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

Abstract

Currently, there is no consensus on the use of 90 Y radioembolization for salvage patients with colorectal cancer liver metastases. The purpose of this study was to provide a comprehensive overview of the available data on tumor response and survival after 90 Y radioembolization for this group of patients. Methods: A systematic literature search was conducted in PubMed (Medline), Excerpta Medica (EMBASE), and the Cochrane Library (September 2012) with synonyms for "radioembolization" and "colorectal cancer liver metastases." Results were described separately for patient cohorts treated with 90 Y radioembolization as monotherapy and with 90 Y radioembolization in combination with chemotherapy. Results: The search yielded 13 relevant articles for systematic review on 90 Y radioembolization as monotherapy and 13 relevant articles on 90 Y radioembolization combined with chemotherapy. Disease control rates (i.e., complete response, partial response, and stable disease) ranged from 29% to 90% for 90 Y radioembolization as monotherapy and from 59% to 100% for 90 Y radioembolization combined with chemotherapy. Heterogeneity in the data prohibited pooling of response rates. Survival proportions at 12 mo ranged from 37% to 59% for 90 Y radioembolization as monotherapy and from 43% to 74% for 90 Y radioembolization combined with chemotherapy. Conclusion: In the studies included in this systematic review, approximately 50% of salvage patients with colorectal cancer liver metastases survive more than 12 mo after treatment with 90 Y radioembolization, either as monotherapy or in combination with chemotherapy. Heterogeneity between studies has unfortunately prohibited pooling of data. Future research will discern the precise role of 90 Y radioembolization in general clinical practice in comparison with chemotherapy.

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

“…The lowest survival results were found in the patient populations previously treated with the most lines of intravenous chemotherapy, as in our patient population [20]. Additionally, we did not administer an intravenous 5-FU infusion immediately after the 90 Y infusion as described by…”

The dosimetric importance of the number of 90Y microspheres in liver transarterial radioembolization (TARE)

“…The SORAMIC study (http://www.clinicaltrials.gov/ ct2/show/NCT01126645?term=soramic&rank=1) will compare the TARE + sorafenib and sorafenib alone in the palliative treatment group. Regarding metastases, because of heterogeneity among studies on colorectal carcinoma (CRC) secondary lesions, the role of TARE has not been defined [12]. Only two completed phase III trials have demonstrated an improvement in tumour response, progression-free survival [13] and time to progression [14] following the addition of TARE to chemotherapy alone.…”

Insights into the Dose–Response Relationship of Radioembolization with Resin 90Y-Microspheres: A Prospective Cohort Study in Patients with Colorectal Cancer Liver Metastases

“…A beneficial effect on liver disease control has already been shown in the salvage setting, and large randomized controlled trials are investigating the role of radioembolization with concomitant systemic therapy as first-or second-line treatment (2,3).…”