Is Yttrium-90 Radioembolization a Viable Treatment Option for Unresectable, Chemorefractory Colorectal Cancer Liver Metastases? A Large Single-Center Experience of 302 Patients

Saxena, Akshat; Meteling, Baerbel; Kapoor, Jada; Golani, Sanjeev; Morris, David L.; Bester, Lourens

doi:10.1245/s10434-014-4164-x

Cited by 62 publications

(37 citation statements)

References 32 publications

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“…There is a lot of data existing about the effectiveness of radioembolization therapy in patients suffering from hepatocellular carcinoma [6,26] and intrahepatic cholangiocarcinoma [8] as well as patients with unresectable liver metastases of colorectal cancer [9,27], breast carcinoma [7,23], pancreatic carcinoma [21], and neuroendocrine tumors [8,13,31].…”

Section: Discussionmentioning

confidence: 99%

Safety of Radioembolization with 90Yttrium Resin Microspheres Depending on Coiling or No-Coiling of Aberrant/High-Risk Vessels

Paprottka

Walter

et al. 2015

Cardiovasc Intervent Radiol

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Purpose To evaluate the safety of radioembolization (RE) with 90 Yttrium ( 90 Y) resin microspheres depending on coiling or no-coiling of aberrant/high-risk vessels. Materials and MethodsEarly and late toxicity after 566 RE procedures were analyzed retrospectively in accordance with the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE v3.0). For optimal safety, aberrant vessels were either coil embolized (n = 240/566, coiling group) or a more peripheral position of the catheter tip was chosen to treat right or left liver lobes (n = 326/566, no-coiling group). Results Clinically relevant late toxicities (CGrade 3) were observed in 1 % of our overall cohort. The no-coiling group had significantly less ''any'' (P = 0.0001) or ''clinically relevant'' (P = 0.0003) early toxicity. There was no significant difference (P [ 0.05) in delayed toxicity in the coiling versus the no-coiling group. No RE-induced liver disease was noted after all 566 procedures. Conclusion RE with 90 Y resin microspheres is a safe and effective treatment option. Performing RE without coil embolization of aberrant vessels prior to treatment could be an alternative for experienced centers.

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Section: Discussionmentioning

confidence: 99%

Safety of Radioembolization with 90Yttrium Resin Microspheres Depending on Coiling or No-Coiling of Aberrant/High-Risk Vessels

Paprottka

Walter

et al. 2015

Cardiovasc Intervent Radiol

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“…The toxicity profile and safety of radioembolization in unresectable CLM patients was found to be acceptable by several studies [14–17], even in the heavily pre-treated population [18, 19]. Retrospective studies with the largest sample sizes to date (n=214–606) report a median survival of 7.2–10.6 months after radioembolization of CLM; mostly in the salvage setting [14–16]. …”

Section: Introductionmentioning

confidence: 99%

Metabolic tumor volume and total lesion glycolysis on FDG-PET/CT can predict overall survival after 90Y radioembolization of colorectal liver metastases: A comparison with SUVmax, SUVpeak, and RECIST 1.0

Shady

Kishore

Gavane

et al. 2016

European Journal of Radiology

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Purpose To compare the performance of 4 metrics of metabolic response on FDG-PET/CT against RECIST 1.0 for determining response and predicting overall survival (OS) following 90Y resin microspheres radioembolization of colorectal liver metastases (CLM). Methods We conducted an IRB-waived retrospective review of our radioembolization database to identify patients with unresectable CLM treated between December 2009 and December 2013. We included patients who had both PET/CT and contrast enhanced CT (CECT) available at baseline and on the first follow-up post-radioembolization. On baseline CECT up to five target tumors were chosen per patient according to RECIST 1.0. Four metrics of FDG-avidity (SUVmax, SUVpeak, metabolic tumor volume (MTV), and total lesion glycolysis (TLG)) on PET/CT were measured for the same target tumors. Using RECIST 1.0, patients were classified as no progression (partial response or stable disease) and progression. For each PET metric, a cut-off point of ≥30% decrease was chosen to define response. OS was calculated from the time of radioembolization using Kaplan-Meier methodology. The log-rank test was used for univariate analysis to identify predictors of OS. Results The study enrolled 49 patients with 119 target tumors; a median of 2 (range: 1–5) tumors were selected per patient. Median OS was 12.7 months (95%CI: 7.2–16.7). Response by MTV (P=0.035) and TLG (P=0.044) reached statistical significance in predicting OS. Response by SUVmax (P=0.21), SUVpeak (P=0.20) or no progression by RECIST1.0 (P=0.44) did not predict OS. Conclusion Metabolic response based on changes in MTV and TLG can predict OS post-radioembolization of CLM.

