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Selective transarterial radioembolisation of unresectable liver-dominant colorectal cancer refractory to chemotherapy

  • VASCULAR AND INTERVENTIONAL RADIOLOGY
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

The target lesion response (according to the Choi criteria), safety and survival following selective or superselective transarterial radioembolisation using yttrium-90-resin microspheres (90Y-RE) were evaluated in patients with unresectable, chemotherapy-refractory colorectal cancer liver metastases (mCRC).

Materials and methods

A prospective case series evaluated 52 consecutive patients with mCRC who were treated at a single centre following a median of 2 lines of chemotherapy.

Results

Nearly half (46.2 %) of the 52 patients had a prior resection of the liver. At baseline, mCRC was limited to the liver (in 56.9 %), liver plus extra-hepatic metastases (23.5 %) or liver plus lung micro-nodules (19.6 %). Disease control rates of target lesions (partial response plus stable disease) at 3 and 6 months post-90Y-RE were 59 and 29 %, respectively. Target lesions were sufficiently downsized in two patients for hepatic resection and in one patient for radiofrequency ablation. Median Kaplan–Meier survival was 11.0 months (95 % confidence interval: 8.0–14.0 months) overall and 12.0 months in liver-only disease (±lung micro-nodules). Determinants of prolonged survival were response at 3 months (P = 0.046), ≤5 liver nodules (P = 0.004), single-liver-lobe involvement (P = 0.037), tumour-to-whole liver ratio <25 % (P = 0.021) and absence of extrahepatic metastases (P = 0.045). Adverse events possibly related to the nontarget distribution of 90Y-RE were grade 1 90Y-RE-induced liver disease (n = 1), grade 2 and 3 gastric ulcers (n = 2).

Conclusion

These results confirm the effectiveness and safety of selective 90Y-RE in patients with chemotherapy-refractory mCRC, showing 90Y-RE’s potential as a bridging therapy to subsequent resection even in this end-stage population.

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Acknowledgments

An educational grant was provided by Sirtex Medical Ltd to aid in the analysis of data and the editing of the manuscript. We would like to thank Mark Van Buskirk for his statistical work and advice; and Rae Hobbs for her editorial assistance. The final version of the manuscript has been approved by all authors.

Conflict of interest

Dr. Golfieri has been a speaker for Bayer AG (Leverkusen, Germany), Boston Scientific (Natick, MA, USA) and Sirtex Medical Ltd (Sydney, Australia). All other authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Radiology Unit, Department of Digestive Diseases and Internal Medicine, Azienda Ospedaliero Universitaria, Policlinico S. Orsola-Malpighi, Via Massarenti 9, Bologna, Italy

    Rita Golfieri, Cristina Mosconi, Emanuela Giampalma, Alberta Cappelli, Maria Cristina Galaverni & Matteo Renzulli

  2. Medical Physics Unit, Azienda Ospedaliero Universitaria, Bologna, Italy

    Cinzia Pettinato

  3. Radiation Oncology Unit, Azienda Ospedaliero Universitaria, Bologna, Italy

    Fabio Monari & Renzo Mazzarotto

  4. Oncology Unit, Azienda Ospedaliero Universitaria, Bologna, Italy

    Carmine Pinto & Bruna Angelelli

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  1. Rita Golfieri
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Correspondence to Cristina Mosconi.

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Golfieri, R., Mosconi, C., Giampalma, E. et al. Selective transarterial radioembolisation of unresectable liver-dominant colorectal cancer refractory to chemotherapy. Radiol med 120, 767–776 (2015). https://doi.org/10.1007/s11547-015-0504-6

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  • DOI: https://doi.org/10.1007/s11547-015-0504-6

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