SELECTIVE INTERNAL RADIATION THERAPY WITH <sup>90</sup>Y MICROSPHERES FOR COLORECTAL LIVER METASTASES: SINGLE‐CENTRE EXPERIENCE WITH 100 PATIENTS

Stubbs, Richard S.; O'Brien, I M; Correia, Mauro Monteiro

doi:10.1111/j.1445-2197.2006.03834.x

Cited by 92 publications

(50 citation statements)

References 19 publications

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“…Thus, in recent years development of new methods of treatment of non-resectable hepatic tumours has received much attention. External radiation is regarded as ineffective in the treatment of hepatic primary or secondary tumours since the dose of radiation that can be applied to the tumour is limited by the tolerance level of the nontumorous liver tissue [3][4][5] . Intra-arterial administration of 90 Yttrium-microspheres, i.e.…”

mentioning

confidence: 99%

“…Thus, apart from microembolization, a radiation dose from 30 to 60 Gy can be applied to the tumour tissue. Furthermore radiation therapy may be followed by the selective infusion of chemotherapeutic agents into the hepatic artery [4,7,8] .…”

mentioning

confidence: 99%

“…This technique allows the application of high radiation dose to hepatic tumours while sparing, for the most part, normal liver parenchyma. During SIRT, 90 Y-microspheres are infused into the hepatic artery either by a surgically placed subcutaneous port or through a percutaneous femoral catheter [3][4][5][6] . The radiopharmaceutical agent consists of non-biodegradable 90 Y-imprinted microspheres with a glass or a resin matrix with a diameter of 29-35 μm.…”

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confidence: 99%

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An uncommon cause of gastro-duodenal ulceration

Mallach

Ramp²,

Erhardt

et al. 2008

WJG

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confidence: 99%

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confidence: 99%

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An uncommon cause of gastro-duodenal ulceration

Mallach

Ramp²,

Erhardt

et al. 2008

WJG

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“…Previously, various clinical studies have reported the routine use of AT-II infusion during 90 Y-RE [2,4,12,28,29,30]. However, the efficacy of using AT-II for this purpose is not clear.…”

Section: Introductionmentioning

confidence: 99%

The effect of intra-arterial angiotensin II on the hepatic tumor to non-tumor blood flow ratio for radioembolization: a systematic review

Hoven

Smits

Rosenbaum

et al. 2014

Journal of Vascular and Interventional Radiology

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Purpose: Treatment efficacy of intra-arterial radioembolization for liver tumors depends on the selective targeting of tumorous tissue. Recent investigations have demonstrated that tumors may receive inadequate doses of radioactivity after radioembolization, due to unfavorable tumor to non-tumor (T/N) uptake ratios of radioactive microspheres. Hepatic arterial infusion of the vasoconstrictor angiotensin II (AT-II) is reported to increase the T/N blood flow ratio. The purpose of this systematic review was to provide a comprehensive overview of the effect of hepatic arterial AT-II on T/N blood flow ratio in patients with hepatic malignancies, and determine its clinical value for radioembolization.Methods: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and MetaAnalyses guidelines. A structured search was performed in the PubMed, EMBASE and Cochrane databases. Only studies that presented data on T/N ratios before and after infusion of AT-II into the hepatic artery, in human patients with hepatic malignancies, were selected. Median T/N ratios before, during and after AT-II infusion, and the median T/N ratio improvement factor were extracted from the selected articles. All data on systemic blood pressure measurements and clinical symptoms were also extracted. Results:The search identified 524 titles of which 5 studies, including a total of 71 patients were considered relevant. Median T/N ratios before infusion of AT-II ranged from 0.4 to 3.4. All studies observed a substantial improvement of the T/N ratio after AT-II infusion, with median improvement factors ranging from 1.8 to 3.1. A transitory increase of systemic blood pressure was observed during AT-II infusion.Conclusions: Infusion of AT-II into the hepatic artery leads to an increase of the tumor to non-tumor blood flow ratio, as measured by T/N uptake ratios. Clinical trials are warranted to assess safety aspects, optimal administration strategy and impact on treatment efficacy during radioembolization.

