• Sequential yttrium-90 radioembolization used for ovarian liver metastases. • Demonstrates feasibility of repeated liver-directed therapy. • Integrated with systemic therapy, surgery, and nodal radiation. • Maintained hepatic control while preserving functional liver reserve. • Achieved durable disease control beyond two years. Hepatic metastases from ovarian cancer are associated with poor prognosis, particularly in patients with platinum-resistant disease, and treatment options are limited. We present a case illustrating the feasibility and potential benefit of sequential locoregional therapy using yttrium-90 radioembolization for liver-dominant metastatic ovarian carcinoma. A 62-year-old female with stage IVB high-grade serous ovarian carcinoma and unresectable hepatic metastases underwent neoadjuvant platinum chemotherapy followed by selective internal radiation therapy targeting dominant liver lesions. Therapy was repeated in a staged manner alongside non-platinum systemic therapy, cytoreductive surgery, and nodal radiation as clinically indicated. Imaging and functional assessments were used to evaluate tumor response and liver function throughout treatment. Sequential radioembolization achieved durable hepatic disease control over a two-year period. The treated right hepatic lobe underwent gradual atrophy with compensatory hypertrophy of the left lobe, preserving overall liver function and enabling repeated therapy. Integration with systemic therapy and surgery allowed continued management of peritoneal disease. Treatment was well tolerated, with manageable laboratory and clinical toxicities. Imaging demonstrated a significant reduction in tumor size and resolution of metabolic activity, supporting effective locoregional control. Sequential yttrium-90 radioembolization is a feasible and potentially durable locoregional strategy for patients with unresectable, platinum-resistant ovarian cancer liver metastases. When integrated with systemic therapy and surgery, this approach may provide meaningful disease control while preserving liver function. Prospective studies are warranted to further define patient selection, optimal sequencing, and clinical outcomes for this emerging therapy.
Wahl et al. (Fri,) studied this question.