Liver Resection for Colorectal Hepatic Metastases after Systemic Chemotherapy and Selective Internal Radiation Therapy with Yttrium-90 Microspheres: A Systematic Review

Abstract

Background: Selective internal radiation therapy (SIRT) using yttrium-90 resin microspheres has been used together with systemic chemotherapy to treat patients with unresectable liver metastases. This study undertook the first systematic pooled assessment of the case profile, treatment and outcome in patients with initially inoperable colorectal hepatic metastases undergoing resection after systemic chemotherapy and SIRT. Methods: A systematic review of the literature was performed using Medline and Embase for publications between January 1998 and August 2017. Keywords and MESH headings “SIRT”, “Yttrium-99 radio embolization” and “liver metastases” were used. Reports on patients undergoing liver resection after SIRT for colorectal liver metastases were included. Case reports, reviews and papers without original data were excluded. The study protocol was registered with PROSPERO, (registration number: CRD42017072374). Results: The study population comprised of 120 patients undergoing liver resection after chemotherapy and SIRT. The conversion rate to hepatectomy in previously unresectable patients was 13.6% (109 of 802). All studies report a single application of SIRT. The interval from SIRT to surgery ranged from 39 days to 9 months. Overall, there were 4 (3.3%) deaths after hepatectomy in patients treated by chemotherapy and SIRT. Conclusions: This large pooled report of patients undergoing hepatectomy for colorectal liver metastases after chemotherapy and SIRT shows that 13.6% of patients with initially inoperable disease undergo resection with low procedure-related mortality.

Hepatic Resection Following Selective Internal Radiation Therapy for Colorectal Cancer Metastases in the FOXFIRE Clinical Trial: Clinical Outcomes and Distribution of Microspheres

“…It concluded that the mortality, complication and liver failure rates were similar in these patients to rates expected in patients who had not received SIRT prior to resection or transplantation. Similarly, a systematic review of the published literature found a conversion rate to hepatectomy of 13.6% in 120 patients and low surgical mortality [15]. Collectively, these studies are very relevant to multi-disciplinary teams considering SIRT to downstage tumours to subsequent resection.…”

Irreversible Electroporation for Liver Metastases from Colorectal Cancer: A Systematic Review

“…There is a substantial heterogeneity of treatments, with some reports using a combination of IRE with RFA and SIRT despite the published limited efficacy of the latter intervention for the treatment of colorectal hepatic metastases [25]. In keeping with a treatment used in the metastatic setting, systemic chemotherapy is the most frequently used pre-IRE treatment.…”

Conversion therapy in patients with colorectal liver metastases

“…Selective internal radiation therapy (SIRT) with beta-particle emitting yttrium-90 bound to microspheres is another technique enabling therapy directly to the liver and thereby limiting the toxic effect of systemic treatments [33,34]. SIRT in combination with systemic therapy has been shown to enable resectability in a selected group of patients with initially unresectable CRLM [35,36]. The techniques HAIC and SIRT are not used routinely in patients with CRLM at the study centre and consequently their potential role in conversion therapy could not be evaluated in this study.…”