Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2019 Sep 28;11(9):116-125.
doi: 10.4329/wjr.v11.i9.116.

Metastatic appendiceal cancer treated with Yttrium 90 radioembolization and systemic chemotherapy: A case report

Ambarish P Bhat  1 , Philip A Schuchardt  2 , Roopa Bhat  2 , Ryan M Davis  2 , Sindhu Singh  3
Affiliations
Case Reports

Metastatic appendiceal cancer treated with Yttrium 90 radioembolization and systemic chemotherapy: A case report

Ambarish P Bhat et al. World J Radiol. .

Abstract

Background: Primary appendiceal cancers are rare, and they generally present with liver and/or peritoneal metastases. Currently there are no guidelines to treat metastatic appendiceal cancer, and hence they are treated as metastatic colorectal cancer. Combining Yttrium 90 (Y-90) radioembolization (RE) with systemic chemotherapy early in the treatment of right sided colon cancers has been shown to improve survival. Based on this data, a combination of systemic chemotherapy and Y-90 RE was used to treat a case of metastatic appendiceal cancer.

Case summary: A 76-year-old male presented to the emergency room with progressive right lower quadrant pain. A Computed Tomography of the abdomen and pelvis was performed which showed acute appendicitis and contained perforation. Urgent laparoscopic appendectomy was then followed by histological analysis, which was significant for appendiceal adenocarcinoma. After complete workup he underwent right hemicolectomy and lymph node dissection. He received adjuvant chemotherapy as the local lymph nodes were positive. Follow-up imaging was significant for liver metastasis. Due to rapid growth of the liver lesions and new peritoneal nodules, the patient was treated with a combination of Y-90 RE and folinic acid, fluorouracil, and irinotecan with bevacizumab and not microwave ablation as previously planned. Follow up imaging demonstrated complete response of the liver lesions. At 12-mo follow-up, the patient continued to enjoy good quality of life with no recurrent disease.

Conclusion: Utilization of Y-90 RE concomitantly with systemic chemotherapy early in the treatment of appendiceal cancer may provide improved control of this otherwise aggressive cancer.

Keywords: Appendix cancer with peritoneal metastasis; Case report; Colorectal cancer; Hyperthermic intraperitoneal chemotherapy; Liver metastases; Radioembolization; Yttrium 90 microspheres.

PubMed Disclaimer

Conflict of interest statement

No conflict of interest declared.

Figures

Figure 1
Figure 1
Axial and coronal abdominal contrast enhanced computed tomography images depict a fluid filled and dilated appendix (gray arrows) and adenopathy (white arrow). Surrounding inflammatory changes present.
Figure 2
Figure 2
Axial sequential abdominal contrast enhanced computed tomography images (A-C) depict 3 new hepatic lesions in the right lobe (white arrows).
Figure 3
Figure 3
Coronal and axial fluorodeoxyglucose positron emission tomography images show fluorodexoyglucose avid liver (white arrows) and peritoneal (black arrows) metastases.
Figure 4
Figure 4
Dose and activity visualizer for Yttrium-90 radioembolization (DAVYR) application chart obtained after inputting the necessary fields, displaying the medical internal radiation dose, body surface area and partition models with prescribed activity Gigabecquerel, estimated dose to the tumor, liver and lungs Gray.
Figure 5
Figure 5
Hepatic angiogram. Yttrium 90 administration to the right lobe. The tip of the catheter (purple arrow) is at the bifurcation of the sectoral branches of the right hepatic artery. Coils in the gastro-duodenal artery (yellow arrow).
Figure 6
Figure 6
Axial post procedure single photon emission tomography image shows appropriate distribution of Yttrium 90 particles in the right hepatic lobe with increased focal uptake in one of the right lobe lesions (white arrow).
Figure 7
Figure 7
A restaging skull base to mid-thigh fluorodeoxyglucose positron emission tomography/computed tomography scan was performed after injection of 4.9 mCi of flurodexoyglucose 2 mo following Yttrium 90 radioembolization. The post Yttrium 90 treatment positron emission tomography (PET) maximum intensity projection (MIP) coronal (A), attenuation corrected axial (B) and fused axial (C) PET images show complete resolution of all lesions with focal photopenia in the right hepatic lobe (white arrowheads). Incidentally, there is chemotherapy induced diffuse skeletal uptake and a small urinary bladder diverticulum (purple straight arrow A). The pre-therapy Positron emission tomography images are provided for comparison. Coronal MIP image (D) axial attenuation correction (E), and fused axial (F). Pretreatment PET images show multiple flurodexoyglucose avid right lobe hepatic (white arrows) and peritoneal (black arrows) lesions. PET: Positron emission tomography; MIP: Maximum intensity projection.
See this image and copyright information in PMC

References

    1. Verwaal VJ, van Ruth S, de Bree E, van Sloothen GW, van Tinteren H, Boot H, Zoetmulder FA. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol. 2003;21:3737–3743. - PubMed
    1. Cosimelli M, Golfieri R, Cagol PP, Carpanese L, Sciuto R, Maini CL, Mancini R, Sperduti I, Pizzi G, Diodoro MG, Perrone M, Giampalma E, Angelelli B, Fiore F, Lastoria S, Bacchetti S, Gasperini D, Geatti O, Izzo F Italian Society of Locoregional Therapies in Oncology (SITILO) Multi-centre phase II clinical trial of yttrium-90 resin microspheres alone in unresectable, chemotherapy refractory colorectal liver metastases. Br J Cancer. 2010;103:324–331. - PMC - PubMed
    1. Bester L, Meteling B, Pocock N, Pavlakis N, Chua TC, Saxena A, Morris DL. Radioembolization versus standard care of hepatic metastases: comparative retrospective cohort study of survival outcomes and adverse events in salvage patients. J Vasc Interv Radiol. 2012;23:96–105. - PubMed
    1. van Hazel GA, Pavlakis N, Goldstein D, Olver IN, Tapner MJ, Price D, Bower GD, Briggs GM, Rossleigh MA, Taylor DJ, George J. Treatment of fluorouracil-refractory patients with liver metastases from colorectal cancer by using yttrium-90 resin microspheres plus concomitant systemic irinotecan chemotherapy. J Clin Oncol. 2009;27:4089–4095. - PubMed
    1. McCusker ME, Coté TR, Clegg LX, Sobin LH. Primary malignant neoplasms of the appendix: a population-based study from the surveillance, epidemiology and end-results program, 1973-1998. Cancer. 2002;94:3307–3312. - PubMed

Publication types