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Y90 Radioembolization in chemo-refractory metastastic, liver dominant colorectal cancer patients: outcome assessment applying a predictive scoring system
In treatment-refractory liver dominant metastatic colorectal cancer, the role of liver directed therapies still is unclear. We sought to determine a prognostic score for Y90 radioembolization in these patients. We analyzed 106 patients with refractory liver dominant mCRC who had undergone a total of...
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| Published in: | BMC cancer 2016-07, Vol.16 (1), p.509, Article 509 |
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| creator | Damm, Robert Seidensticker, Ricarda Ulrich, Gerhard Breier, Leonie Steffen, Ingo G Seidensticker, Max Garlipp, Benjamin Mohnike, Konrad Pech, Maciej Amthauer, Holger Ricke, Jens |
| description | In treatment-refractory liver dominant metastatic colorectal cancer, the role of liver directed therapies still is unclear. We sought to determine a prognostic score for Y90 radioembolization in these patients.
We analyzed 106 patients with refractory liver dominant mCRC who had undergone a total of 178 Y90 radioembolizations with resin microspheres was collected. Potential factors influencing survival were analyzed using a Cox regression. The Log rank test served to establish prognostic factors and to form a clinical score for outcome prediction after Y90 radioembolization.
Median survival of all patients was 6.7 months. Neither age nor prior surgical or systemic therapy nor metastatic spread had an effect on survival. In contrast, hepatic tumor load, Karnofsky index as well as CEA and CA19-9 serums level had a significant influence (p 130 ng/ml or CA19-9 > 200U/ml and Karnofsky index |
| doi_str_mv | 10.1186/s12885-016-2549-x |
| format | article |
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We analyzed 106 patients with refractory liver dominant mCRC who had undergone a total of 178 Y90 radioembolizations with resin microspheres was collected. Potential factors influencing survival were analyzed using a Cox regression. The Log rank test served to establish prognostic factors and to form a clinical score for outcome prediction after Y90 radioembolization.
Median survival of all patients was 6.7 months. Neither age nor prior surgical or systemic therapy nor metastatic spread had an effect on survival. In contrast, hepatic tumor load, Karnofsky index as well as CEA and CA19-9 serums level had a significant influence (p < 0.001, p = 0.037, p = 0.023 and p < 0.001, respectively). These three factors formed a score with 1 point each for tumor load >20 %, CEA >130 ng/ml or CA19-9 > 200U/ml and Karnofsky index <80 %. Patients with a score of 0 and 1 displayed a median OS of 10.4 months. Patients with a score of 2 and 3 demonstrated a median OS of 5.1 months only (p < 0.001).
Overaggressive patient selection for Y90 radioembolization of liver dominant chemorefractory mCRC is of questionable benefit. A scoring system comprising hepatic tumor load, CEA and CA19-9 serum levels and Karnofsky index (TuCK-score) may support an improved patient selection. In our cohort of liver only versus liver dominant disease, extrahepatic lung or lymphatic metastases did not significantly alter the prognosis.</description><identifier>ISSN: 1471-2407</identifier><identifier>EISSN: 1471-2407</identifier><identifier>DOI: 10.1186/s12885-016-2549-x</identifier><identifier>PMID: 27439702</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adult ; Aged ; Antigens ; Biomarkers ; CA-19-9 Antigen - blood ; Cancer ; Cancer therapies ; Carcinoembryonic Antigen - blood ; Care and treatment ; Chemotherapy ; Colorectal cancer ; Colorectal Neoplasms - pathology ; Colorectal Neoplasms - therapy ; Complications and side effects ; Drug Resistance, Neoplasm ; Embolization, Therapeutic - methods ; Female ; Health aspects ; Humans ; Kaplan-Meier Estimate ; Karnofsky Performance Status ; Liver ; Liver - pathology ; Liver Neoplasms - secondary ; Liver Neoplasms - therapy ; Magnetic resonance imaging ; Male ; Metastasis ; Middle Aged ; Multivariate Analysis ; Neoplasm Metastasis ; Outcome Assessment (Health Care) - methods ; Outcome Assessment (Health Care) - statistics & numerical data ; Patient outcomes ; Patients ; Prognosis ; Proportional Hazards Models ; Regression analysis ; Risk factors ; Yttrium Radioisotopes - therapeutic use</subject><ispartof>BMC cancer, 2016-07, Vol.16 (1), p.509, Article 509</ispartof><rights>COPYRIGHT 2016 BioMed Central Ltd.