Y-90 Selective Internal Radiation Therapy for Inoperable, Chemotherapy-Resistant Liver Metastases: A Meta-analysis.

Rationale and objectives: Yttrium-90 (Y-90) radioembolization has emerged as an effective therapeutic modality for patients with liver metastases, despite the absence of Level I evidence. The objective of this study is to evaluate the efficacy of this treatment approach through a meta-analysis of the available literature.

Methods: A comprehensive review protocol was implemented to screen all relevant reports in the literature. Strict inclusion criteria were applied to ensure consistency among the following selected studies: individual and complete data on Y-90 treatment for liver metastases, even if the studies included various tumor types. The selected studies were rigorously assessed according to the Reporting Standards of Radioembolization, based on 28 study criteria. Response data were extracted and analyzed using both fixed-effect and random-effect meta-analysis models.

Results: A total of 28 studies, involving 1662 patients, were included. Begg's test showed no significant evidence of publication bias. The random-effects weighted average overall response rate (complete response [CR] and partial response [PR]) was 34% (range: 26%-44%, I²=86%). The disease control rate (CR, PR, and stable disease [SD]) was 64% (range: 53%-75%, I²=91%). The progressive disease rate was 24% (range: 16%-33%, I²=87%), while the rate of adverse events was 57% (range: 16%-93%, I²=98%). The rate of grade 3-5 adverse events was 20% (range: 7%-36%, I²=9%).

Conclusion: This meta-analysis confirms that Yttrium-90 radioembolization is an effective treatment option for patients with liver metastases, demonstrating a high disease control rate with a relatively low incidence of severe adverse reactions.