Yttrium-90 Radioembolization as Salvage Therapy for Colorectal Cancer With Liver Metastases

Abstract

Yttrium-90 (90Y) radioembolization is a treatment option for patients with metastatic colorectal cancer with unresectable liver metastases. We conducted a retrospective analysis to evaluate outcomes in 24 such patients who underwent 90Y radioembolization. We concluded that 90Y radioembolization is reasonable for select patients with unresectable hepatic metastases in the absence of other metastatic sites. Background Few patients with metastatic colorectal cancer (mCRC) are candidates for resection of their hepatic disease. Yttrium-90 (90Y) radioembolization has promise in the treatment of unresectable mCRC. We conducted retrospective study to assess the efficacy in patients with refractory mCRC who underwent 90Y radioembolization. Materials and methods Patients with unresectable mCRC with liver metastases treated at The Ohio State University were included in this analysis. Demographic data, carcinoembryonic antigen (CEA) values, observed toxicities, and information on prior therapies were collected. Response was assessed by RECIST (Response Evaluation Criteria in Solid Tumors) 1.1 criteria. Overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan-Meier method. Results Twenty-four patients (median age, 63 years) were included. Of the patients, 54% had extrahepatic disease; 67% had bilobar involvement. The patients had received a median of 3 prior therapies. No objective responses were observed. Five patients had a CEA response. Median PFS and OS were 3.9 months (95% CI, 2.4–4.8 months) and 8.9 months (95% CI, 4.2–16.7 months), respectively. Patients older than 65 years had improved PFS (4.6 vs. 2.4 months) and OS (14 vs. 5.5 months) vs. younger patients, likely due to receipt of 90Y treatment earlier in their disease course. The presence of extrahepatic disease and the absence of CEA response appeared negatively predictive of efficacy. Toxicities were expected and manageable. Conclusion 90Y radioembolization is active in select patients with refractory mCRC and with liver metastases, and is safe and well tolerated in the elderly. In patients with extensive extrahepatic disease, 90Y should be used in combination with chemotherapy. CEA may be a predictor of efficacy.

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).…”

“…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.…”

Power output and efficiency of beta-emitting microspheres

“…Beta-minus emitting radioactive microspheres are increasingly used in medical applications such as PET/SPECT imaging [1][2][3][4] and radiation therapy [5][6][7][8][9][10][11][12] as they often offer advantages over alternative methods such as chemoembolization and external beam radiation [13][14]. For instance, in radioembolization [6,8,15] or Selective Internal Radiation Therapy (SIRT) [16], radioactive microspheres are delivered to a tumour through the bloodstream via a catheter prior to an angiogram.…”

“…For instance, in radioembolization [6,8,15] or Selective Internal Radiation Therapy (SIRT) [16], radioactive microspheres are delivered to a tumour through the bloodstream via a catheter prior to an angiogram. The particles lodge in the tumour and emit radiation that kills the tumour.…”