</rights><rights>Copyright BioMed Central 2016</rights><rights>The Author(s). 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c559t-230f2d838bd33b5c8d24d6cf94e6bf0ba784fed6086bbfc2df93c61a51fba4d23</citedby><cites>FETCH-LOGICAL-c559t-230f2d838bd33b5c8d24d6cf94e6bf0ba784fed6086bbfc2df93c61a51fba4d23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4955133/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/1807925949?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,44590,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27439702$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Damm, Robert</creatorcontrib><creatorcontrib>Seidensticker, Ricarda</creatorcontrib><creatorcontrib>Ulrich, Gerhard</creatorcontrib><creatorcontrib>Breier, Leonie</creatorcontrib><creatorcontrib>Steffen, Ingo G</creatorcontrib><creatorcontrib>Seidensticker, Max</creatorcontrib><creatorcontrib>Garlipp, Benjamin</creatorcontrib><creatorcontrib>Mohnike, Konrad</creatorcontrib><creatorcontrib>Pech, Maciej</creatorcontrib><creatorcontrib>Amthauer, Holger</creatorcontrib><creatorcontrib>Ricke, Jens</creatorcontrib><title>Y90 Radioembolization in chemo-refractory metastastic, liver dominant colorectal cancer patients: outcome assessment applying a predictive scoring system</title><title>BMC cancer</title><addtitle>BMC Cancer</addtitle><description>In treatment-refractory liver dominant metastatic colorectal cancer, the role of liver directed therapies still is unclear. We sought to determine a prognostic score for Y90 radioembolization in these patients.
We analyzed 106 patients with refractory liver dominant mCRC who had undergone a total of 178 Y90 radioembolizations with resin microspheres was collected. Potential factors influencing survival were analyzed using a Cox regression. The Log rank test served to establish prognostic factors and to form a clinical score for outcome prediction after Y90 radioembolization.
Median survival of all patients was 6.7 months. Neither age nor prior surgical or systemic therapy nor metastatic spread had an effect on survival. In contrast, hepatic tumor load, Karnofsky index as well as CEA and CA19-9 serums level had a significant influence (p < 0.001, p = 0.037, p = 0.023 and p < 0.001, respectively). These three factors formed a score with 1 point each for tumor load >20 %, CEA >130 ng/ml or CA19-9 > 200U/ml and Karnofsky index <80 %. Patients with a score of 0 and 1 displayed a median OS of 10.4 months. Patients with a score of 2 and 3 demonstrated a median OS of 5.1 months only (p < 0.001).
Overaggressive patient selection for Y90 radioembolization of liver dominant chemorefractory mCRC is of questionable benefit. A scoring system comprising hepatic tumor load, CEA and CA19-9 serum levels and Karnofsky index (TuCK-score) may support an improved patient selection. In our cohort of liver only versus liver dominant disease, extrahepatic lung or lymphatic metastases did not significantly alter the prognosis.</description><subject>Adult</subject><subject>Aged</subject><subject>Antigens</subject><subject>Biomarkers</subject><subject>CA-19-9 Antigen - blood</subject><subject>Cancer</subject><subject>Cancer therapies</subject><subject>Carcinoembryonic Antigen - blood</subject><subject>Care and treatment</subject><subject>Chemotherapy</subject><subject>Colorectal cancer</subject><subject>Colorectal Neoplasms - pathology</subject><subject>Colorectal Neoplasms - therapy</subject><subject>Complications and side effects</subject><subject>Drug Resistance, Neoplasm</subject><subject>Embolization, Therapeutic - methods</subject><subject>Female</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Karnofsky