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Liver metastases in cervical cancer is rare and can be difficult-to-treat. The current guidelines established by the Gynecologic Oncology Group recommend platinum-based systemic chemotherapy in combination with an anti-angiogenic agent such as bevacizumab, however, overall survival remains poor following diagnosis and options for patients who fail chemotherapy are limited. Yttrium-90 (Y90) radioembolization (RE) has shown great promise in the treatment of chemo-refractory colorectal liver metastases. We describe a 30-year-old female with a history of stage IB endocervical adenocarcinoma who later developed metastases to the liver, that were unresponsive to multiple chemotherapeutics and chemoembolization, and was successfully treated with Y90 RE with concurrent systemic Pembrolizumab. The Y90 RE treatment resulted in positive clinical and imaging responses with improvement in her quality of life, all of which continue to persist at the time of writing this manuscript about 8-months into her RE treatment.

Introduction: TheraSphere® microspheres containing yttrium 90Y are among many radioembolization agents used clinically to reduce liver tumor burden, and their effects on cancer volume reduction are well-established. At the same time, concerns about off target tissue injury often limit their use. Deeper investigation into tissue distribution and long-term impact of these microspheres could inform us about additional ways to use them in practice.Methods: Healthy rat liver and rabbit liver tumor samples from animals treated with TheraSpheres were sectioned and their elemental maps were generated by X-ray fluorescence microscopy (XFM) at the Advanced Photon Source (APS) synchrotron at Argonne National Laboratory (ANL).Results: Elemental imaging allowed us to identify the presence and distribution of TheraSpheres in animal tissues without the need for additional sample manipulation or staining. Ionizing radiation produced by 90Y radioactive contaminants present in these microspheres makes processing TheraSphere treated samples complex. Accumulation of microspheres in macrophages was observed.Conclusions: This is the first study that used XFM to evaluate the location of microspheres and radionuclides in animal liver and tumor samples introduced through radioembolization. XFM has shown promise in expanding our understanding of radioembolization and could be used for investigation of human patient samples in the future.

An expert panel met to review the evidence for selective internal radiation therapy (SIRT) using yttrium-90 microspheres in hepatocellular carcinoma and metastases from colorectal cancer and neuroendocrine tumors. There is now convincing evidence for the safety and efficacy of SIRT in these situations albeit mostly from retrospective cohort studies. There are a number of ongoing prospective randomized controlled clinical trials investigating the role of SIRT in liver tumors; however, data from these trials are still several years away (although the SIRFLOX study has been recently published). In this evolving environment, published evidence and the authors' experience were used to summarize the current and potential role of SIRT in the management of hepatocellular carcinoma of intermediate or advanced stage and in liver-dominant metastatic colorectal cancer and metastatic neuroendocrine tumors. [ABSTRACT FROM AUTHOR]

Background: Positron emission tomography-computed tomography (PET-CT) has proven to be an invaluable tool for disease assessment in oncology. The tumor standard uptake value (SUV), a measure of the fluorodeoxyglucose (FDG) uptake, is used as a clinical tool for determining disease prognosis, as a marker for tumor biology, and as an evaluation of treatment response. A more comprehensive approach involving the determination of functional tumor volume is needed to better define disease biology and express treatment-related changes. Methods: The relationship between functional and anatomic volume was evaluated using phantom and patient studies. Phantom studies were performed using a cylindrical phantom containing hollow spheres of volume ranging from 0.5 to 16.0 cc. Solutions with different concentrations of fluorine 18 FDG were added to the spheres and the phantom to provide different target to background ratios (TBRs). The phantom was imaged using a PET-CT scanner, and functional volumes were determined using the background maximum activity concentration as the threshold value (BTV). Next, the optimal threshold value (OTV) was determined to result in a measured functional volume equal to the known sphere volume. A threshold correction factor (TCF) was established to estimate the OTV. Functional tumor volumes were determined and compared with anatomic tumor volumes for patients with liver lesions. Functional tumor volumes were initially determined using the normal liver SUVmax as a threshold and then using the OTVs established using the phantom studies. Results: An increase in measured functional volume with TBRmax and sphere volume was observed in the phantom studies. When the liver SUVmax was used as the threshold in patient studies (BTV), a linear relationship was observed between the functional and the anatomic tumor volume. The use of the OTVs in the determination of functional tumor volume resulted in a reduction in percent error from 89% to 13%. A reduction in the variability about the best fit line was observed when comparing the BTV and OTV methods as expressed by an increase in R2 values from .80 to .94. Conclusion: The method proposed for measuring functional tumor volumes in PET-CT clinical liver studies is reproducible and accurate when compared with anatomic volumes assessed using contrast-enhanced CT scans. [ABSTRACT FROM AUTHOR]

Introduction: TheraSphere ® microspheres containing yttrium 90 Y are among many radioembolization agents used clinically to reduce liver tumor burden, and their effects on cancer volume reduction are well-established. At the same time, concerns about off target tissue injury often limit their use. Deeper investigation into tissue distribution and long-term impact of these microspheres could inform us about additional ways to use them in practice. Methods: Healthy rat liver and rabbit liver tumor samples from animals treated with TheraSpheres were sectioned and their elemental maps were generated by X-ray fluorescence microscopy (XFM) at the Advanced Photon Source (APS) synchrotron at Argonne National Laboratory (ANL). Results: Elemental imaging allowed us to identify the presence and distribution of TheraSpheres in animal tissues without the need for additional sample manipulation or staining. Ionizing radiation produced by 90 Y radioactive contaminants present in these microspheres makes processing TheraSphere treated samples complex. Accumulation of microspheres in macrophages was observed. Conclusions: This is the first study that used XFM to evaluate the location of microspheres and radionuclides in animal liver and tumor samples introduced through radioembolization. XFM has shown promise in expanding our understanding of radioembolization and could be used for investigation of human patient samples in the future., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Paunesku, Gordon, White, Harris, Antipova, Maxey, Vogt, Smith, Daddario, Procissi, Larson and Woloschak.)