Multicenter evaluation of the safety and efficacy of radioembolization in patients with unresectable colorectal liver metastases selected as candidates for (90)Y resin microspheres

Andrew S Kennedy; David Ball; Steven J Cohen; Michael Cohn; Douglas M Coldwell; Alain Drooz; Eduardo Ehrenwald; Samir Kanani; Steven C Rose; Charles W Nutting; Fred M Moeslein; Michael A Savin; Sabine Schirm; Samuel G Putnam 3rd; Navesh K Sharma; Eric A Wang

doi:10.3978/j.issn.2078-6891.2014.109

Multicenter evaluation of the safety and efficacy of radioembolization in patients with unresectable colorectal liver metastases selected as candidates for (90)Y resin microspheres

J Gastrointest Oncol. 2015 Apr;6(2):134-42. doi: 10.3978/j.issn.2078-6891.2014.109.

Authors

Andrew S Kennedy¹, David Ball¹, Steven J Cohen¹, Michael Cohn¹, Douglas M Coldwell¹, Alain Drooz¹, Eduardo Ehrenwald¹, Samir Kanani¹, Steven C Rose¹, Charles W Nutting¹, Fred M Moeslein¹, Michael A Savin¹, Sabine Schirm¹, Samuel G Putnam 3rd¹, Navesh K Sharma¹, Eric A Wang¹

Affiliation

¹ 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN 37203, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbott Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 University of California, San Diego Moores Cancer Center, La Jolla, CA, USA ; 10 Radiology Imaging Associates, Englewood, CO, USA ; 11 University of Maryland Medical Center, Baltimore, MD, USA ; 12 Beaumont Hospital, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA.

Abstract

Background: Metastatic colorectal cancer liver metastases Outcomes after RadioEmbolization (MORE) was an investigator-initiated case-control study to assess the experience of 11 US centers who treated liver-dominant metastases from colorectal cancer (mCRC) using radioembolization [selective internal radiation therapy (SIRT)] with yttrium-90-((90)Y)-labeled resin microspheres.

Methods: Data from 606 consecutive patients who received radioembolization between July 2002 and December 2011 were collected by an independent research organization. Adverse events (AEs) and survival were compared across lines of treatment using Fisher's exact test and Kaplan-Meier estimates, respectively.

Results: Patients received a median of 2 (range, 0-6) lines of prior chemotherapy; 35.1% had limited extrahepatic metastases. Median tumor-to-liver ratio and -activity administered at first procedure were 15% and 1.17 GBq, respectively. Hospital stay was <24 hours in 97.8% cases. Common grade ≥3 AEs over 184 days follow-up were: abdominal pain (6.1%), fatigue (5.5%), hyperbilirubinemia (5.4%), ascites (3.6%) and gastrointestinal ulceration (1.7%). There was no statistical difference in AEs across treatment lines (P>0.05). Median survivals [95% confidence interval (CI)] following radioembolization as a 2(nd)-line, 3(rd)-line, or 4(th)-plus line were 13.0 (range, 10.5-14.6), 9.0 (range, 7.8-11.0), and 8.1 (range, 6.4-9.3) months, respectively; and significantly prolonged in patients with ECOG 0 vs. ≥1 (P=0.009). Statistically significant independent variables for survival at radioembolization were: disease stage [extrahepatic metastases, extent of liver involvement (tumor-to-treated-liver ratio)], liver function (uncontrolled ascites, albumin, alkaline phosphatase, aspartate transaminase), leukocytes, and prior chemotherapy.

Conclusions: Radioembolization appears to have a favorable risk/benefit profile, even among mCRC patients who had received ≥3 prior lines of chemotherapy.

Keywords: Yttrium-90 (90Y); albumin; alkaline phosphatase; ascites; bilirubin; brachytherapy; salvage therapy.