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Effectiveness of Hepatic Artery Infusion (HAI) Versus Selective Internal Radiation Therapy (Y90) for Pretreated Isolated Unresectable Colorectal Liver Metastases (IU-CRCLM)

  • Hepatobiliary Tumors
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Abstract

Background

In the era of modern effective systemic chemotherapy, the comparative effectiveness of hepatic artery infusion (HAI) versus selective internal radiation therapy (yttrium-90 [Y90]) for pretreated patients with isolated unresectable colorectal liver metastasis (IU-CRCLM) remains unknown. This study sought to compare the overall survival (OS) after HAI versus Y90 for IU-CRCLM patients treated with modern chemotherapy and to perform a cost analysis of both regional methods.

Methods

This study retrospectively reviewed patients receiving HAI or Y90 in combination with modern chemotherapy as second-line therapy for IU-CRCLM. Overall survival was calculated from the time of IU-CRCLM diagnosis. Uni- and multivariate models were constructed to identify independent predictors of survival.

Results

The inclusion criteria were met by 97 patients (48 HAI patients and 49 Y90 patients). Both groups were similar in terms of age, gender, body mass index (BMI), synchronous disease, carcinoembryonic antigen (CEA), liver tumor burden, and chemotherapy-related characteristics including use of biologics and lines of chemotherapy (all p > 0.05). The HAI group had a better OS than the Y90 group (31.2 vs. 16.3 months; p < 0.001). A trend toward reduced cost favored the HAI group (median, $29,479 vs. $39,092; p = 0.296). The multivariate analysis showed that receipt of HAI (hazard ratio 0.465) and number of chemotherapy lines (HR 0.797) were associated with improved OS from the date of IU-CRCLM diagnosis.

Conclusions

This is the first study to evaluate the comparative effectiveness of HAI versus Y90 in the era of modern chemotherapy, and the findings suggests that HAI is associated with better survival than Y90 for patients with pretreated IU-CRCLM.

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Authors and Affiliations

  1. Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA

    Mashaal Dhir MD

  2. Department of Biostatistics and Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA

    Mazen S. Zenati MD, PhD

  3. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Heather L. Jones PA, David L. Bartlett MD, M. Haroon A. Choudry MD, James F. Pingpank MD, Matthew P. Holtzman MD, Melissa E. Hogg MD, Herbert J. Zeh III MD, David A. Geller MD, J. Wallis Marsh MD, MBA & Allan Tsung MD

  4. Department of Medical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Nathan Bahary MD

  5. Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Amer H. Zureikat MD

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  1. Mashaal Dhir MD
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  2. Mazen S. Zenati MD, PhD
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Correspondence to Amer H. Zureikat MD.

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10434_2017_6265_MOESM1_ESM.tif

The 2-year overall survival after hepatic artery infusion (HAI) pump placement versus first yttrium-90 (Y90) treatment for patients with isolated unresectable colorectal liver metastasis (IU-CRCLM). Supplementary material 1 (TIFF 1735 kb)

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Dhir, M., Zenati, M.S., Jones, H.L. et al. Effectiveness of Hepatic Artery Infusion (HAI) Versus Selective Internal Radiation Therapy (Y90) for Pretreated Isolated Unresectable Colorectal Liver Metastases (IU-CRCLM). Ann Surg Oncol 25, 550–557 (2018). https://doi.org/10.1245/s10434-017-6265-9

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  • DOI: https://doi.org/10.1245/s10434-017-6265-9

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