Predictors for Survival After Yttrium-90 Radioembolization for Colorectal Cancer Liver Metastases

Abstract

Purpose/Objective(s): To evaluate the role of the albumin-bilirubin (ALBI) score and grade and the inflammation-based index (IBI) for treatment outcome and morbidity assessment in patients with hepatocellular carcinoma treated with stereotactic body radiotherapy (SBRT). Materials/Methods: Patients with HCCs with Barcelona-Clinic Liver Cancer (BCLC) classification stage B or C were treated with SBRT in 3 to 12 fractions. The ALBI grade and the IBI were calculated at different time points (baseline, during and at the end of treatment and at follow up) and were compared with the Child-Turcotte-Pugh (CTP) score. Results: Forty patients with 47 lesions were treated with SBRT. The median follow-up was 14.3 months. The median overall survival (OS) from SBRT was 10 (95% CI 8.3-11.6) months and the local control at 1 year was 79%. Predictors associated with OS were CTP score at first follow up (pZ0.05) and IBI during treatment (pZ0.03). Higher C-reactive protein (CRP) serum concentrations at baseline (HR: 1.043, pZ0.001), during treatment (HR: 1.024, pZ0.02) and at the end of treatment (HR: 1.031, pZ0.02) correlated with worse OS. Higher IBI at the first follow up (18 vs 8 months, pZ0.006) correlated with a worse overall survival. Patients with higher CTP (pZ0.001) and ALBI score (pZ0.02) at baseline were at risk for grade > 2 toxicities. Conclusion: Both ALBI score and CTP are useful for risk assessment in patients treated with SBRT and IBI could be a predictor for OS. These results should be further evaluated in prospective studies.

Yttrium-90 Hepatic Radioembolization for Advanced Chemorefractory Metastatic Colorectal Cancer: Survival Outcomes Based on Right- Versus Left-Sided Primary Tumor Location

“…This suggests that poorer survival observed in right-sided primaries may be associated with factors other than radiologically assessed progression in liver tumor and extrahepatic disease. Similar results describing decreased survival in right-sided primaries after salvage radioembolization have been reported [33,39].…”

“…For example, our patients comparatively had worse disease burden prior to Y90 based on their high average CEA of 847 ng/mL. Pre-treatment CEA from other studies that had longer post-Y90 survival ranged from 37 to 55 ng/mL [24,33]. Patients in our study also had a higher mean tumor volume percentage of 17% compared to the study from Weiner et al, which had a mean tumor volume percentage of 13% [33].…”

“…Pre-treatment CEA from other studies that had longer post-Y90 survival ranged from 37 to 55 ng/mL [24,33]. Patients in our study also had a higher mean tumor volume percentage of 17% compared to the study from Weiner et al, which had a mean tumor volume percentage of 13% [33]. Furthermore, 61% of our patients did not receive systemic therapy after Y90, compared to only 25% patients that did not receive post-Y90 chemotherapy in the study by Kurilova et al [24].…”

“…Despite the implications of primary tumor location on treatment efficacy, outcomes based on tumor location in patients undergoing salvage therapy with Y90 are not well understood. A prior study described a nonsignificant decrease in post-Y90 survival in the treatment of liver metastases from right-sided primaries compared to left-sided primaries [33]. In this study, we assess survival outcomes in patients treated with Y90 for chemorefractory mCRC liver metastases, with stratification based on primary tumor location, and explore potential factors predictive of survival.…”

“…The median post-Y90 survival was 5.8 months, shorter than the post-Y90 survival reported by other studies of heavily-pretreated mCRC liver metastases. Studies have reported median post-Y90 survival ranging from 8.9 to 12.7 months [18,24,25,27,33]. A number of factors may explain this discrepancy.…”