Selective Internal Radiation Therapy with SIR-Spheres for the Treatment of Unresectable Colorectal Hepatic Metastases

Abstract

The purpose of this study was to evaluate the effectiveness of colorectal cancer (CRC) liver metastasis radioembolization with yttrium-90 (Y90), assessing toxicity and survival rates in patients with no response to chemotherapy through our 3-year experience. From February 2005 to January 2008, we treated 41 patients affected by CRC from a cohort of selective internal radiation therapy patients treated at our institution. All patients examined showed disease progression and arrived for our observation with an abdominal CT, a body PET, and a hepatic angiography followed by gastroduodenal artery coiling previously performed by us. We excluded patients with a bilirubin level>1.8 mg/dl and pulmonary shunt>20% but not patients with minor extrahepatic metastases. On treatment day, under fluoroscopic guidance, we implanted a dose of Y90 microspheres calculated on the basis of liver tumoral involvement and the body surface area formula. All patients were discharged the day after treatment. We obtained, according to Response Evaluation Criteria on Solid Tumors, a complete response in 2 patients, a partial response in 17 patients, stable disease in 14 patients, and progressive disease in 8 patients. In all cases, we obtained a carcinoembryonic antigen level decrease, especially in the week 8 evaluation. Technical success rate was 98% and technical effectiveness estimated at 3 months after treatment was 80.5%. Side effects graded by Common Terminology Criteria on Adverse Events were represented by one grade 4 hepatic failure, two grade 2 gastritis, and one grade 2 cholecystitis. The median survival and the progression-free survival calculated by Kaplan-Meier analysis were 354 and 279 days, respectively. In conclusion, according to our 3-year experience, Y90 SIR-Spheres radioembolization is a feasible and safe method to treat CRC liver metastases, with an acceptable level of complications and a good response rate.

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

“…Post-treatment CT changes, such as edema, hemorrhage, and ring enhancement, can also confound assessment of tumor response. Although we were able to demonstrate that pretreatment volume was predictive of response using volumetric criteria, our results might have been improved by the use of metabolic imaging, including 18 F-FDG PET or functional MR imaging with diffusionweighted sequences (14,20).…”

“…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.…”

“…Several of these studies have investigated prognostic factors for improved outcomes in SIRT, including age, extrahepatic disease, performance status, and carcinoembryonic antigen levels (10,14,19,20). However, the relationship between pre-SIRT liver tumor volume independent of total number of liver lesions and outcomes has not well described.…”

Radioembolization for Treatment of Salvage Patients with Colorectal Cancer Liver Metastases: A Systematic Review

“…Cross-referencing did not yield any additional relevant articles. Among the selected studies reporting on 90 Y radioembolization as monotherapy were 3 phase 2 trials (7,15,16), 2 prospective cohort studies (12,17), and 8 retrospective cohort studies (9,(18)(19)(20)(21)(22)(23)(24), involving a total of 901 patients (Supplemental Table 1). All studies had included patients with unresectable and chemorefractory liver lesions (i.e., salvage patients), and most studies included patients with liver-dominant disease, that is, the studies accepted patients with minor extrahepatic disease for treatment.…”

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

“…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].…”