Radioembolization versus Standard Care of Hepatic Metastases: Comparative Retrospective Cohort Study of Survival Outcomes and Adverse Events in Salvage Patients

Bester, Lourens; Meteling, Baerbel; Pocock, Nicholas; Pavlakis, Nick; Chua, Terence C.; Saxena, Akshat; Morris, David L.

doi:10.1016/j.jvir.2011.09.028

Cited by 119 publications

(77 citation statements)

References 32 publications

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“…SIRT delivers beta-emitting yttrium-90 ( 90 Y) microspheres to liver tumors through the hepatic arterial system and is able to largely spare the normal liver because of the short distance over which radiation is emitted from each microsphere. SIRT has been studied as first-line therapy for hepatic colorectal metastases (7)(8)(9)(10), in combination with secondor third-line chemotherapy (11,12), and as salvage therapy for chemorefractory patients (13)(14)(15)(16)(17)(18). These studies have been important in demonstrating that SIRT can prolong intrahepatic disease control and improve OS.…”

Section: Introductionmentioning

confidence: 99%

Pretreatment tumor volume as a prognostic factor in metastatic colorectal cancer treated with selective internal radiation to the liver using yttrium-90 resin microspheres

Bhooshan

Sharma

Badiyan³

et al. 2016

J. Gastrointest. Oncol.

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Background: Yttrium-90 ( 90 Y)-resin microspheres can prolong intrahepatic disease control and improve overall survival (OS) in patients with metastatic colorectal cancer (CRC). Prognostic factors for improved outcomes in patients undergoing selective internal radiation therapy (SIRT) have been studied, but the relationship between pre-SIRT liver tumor volume and outcomes has not well described. Methods: We retrospectively reviewed the records of patients with metastatic CRC who were treated at our institution with 90 Y-resin microspheres. Each patient underwent either MR or CT imaging of the liver with intravenous (IV) contrast before and within ~2-3 months after SIRT. Imaging data were transferred into our treatment planning system. Each metastatic liver lesion was contoured, and the volume of each lesion was summed to determine the total liver tumor volume at a given time point. We evaluated whether pretreatment liver tumor volume was related to OS. We also evaluated the relationship between pre-SIRT tumor volume and radiographic treatment response by either unidimensional Response Evaluation Criteria in Solid Tumors (RECIST) or three-dimensional volumetric criteria. Results: We included 60 patients with a median age of 59 years (range, 38-97 years); 60% of patients received sequential lobar treatment. The median number of chemotherapy cycles received prior to SIRT was 2. Median follow-up from first SIRT was 8.9 months. Pre-and post-SIRT tumor volumes were primarily calculated on CT (87%). The median pre-SIRT tumor volume was 77 cc (range, 4.5-2,170.4 cc). The median intervals between the first SIRT and the first, second, and third follow-up scans were 2.2, 4.4, and 7.7 months, respectively. No patient experienced a radiographic complete response. Pretreatment volume was a significant predictor for estimating the odds of a patient having stable disease or partial response using volumetric response criteria at first (P=0.016), second (P=0.023), and third (P=0.015) follow-ups. For each unit increase in log volume, a patient's odds of having a stable or partial response were 0.57, 0.63, and 0.61 times as likely at first, second, and third follow-up, respectively. OS was not significantly associated with pretreatment tumor volume. Conclusions: Patients with metastatic CRC with larger overall pretreatment liver tumor volumes, regardless of number of individual liver lesions, are less likely to have radiographic evidence of stable disease or partial response following SIRT using volumetric response criteria. However, pretreatment volume was not significantly associated with OS, and thus SIRT should be considered for patients with larger pretreatment volumetric tumor burden.

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Section: Introductionmentioning

confidence: 99%

Pretreatment tumor volume as a prognostic factor in metastatic colorectal cancer treated with selective internal radiation to the liver using yttrium-90 resin microspheres

Bhooshan

Sharma

Badiyan³

et al. 2016

J. Gastrointest. Oncol.

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“…Based on these findings, radioembolization is recommended in the guidelines from the European Society of Medical Oncology (ESMO) for patients with liver-limited metastases in whom the available chemotherapeutic options have failed [2]. Several observational cohort studies [4][5][6][7][8][9][10] as well as a few meta-analyses dealing with radioembolization for chemorefractory mCRC have been published, all of them demonstrating the relative safety of the radioembolization technique and the potential for better survival. However, only limited data on late toxicity of 90 Y in this patient population are available [11][12][13].…”

