Factors Affecting Oncologic Outcomes of 90Y Radioembolization of Heavily Pre-Treated Patients With Colon Cancer Liver Metastases

Abstract

Objectives-To identify predictors of overall (OS) and liver progression-free survival (LPFS) following 90 Y radioembolization (RAE) of heavily pretreated patients with colorectal cancer liver metastases (CLM). Create and validate a predictive nomogram for OS.Materials and Methods-Metabolic, anatomic, laboratory, pathologic, genetic, primary-disease and procedure-related factors, as well as pre-and post-RAE therapies in 103 CLM patients treated with RAE from 9/15/2009 to 3/21/2017 were analyzed. LPFS was defined by RECIST 1.1 and EORTC criteria. Prognosticators of OS and LPFS were selected using univariate Cox regression, adjusted for clustering and competing risk analysis (for LPFS) and subsequently tested in

Mode of progression after radioembolization in patients with colorectal cancer liver metastases

“…Objective response (CR or PR) at 3 months after treatment was obtained in only 6% of our patients. This is in line with other studies in salvage mCRC patients, with reported response ranges of 6-24% [24,56,57]. Median OS in our study was 10 months, which is also in line with other studies in a comparable patient population [22,24,58].…”

“…We found a difference in median OS with and without the presence of extrahepatic metastases at baseline, respectively 7 versus 10 months (p = 0.0018). Several other studies with a comparable patient population also found that extrahepatic disease was a predictor of survival after radioembolization [24,[45][46][47][48][49]. Other known prognostic factors are tumor load, baseline CEA level, and location (left-versus right-sidedness) of the primary tumor [24,49,50].…”

“…The extent of extrahepatic disease we are willing to accept is under constant debate at tumor board meetings in our center, but clear guidance is currently missing, due to the lack of data on this matter. Other prognostic factors that are known to influence response after treatment with radioembolization are (among others) KRAS status, primary tumor location, percentage tumor involvement, and pre-treatment CEA level [19,24,25]. These factors could possibly be used in patient selection as well.…”

Clinical Application of Trans-Arterial Radioembolization in Hepatic Malignancies in Europe: First Results from the Prospective Multicentre Observational Study CIRSE Registry for SIR-Spheres Therapy (CIRT)

“…The relatively low number of patients receiving any systemic therapy (33.1%) or loco-regional treatments (16.3%) after TARE suggests that TARE is used as ''last meaningful treatment'' rather than being planned as an early consolidation in the scope of various treatment options, suggesting that TARE is used according to most of Considering the timing of the TARE treatment in relation to prior systemic therapies, our study reported that the majority of the metastatic liver malignancies (mCRC, NET, breast and pancreatic) were treated with TARE after one or more systemic therapy line (Supplement 2). For mCRC, studies have shown that good results can still be achieved in heavily pre-treated patients (see below) [38][39][40]. In NET, TARE can be considered for patients not responding to systemic therapies or have undergone prior peptide receptor radionuclide therapy (PRRT), TACE or bland embolization, which is reflected in the long median time from metastatic diagnosis to TARE (1242 days, Table 4) [35,41,42].…”

“…Our study confirms previous findings that independent of indication, prognostic factors commonly associated with an increased survival rate are ECOG 0, reduced tumour burden, lack of cirrhosis and ascites, low number of chemotherapy lines prior to TARE and no extra-hepatic disease [16,57,[59][60][61][62]. Kurilova et al have shown that in mCRC patients in the salvage setting, 1-year OS can range from 10% to 90% based on independent baseline parameters (number of extra-hepatic disease sites, carcinoembryonic antigen, albumin, alanine aminotransferase level, tumour differentiation level and the sum of the two largest tumour diameters) [38]. Damm et al have developed a scoring system for patients with mCRC consisting of a combination of tumour load, CEA or CA19-9 levels and Karnofsky index to improve patient selection for TARE [39].…”