. and some transplants may fail during the life of a child. "

The ichthyone-90 is a beta-emitting isotope with high energy radiation traveling averaging 2.5 mm and a maximum of about 1

1 mm. In contrast to the external beam radiation that is not typically used in children due to the damage that can cause normal hepatic tissue, trans-arterial radioembolization with yttrium-90 (TARE-Y90) deposits the radiation in the target tissue and only a small amount of fabric around it, according to Aguado.

The study included 10 pediatric patients with a mean age at treatment of 5.5 years (range, 2-18 years). At baseline of treatment, all patients had previously received chemotherapy and had unresectable, metastatic, or both liver disease.

Based on the RECIST 1.1 criteria of all target lesions, eight patients had stable disease and one patient had progressive disease. Based on the mRECIST criteria, two patients had a partial response, four had a stable disease and one had a progressive disease. Overall, six patients had a progressive disease, all with metastatic lung progression, two with progression of liver disease and one with progression of the nodal disease.

TARE-Y90 was well tolerated with five patients without side effects. The most common side effect was fatigue and two patients had fever without evidence of infection. One patient who had an almost complete substitution of the treated lobe by the tumor reported abdominal pain, elevated aspartate aminotransferase and lipase and thrombocytopenia.

"Therapy is performed primarily as an outpatient procedure," explained Aguado. "If patients have good liver function before the procedure, they are usually able to maintain their liver function later than in adults who often have cirrhosis or basic liver disease, while children generally do not have liver complications. underlying. "

The median survival of the patient from the initial diagnosis was 12.5 months (range, 10-28 months). The patient's median survival after TARE-Y90 was 4 months (interval, 2-20 months). Three patients whose reprocessing was well tolerated demonstrated longer survival times (17-20 months interval).

"Hepatoblastoma is becoming more common and we are witnessing an increased incidence related to premature birth and low birth weight" Aguado said. "While we are delivering children before and after, hepatoblastoma is becoming more common, it is still an unusual tumor, but we see it more often than it was 20 years ago."

Aguado explained that, although it is a fortune that liver tumors are rare in children – about 1% to 2% in the year – confirming the safety and efficacy of TARE-Y90 will simply take time to increase the number of cases . – by Talitha Bennett

Disclosure: The authors do not report any relevant financial disclosure.


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