Use of yttrium-90 radioembolization to control liver metastases in pancreatic acinar cell carcinoma and pancreatoblastoma: Two case reports

Table 1 Molecular pathology

Tumor type	Mutated gene
Pancreatoblastoma: (NCI COMPASS)	Pathogenic: CTNNB1, GRIN2A
	VUS: ACIN1, CDKL2, CHRNA2, DCHS2, ERBIN, FCRL3, FNDC1, GLDC, GMPS, GRID2, IL23A, JAK3, KRT34, L3MBTL3, LTBP2, MAML1, MRPS30, NRP2, OR51M1, PCDH19, PPM1N, PRDM10, SETD6, SGPL1, SLC27A6, SMAD4, SORBS3, SP100, SPATC1 L, TBXA2R, TCHP
PACC: (NCI COMPASS)	Pathogenic: KRAS Q61H, CREBBP, PRKAR1A, TGFBR2
	CNV: Amplification, AKT3, NTRK1, MDM4; loss: RB1, BRCA2
	VUS: ATR, CHD4, FGF6, FGFR3, LAMP1, LRP1B, MGA, PRKDC, SETD2, SLX4, ZBTB7A, ZFHX3

VUS: Variant of uncertain significance; CNV: Copy number variation; PACC: Pancreatic acinar cell carcinoma.

Table 2 Clinical outcomes of yttrium-90 radioembolization in pancreatic malignancies

Ref.	Time period	Report type	Tumor type	Intervention	Patients (n)	Setting/Location	Clinical outcomes	Safety notes
Nasser et al[14], 2017		Case report	PACC	Y-90	1	Brazil	> 50% tumor shrinkage in all liver metastases; 3 lesions complete response; disease control > 12 months with adjunct chemotherapy	No Y-90-related toxicity reported; lipase tumor marker normalized
Blume et al[15], 2025	2013-2023	Retrospective study	PACC	Y-90, HAE	9 (18 sessions: 14 HAE, 4 Y-90)	United States (MSKCC)	LTPFS 6.77 months after 1st treatment; 6 months; LTPFS: 59.83%: Extended to 22.3 months with repeat treatments; 1-year OS 66.67% (mOS not reached at approximately 16 months follow-up)	28% of treatments had AEs, mostly mild (grade 1 post-embolization syndrome); 1 fatal hepatic abscess (post-Whipple patient). 1 grade 3 PE. Concludes acceptable safety
Krug et al[18], 2012		Case report	SPNP	Y-90	1	Germany	Durable complete remission of liver metastases for 4 years postY-90 and 10 years after initial diagnosis	No complications
Dyas et al[19], 2020		Case report	SPNP	Y-90	1	United States (University of Colorado)	Y-90 enabled right hemi-hepatectomy for recurrent SPNP; 50% residual viability	No complications
Cao et al[21], 2010		Retrospective study	PC	Y-90	7	Australia	2/5 PR, 1/5 SD	No major complications
Michl et al[9], 2014	2004-2011	Retrospective study	PC	Y-90	19	Germany	Objective liver ORR: 47%; liver mPFS 3.4 months; mOS 9.0 months after Y-90 (24% 1-year survival)	Mostly mild acute toxicity (≤ grade 3); noted long-term risks: Abscess, ulcer, cholangitis in few
Gibbs et al[20], 2015	2006-2009	Prospective phase II trial	PDAC	Y-90 + chemotherapy	14	Australia (2 centers)	Whole-liver Y-90 + 5FU, gem chemotherapy; liver DCR 93% (PR or SD); median liver PFS 5.2 months; OS 5.5 months overall (12.2 months for patients with liver-only disease)	Grade 3/4 biochemical/clinical toxicity in 57% of patients; 1 treatment-related death (liver failure). Advised careful selection (better outcomes if primary resected)
Kim et al[23], 2016	2012-2015	Retrospective study	PDAC	Y-90 + chemotherapy	16	United States (Georgetown)	Y-90 integrated with chemotherapy in 15 patients; mOS 22 months from metastasis diagnosis, 12.5 months post-Y-90; liver ORR 31% (4/13), SD 38% (4/13)	2 patients with grade 3 events (bilirubin elevation, cholecystitis); no grade 4-5 toxicity
Kim et al[22], 2019	2011-2017	Multicenter retrospective study	PDAC	Y-90 + chemotherapy	33	United States (3 centers)	Y-90 as 2nd-line; RECIST: 42% PR, 37% SD; mOS 8.1 months after Y-90 (20.8 months from diagnosis)	No grade 4-5 toxicity; 3 patients with grade 3 LFT elevations; 2 patients showing short-term grade 3 pain or ascites (approximately 6%)
Nezami et al[24], 2019		Phase Ib trial	PDAC, ICC	Y-90 + gemcitabine	8 (3 PDAC, 5 ICC)	United States (Yale)	Combined Y-90 glass microspheres + gemcitabine (up to 600 mg/m2): PC + ICC: Median hepatic PFS 8.7 months; ORR 62%; 1/8 patients with CR; PC: Hepatic mPFS 2.37 months, mPFS 4.4 months, best response: SD	All patients had grade 1 AEs, 3/8 grade 2 hepatobiliary toxicity, 1/8 grade 3 (short hospitalization); no treatment-related deaths
Kayaleh et al[8], 2020	2010-2017	Retrospective study	PDAC		26	United States (Moffitt)	Y-90 (glass microspheres) as 2nd line; mOS 7.0 months from Y-90, mOS from diagnosis 33.0 months; at 3 months: 1/22 PR, 9/22 SD, on imaging	4/26 (15%) had grade 3 toxicities (LFT or bilirubin elevations); clinical side effects mostly grade 1-2 fatigue, pain
Helmberger et al[13], 2021	2015-2017	Prospective observational study (CIRT registry)	Tumors with liver metastases		1027 total; 32 PC	Europe (multicenter)	All indications: 68.2% palliative intent; PC metastases: MOS 5.6 months	All patients 2.5% grade 3-4 AEs within 30 days

CIRT: Carbon ion radiotherapy; PACC: Pancreatic acinar cell carcinoma; SPNP: Solid pseudopapillary neoplasm of pancreas; PC: Pancreatic cancer; PDAC: Pancreatic ductal adenocarcinoma; ICC: Intrahepatic cholangiocarcinoma; Y-90: Yttrium-90; HAE: Hepatic arterial embolization; MSKCC: Memorial Sloan Kettering Cancer Center; LTPFS: Local tumor progression-free survival; OS: Overall survival; PR: Partial response; SD: Stable disease; ORR: Objective response rate; PFS: Progression-free survival; RECIST: Response Evaluation Criteria in Solid Tumors; CR: Complete response; AEs: Adverse events; LFT: Liver function test; PE: Pancreatic enzymes; mOS: Median overall survival; mPFS: Median progression-free survival; 5FU: 5-fluorouracil; DCR: Disease control rate.