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“…This treatment preferentially delivers a high dose of radiation to the liver tumour, whilst sparing much of the normal liver, by virtue of the fact that the tumour derives the majority of its blood supply from the hepatic artery and this characteristic ensures the injected microspheres lodge in the tumour microvasculature [6], whereas the normal liver predominantly receives its blood supply from the portal venous system. Many theoretical and clinical aspects of the utility of SIR-spheres for the treatment of metastatic colorectal cancer have been published, including reviews of the clinical response rate to treatment in the firstline, second-line and salvage settings [7][8][9][10][11].…”

mentioning

confidence: 99%

Multi-modality Therapy of Hepatic Metastases from Colorectal Carcinoma: Optimal Combination of Systemic Chemotherapy with Radio-embolization

Hill¹,

Sharma²

2011

J Nucl Med Radiat Ther

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Despite major advances in the systemic treatment of metastatic colorectal carcinoma, the 5 year survival rate remains disappointingly low at approximately 7% [1]. Median survival for this patient group is currently in the range 1.5 to 2.5 years, and depends on continuation of systemic therapy for much of the patient's remaining life. Of all patients with metastatic colorectal cancer, 20-30% have liver-only metastases and approximately 50% of recurrences following resection of the primary tumour are confined to the liver alone. Surgical resection of hepatic metastases is the treatment of choice, where possible, but this is feasible for less than 15% of patients at presentation [2]. For the subset of patients with metastatic colorectal cancer in whom surgical resection can be achieved, the 5 year overall survival probability is 30-40%, with 20% of patients achieving long-term cure [3]. Patients with unresectable liver predominant metastases have increasingly become a focus of interest for improving survival for patients with metastatic colorectal cancer. This prioritization is due to the outcomes from Phase II studies utilising downstaging neo-adjuvant chemotherapy in which 10-20% of patients with inoperable liver disease have been converted to curative resection and due to the finding that there is a statistical correlation between tumour response and resection rates across clinical studies [4]. Multimodality treatment combinations of systemic agents with liver surgery have been proffered as a means of improving tumour response rates and so improving the proportion of long term survivors of patients with metastatic colorectal cancer.There has been much optimism that newly developed, expensive, biologically targeted agents may improve survival in this patient group, when combined with systemic chemotherapy, but complete radiological responses or cures remain exceedingly rare. Preliminary data from Phase III trials of chemotherapy and biologically targeted agents have not consistently shown statistically significant increases in response rates,nor the frequency of down-staging to resectability, over chemotherapy alone. There are two limitations of delivering neoadjuvant chemotherapy prior to liver metastectomy. Firstly, the development of pathological liver steatosis and fibrosis, which can occur with oxaliplatin-based chemotherapy or with irinotecan-based chemotherapy, and worsens with cumulative dosing. Secondly, the risk of disease relapse in the liver post-surgery, usually not at the resection site. Of those patients with liver-dominant or liver-only metastases, where the hepatic disease is unlikely to become resectable even with neoadjuvant systemic therapy, there is still a robust rationale for maximising local control of the liver disease, since up to 90% of patients with metastatic colorectal cancer ultimately die of liver failure [5]. Multiple loco-regional strategies are therefore under investigation to improve the outcome for patients with unresectable colorectal liver metastases, including radio-frequen...

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SELECTIVE INTERNAL RADIATION THERAPY WITH ⁹⁰Y MICROSPHERES FOR COLORECTAL LIVER METASTASES: SINGLE‐CENTRE EXPERIENCE WITH 100 PATIENTS

Abstract: Selective internal radiation therapy is a very effective and well-tolerated regional treatment for colorectal liver metastases, which should be considered for those with liver-only metastatic disease.

Cited by 92 publications

References 19 publications

An uncommon cause of gastro-duodenal ulceration

An uncommon cause of gastro-duodenal ulceration

The effect of intra-arterial angiotensin II on the hepatic tumor to non-tumor blood flow ratio for radioembolization: a systematic review

Multi-modality Therapy of Hepatic Metastases from Colorectal Carcinoma: Optimal Combination of Systemic Chemotherapy with Radio-embolization

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SELECTIVE INTERNAL RADIATION THERAPY WITH 90Y MICROSPHERES FOR COLORECTAL LIVER METASTASES: SINGLE‐CENTRE EXPERIENCE WITH 100 PATIENTS

Abstract: Selective internal radiation therapy is a very effective and well-tolerated regional treatment for colorectal liver metastases, which should be considered for those with liver-only metastatic disease.

Cited by 92 publications

References 19 publications

An uncommon cause of gastro-duodenal ulceration

An uncommon cause of gastro-duodenal ulceration

The effect of intra-arterial angiotensin II on the hepatic tumor to non-tumor blood flow ratio for radioembolization: a systematic review

Multi-modality Therapy of Hepatic Metastases from Colorectal Carcinoma: Optimal Combination of Systemic Chemotherapy with Radio-embolization

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SELECTIVE INTERNAL RADIATION THERAPY WITH ⁹⁰Y MICROSPHERES FOR COLORECTAL LIVER METASTASES: SINGLE‐CENTRE EXPERIENCE WITH 100 PATIENTS