Robust evidence for long-term survival with ^sup 90^Y radioembolization in chemorefractory liver-predominant metastatic colorectal cancer

• Published in: European radiology 2017-01, Vol.27 (1), p.113
• Main Authors: Jakobs, T F, Paprottka, K J, Raeßler, F, Strobl, F, Lehner, S, Ilhan, H, Trumm, C G, Fendler, W P, Sommer, W, Paprottka, P M
• Format: Article
• Language: English
• Subjects: Cancer therapies; Chemotherapy; Colorectal cancer; Growth factors; Liver; Metastasis; Radiation therapy; Tumors
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-016-4345-z

Objectives Our aim was to provide further evidence for the efficacy/safety of radioembolization using yttrium-90-resin microspheres for unresectable chemorefractory liver metastases from colorectal cancer (mCRC). Methods We followed 104 consecutively treated patients until death. Overall survival (OS) was calculated from the day of the first radioembolization procedure. Response was defined by changes in tumour volume as defined by Response Evaluation Criteria in Solid Tumours (RECIST) v1.0 and/or a [greater than or equal to]30 % reduction in serum carcinoembryonic antigen (CEA) at 3 months. Results Survival varied between 23 months in patients who had a complete response to prior chemotherapy and 13 months in patients with a partial response or stable disease. Median OS also significantly improved (from 5.8 months to 17.1 months) if response durability to radioembolization extended beyond 6 months. Patients with a positive trend in CEA serum levels ([greater than or equal to]30 % reduction) at 3 months post-radioembolization also had a survival advantage compared with those who did not: 15.0 vs 6.7 months. Radioembolization was well tolerated. Grade 3 increases in bilirubin were reported in 5.0 % of patients at 3 months postprocedure. Conclusions After multiple chemotherapies, many patients still have a good performance status and are eligible for radioembolization. This single procedure can achieve meaningful survivals and is generally well tolerated. Key Points * After multiple chemotherapies, many patients are still eligible for radioembolization (RE). * RE can achieve meaningful survival in patients with chemorefractory liver-predominant metastatic colorectal cancer (mCRC). * Tumour responsiveness to prior systemic treatments is a significant determinant of overall survival (OS) after RE. * Radioembolization in patients with a good performance status is generally well tolerated.