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“…Nonetheless, most colorectal liver metastases become refractory or resistant to these regimens, at which point survival estimates range from 4 to 5 mo. 90 Y radioembolization of hepatic metastases has been increasingly used in this salvage setting and has shown favorable survival outcomes-exceeding 10 mo-after 90 Y radioembolization (1)(2)(3). Most of the published outcomes have been after 90 Y radioembolization using resin microspheres.…”

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confidence: 99%

⁹⁰Y Radioembolization of Colorectal Hepatic Metastases Using Glass Microspheres: Safety and Survival Outcomes from a 531-Patient Multicenter Study

et al. 2015

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Hepatic metastases of colorectal carcinoma are a leading cause of cancer-related mortality. Most colorectal liver metastases become refractory to chemotherapy and biologic agents, at which point the median overall survival declines to 4-5 mo. Radioembolization with 90 Y has been used in the salvage setting with favorable outcomes. This study reports the survival and safety outcomes of 531 patients treated with glass-based 90 Y microspheres at 8 institutions, making it the largest 90 Y study for patients with colorectal liver metastases. Methods: Data were retrospectively compiled from 8 institutions for all 90 Y glass microsphere treatments for colorectal liver metastases. Exposure to chemotherapeutic or biologic agents, prior liver therapies, biochemical parameters before and after treatment, radiation dosimetry, and complications were recorded. Uni-and multivariate analyses for predictors of survival were performed. Survival outcomes and clinical or biochemical adverse events were recorded. Results: In total, 531 patients received 90 Y radioembolization for colorectal liver metastases. The most common clinical adverse events were fatigue (55%), abdominal pain (34%), and nausea (19%). Grade 3 or 4 hyperbilirubinemia occurred in 13% of patients at any time. The median overall survival from the first 90 Y treatment was 10.6 mo (95% confidence interval, 8.8-12.4). Performance status, no more than 25% tumor burden, no extrahepatic metastases, albumin greater than 3 g/dL, and receipt of no more than 2 chemotherapeutic agents independently predicted better survival outcomes. Conclusion: This multiinstitutional review of a large cohort of patients with colorectal liver metastases treated with 90 Y radioembolization using glass microspheres has demonstrated promising survival outcomes with low toxicity and low side effects. The outcomes were reproducible and consistent with prior reports of radioembolization.

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Is Yttrium-90 Radioembolization a Viable Treatment Option for Unresectable, Chemorefractory Colorectal Cancer Liver Metastases? A Large Single-Center Experience of 302 Patients

Abstract: 90Y radioembolization is a safe and effective treatment for unresectable, chemorefractory CRCLM.

Cited by 62 publications

References 32 publications

Safety of Radioembolization with 90Yttrium Resin Microspheres Depending on Coiling or No-Coiling of Aberrant/High-Risk Vessels

Safety of Radioembolization with 90Yttrium Resin Microspheres Depending on Coiling or No-Coiling of Aberrant/High-Risk Vessels

Metabolic tumor volume and total lesion glycolysis on FDG-PET/CT can predict overall survival after 90Y radioembolization of colorectal liver metastases: A comparison with SUVmax, SUVpeak, and RECIST 1.0

⁹⁰Y Radioembolization of Colorectal Hepatic Metastases Using Glass Microspheres: Safety and Survival Outcomes from a 531-Patient Multicenter Study

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Is Yttrium-90 Radioembolization a Viable Treatment Option for Unresectable, Chemorefractory Colorectal Cancer Liver Metastases? A Large Single-Center Experience of 302 Patients

Abstract: 90Y radioembolization is a safe and effective treatment for unresectable, chemorefractory CRCLM.

Cited by 62 publications

References 32 publications

Safety of Radioembolization with 90Yttrium Resin Microspheres Depending on Coiling or No-Coiling of Aberrant/High-Risk Vessels

Safety of Radioembolization with 90Yttrium Resin Microspheres Depending on Coiling or No-Coiling of Aberrant/High-Risk Vessels

Metabolic tumor volume and total lesion glycolysis on FDG-PET/CT can predict overall survival after 90Y radioembolization of colorectal liver metastases: A comparison with SUVmax, SUVpeak, and RECIST 1.0

90Y Radioembolization of Colorectal Hepatic Metastases Using Glass Microspheres: Safety and Survival Outcomes from a 531-Patient Multicenter Study

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⁹⁰Y Radioembolization of Colorectal Hepatic Metastases Using Glass Microspheres: Safety and Survival Outcomes from a 531-Patient Multicenter Study