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confidence: 99%

Yttrium-90 radioembolization for the treatment of chemorefractory colorectal liver metastases: Technical results, clinical outcome and factors potentially influencing survival

et al. 2015

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90 Y radioembolization to treat chemorefractory colorectal liver metastases were identified. Demographic, laboratory, imaging and dosimetry data were collected. Post-treatment technical and clinical outcomes were analyzed as well as overall survival; finally several factors potentially influencing survival were analyzed. Results: In total 88 patients were selected for angiographic workup; 71 patients (81%) finally underwent catheter-directed 90 Y microsphere infusion into the hepatic artery 25 days (standard deviation 13 days) after angiographic workup. Median infused activity was 1809 MBq; 30-day toxicity included: fatigue (n ¼ 39; 55%), abdominal discomfort (n ¼ 33; 47%), nausea (n ¼ 5; 7%), fever (n ¼ 14; 20%), diarrhea (n ¼ 6; 9%), liver function abnormalities and elevated bilirubin (transient) (n ¼ 3; 4%). Gastric ulcer was found in five patients (7%). A late complication was radioembolization-induced portal hypertension (REIPH) in three patients (4%). Median time to progression in the liver was 4.4 months. Estimated survival at six and 12 months was 65% and 30%, respectively, with a 50% estimated survival after 8.0 months in this group of chemorefractory patients. Prognostic factors for worse survival were high preprocedural bilirubin, alkaline phosphatase and tumor volume levels. Conclusion:90 Y microsphere radioembolization for chemorefractory colorectal liver metastases has an acceptable safety profile with a 50% estimated survival after 8.0 months. Pretreatment high bilirubin, alkaline phosphatase and tumor volume levels were associated with early death.

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“…Selective internal radiation therapy (SIRT) with resin or glass microspheres labelled with the β-emitter yttrium-90 (Y-90) enables targeted delivery of radiation to inoperable primary or metastatic liver tumors (1)(2)(3)(4)(5)(6). Most frequently used for the management of hepatocellular carcinoma (HCC) (5) and liver metastasis of colorectal cancer (mCRC) (7), SIRT has also been used to treat the primary liver tumor intrahepatic cholangiocarcinoma (ICC) (8), and liver metastasis of many other tumor types including neuroendocrine tumors (NETs) (9), breast cancer (10,11) and uveal melanoma (12,13).…”

Section: Introductionmentioning

confidence: 99%

Safety of selective internal radiation therapy (SIRT) with yttrium-90 microspheres combined with systemic anticancer agents: expert consensus

Kennedy

Brown

Feilchenfeldt

et al. 2017

J. Gastrointest. Oncol.

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Selective internal radiation therapy (SIRT) with microspheres labelled with the β-emitter yttrium-90 (Y-90) enables targeted delivery of radiation to hepatic tumors. SIRT is primarily used to treat inoperable primary or metastatic liver tumors. Eligible patients have usually been exposed to a variety of systemic anticancer therapies, including cytotoxic agents, targeted biologics, immunotherapy and peptide receptor radionuclide therapy (PRRT). All these treatments have potential interactions with SIRT; however, robust evidence on the safety of these potential combinations is lacking. This paper provides current clinical experiences and expert consensus guidelines for the use of SIRT in combination with the anticancer treatment agents likely to be encountered in clinical practice. It was agreed by the expert panel that precautions need to be taken with certain drugs, but that, in general, systemic therapies do not necessarily have to be stopped to perform SIRT. The authors recommend stopping vascular endothelial growth factor inhibitors 4-6 weeks before SIRT, and restart after the patient has recovered from the procedure. It may also be prudent to stop potent radiosensitizers such as gemcitabine therapy 4 weeks before SIRT, and restart treatment at least 2-4 weeks later. Data from phase III studies combining SIRT with fluorouracil (5FU) or folinic acid/5FU/oxaliplatin (FOLFOX) suggest that hematological toxicity is more common from the combination than it is from chemotherapy without SIRT. There is no evidence to suggest that chemotherapy increases SIRT-specific gastro-intestinal or liver toxicities.

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Radioembolization versus Standard Care of Hepatic Metastases: Comparative Retrospective Cohort Study of Survival Outcomes and Adverse Events in Salvage Patients

Cited by 119 publications

References 32 publications

Pretreatment tumor volume as a prognostic factor in metastatic colorectal cancer treated with selective internal radiation to the liver using yttrium-90 resin microspheres

Pretreatment tumor volume as a prognostic factor in metastatic colorectal cancer treated with selective internal radiation to the liver using yttrium-90 resin microspheres

Yttrium-90 radioembolization for the treatment of chemorefractory colorectal liver metastases: Technical results, clinical outcome and factors potentially influencing survival

Safety of selective internal radiation therapy (SIRT) with yttrium-90 microspheres combined with systemic anticancer agents: expert consensus

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