Performance Status</subject><subject>Liver</subject><subject>Liver - pathology</subject><subject>Liver Neoplasms - secondary</subject><subject>Liver Neoplasms - therapy</subject><subject>Magnetic resonance imaging</subject><subject>Male</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neoplasm Metastasis</subject><subject>Outcome Assessment (Health Care) - methods</subject><subject>Outcome Assessment (Health Care) - statistics & numerical data</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Regression analysis</subject><subject>Risk factors</subject><subject>Yttrium Radioisotopes - therapeutic use</subject><issn>1471-2407</issn><issn>1471-2407</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><recordid>eNptkl1rFDEUhgdRbK3-AG8kIAiCU5NMZibjhVCKH4WCUPXCq5DJx27KJBlzMqXrP_HfmmVr3QWTQMI5z3k5nLxV9ZzgU0J49xYI5bytMelq2rKhvn1QHRPWk5oy3D_cex9VTwCuMSY9x_xxdUR71gw9psfV7x8DRldSu2j8GCf3S2YXA3IBqbXxsU7GJqlyTBvkTZawPU69QZO7MQnp6F2QISMVp5iMynJCSgZVUnMRMiHDOxSXrKI3SAIYAF-CSM7ztHFhhSSak9FO5SKHQMW0DcIGsvFPq0dWTmCe3d0n1fePH76df64vv3y6OD-7rFXbDrmmDbZU84aPumnGVnFNme6UHZjpRotH2XNmje4w78bRKqrt0KiOyJbYUTJNm5Pq_U53XkZvtCr9JTmJOTkv00ZE6cRhJri1WMUbwYa2JU1TBF7eCaT4czGQxXVcUig9C8JxP9B2YMM_aiUnI1ywsYgp70CJM9bxsijBhTr9D1W2Nt6pGIx1JX5Q8PqgoDDZ3OaVXADExderQ_bVHrs2cspriNOy_XE4BMkOVCkCFAvcT4NgsXWe2DlPFOeJrfPEbal5sT_G-4q_Vmv-AAFg19Y</recordid><startdate>20160720</startdate><enddate>20160720</enddate><creator>Damm, Robert</creator><creator>Seidensticker, Ricarda</creator><creator>Ulrich, Gerhard</creator><creator>Breier, Leonie</creator><creator>Steffen, Ingo G</creator><creator>Seidensticker, Max</creator><creator>Garlipp, Benjamin</creator><creator>Mohnike, Konrad</creator><creator>Pech, Maciej</creator><creator>Amthauer, Holger</creator><creator>Ricke, Jens</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ISR</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>5PM</scope></search><sort><creationdate>20160720</creationdate><title>Y90 Radioembolization in chemo-refractory metastastic, liver dominant colorectal cancer patients: outcome assessment applying a predictive scoring system</title><author>Damm, Robert ; Seidensticker, Ricarda ; Ulrich, Gerhard ; Breier, Leonie ; Steffen, Ingo G ; Seidensticker, Max ; Garlipp, Benjamin ; Mohnike, Konrad ; Pech, Maciej ; Amthauer, Holger ; Ricke, Jens</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c559t-230f2d838bd33b5c8d24d6cf94e6bf0ba784fed6086bbfc2df93c61a51fba4d23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antigens</topic><topic>Biomarkers</topic><topic>CA-19-9 Antigen - blood</topic><topic>Cancer</topic><topic>Cancer therapies</topic><topic>Carcinoembryonic Antigen - blood</topic><topic>Care and treatment</topic><topic>Chemotherapy</topic><topic>Colorectal cancer</topic><topic>Colorectal Neoplasms - pathology</topic><topic>Colorectal Neoplasms - therapy</topic><topic>Complications and side effects</topic><topic>Drug Resistance, Neoplasm</topic><topic>Embolization, Therapeutic - methods</topic><topic>Female</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Karnofsky Performance Status</topic><topic>Liver</topic><topic>Liver - pathology</topic><topic>Liver Neoplasms - secondary</topic><topic>Liver Neoplasms - therapy</topic><topic>Magnetic resonance imaging</topic><topic>Male</topic><topic>Metastasis</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neoplasm Metastasis</topic><topic>Outcome Assessment (Health Care) - methods</topic><topic>Outcome Assessment (Health Care) - statistics & numerical data</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Regression analysis</topic><topic>Risk factors</topic><topic>Yttrium Radioisotopes - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Damm, Robert</creatorcontrib><creatorcontrib>Seidensticker, Ricarda</creatorcontrib><creatorcontrib>Ulrich, Gerhard</creatorcontrib><creatorcontrib>Breier, Leonie</creatorcontrib><creatorcontrib>Steffen, Ingo G</creatorcontrib><creatorcontrib>Seidensticker, Max</creatorcontrib><creatorcontrib>Garlipp, Benjamin</creatorcontrib><creatorcontrib>Mohnike, Konrad</creatorcontrib><creatorcontrib>Pech, Maciej</creatorcontrib><creatorcontrib>Amthauer, Holger</creatorcontrib><creatorcontrib>Ricke, Jens</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content (ProQuest)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMC cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Damm, Robert</au><au>Seidensticker, Ricarda</au><au>Ulrich, Gerhard</au><au>Breier, Leonie</au><au>Steffen, Ingo G</au><au>Seidensticker, Max</au><au>Garlipp, Benjamin</au><au>Mohnike, Konrad</au><au>Pech, Maciej</au><au>Amthauer, Holger</au><au>Ricke, Jens</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Y90 Radioembolization in chemo-refractory metastastic, liver dominant colorectal cancer patients: outcome assessment applying a predictive scoring system</atitle><jtitle>BMC cancer</jtitle><addtitle>BMC Cancer</addtitle><date>2016-07-20</date><risdate>2016</risdate><volume>16</volume><issue>1</issue><spage>509</spage><pages>509-</pages><artnum>509</artnum><issn>1471-2407</issn><eissn>1471-2407</eissn><abstract>In treatment-refractory liver dominant metastatic colorectal cancer, the role of liver directed therapies still is unclear. We sought to determine a prognostic score for Y90 radioembolization in these patients.
We analyzed 106 patients with refractory liver dominant mCRC who had undergone a total of 178 Y90 radioembolizations with resin microspheres was collected. Potential factors influencing survival were analyzed using a Cox regression. The Log rank test served to establish prognostic factors and to form a clinical score for outcome prediction after Y90 radioembolization.
Median survival of all patients was 6.7 months. Neither age nor prior surgical or systemic therapy nor metastatic spread had an effect on survival. In contrast, hepatic tumor load, Karnofsky index as well as CEA and CA19-9 serums level had a significant influence (p < 0.001, p = 0.037, p = 0.023 and p < 0.001, respectively). These three factors formed a score with 1 point each for tumor load >20 %, CEA >130 ng/ml or CA19-9 > 200U/ml and Karnofsky index <80 %. Patients with a score of 0 and 1 displayed a median OS of 10.4 months. Patients with a score of 2 and 3 demonstrated a median OS of 5.1 months only (p < 0.001).
Overaggressive patient selection for Y90 radioembolization of liver dominant chemorefractory mCRC is of questionable benefit. A scoring system comprising hepatic tumor load, CEA and CA19-9 serum levels and Karnofsky index (TuCK-score) may support an improved patient selection. In our cohort of liver only versus liver dominant disease, extrahepatic lung or lymphatic metastases did not significantly alter the prognosis.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>27439702</pmid><doi>10.1186/s12885-016-2549-x</doi><oa>free_for_read</oa></addata></record> |
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| ispartof | BMC cancer, 2016-07, Vol.16 (1), p.509, Article 509 |
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| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4955133 |
| source | Open Access: PubMed Central; Publicly Available Content (ProQuest) |
| subjects | Adult Aged Antigens Biomarkers CA-19-9 Antigen - blood Cancer Cancer therapies Carcinoembryonic Antigen - blood Care and treatment Chemotherapy Colorectal cancer Colorectal Neoplasms - pathology Colorectal Neoplasms - therapy Complications and side effects Drug Resistance, Neoplasm Embolization, Therapeutic - methods Female Health aspects Humans Kaplan-Meier Estimate Karnofsky Performance Status Liver Liver - pathology Liver Neoplasms - secondary Liver Neoplasms - therapy Magnetic resonance imaging Male Metastasis Middle Aged Multivariate Analysis Neoplasm Metastasis Outcome Assessment (Health Care) - methods Outcome Assessment (Health Care) - statistics & numerical data Patient outcomes Patients Prognosis Proportional Hazards Models Regression analysis Risk factors Yttrium Radioisotopes - therapeutic use |
| title | Y90 Radioembolization in chemo-refractory metastastic, liver dominant colorectal cancer patients: outcome assessment applying a predictive scoring system |
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