Abstract
Local therapy for colorectal cancer metastatic to the liver has been shown to palliate symptoms, prolong life, and (in select cases) serve as a cure. Minimal and noninvasive approaches have increased in popularity and may be a good alternative to surgical resection. Traditionally, the use of fractionated external beam radiotherapy to the liver has been limited because of a high risk of toxicity. However, recent technologic advances have provided patients with a safer but still locally aggressive treatment modality that incorporates ionizing radiation: stereotactic body radiotherapy. In addition, selective internal radiation therapy with radioactive microspheres is another minimally invasive treatment alternative for liver tumors that are not amenable to aggressive local therapy with surgery or stereotactic body radiotherapy. In this article, we discuss the clinical implementation and selected research findings supporting the use of these treatment modalities.
Similar content being viewed by others
References and Recommended Reading
Jemal A, Siegel R, Ward E, et al.: Cancer statistics, 2008. CA Cancer J Clin 2008, 58:71–96.
Tomlinson JS, Jarnagin WR, DeMatteo RP, et al.: Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol 2007, 25:4575–4580.
Nordlinger B, Guiguet M, Vaillant JC, et al.: Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Cancer 1996, 77:1254–1262.
Fong Y, Fortner J, Sun RL, et al.: Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer. Ann Surg 1999, 230:309–318.
Scheele J, Stang R, Altendorf-Hofmann A, Paul M: Resection of colorectal liver metastases. World J Surg 1995, 19:59–71.
Portier G, Elias D, Bouche O, et al.: Multicenter randomized trial of adjuvant fluorouracil and folinic acid compared with surgery alone after resection of colorectal liver metastases: FFCD ACHBTH AURC 9002 trial. J Clin Oncol 2006, 24:4976–4982.
Timmerman RD, Kavanagh BD, Cho LC, et al.: Stereotactic body radiation therapy in multiple organ sites. J Clin Oncol 2007, 25:947–952.
Herfarth KK, Debus J, Lohr F, et al.: Stereotactic single-dose radiation therapy of liver tumors: results of a phase I/II trial. J Clin Oncol 2001, 19:164–170.
Dawson LA, et al.: Analysis of radiation-induced liver disease using the Lyman NTCP model. Int J Radiat Oncol Biol Phys 2002, 53:810–821. [Published erratum appears in Int J Radiat Oncol Biol Phys 2002, 53:1422.]
Dawson LA, Ten Haken TK: Partial volume tolerance of the liver to radiation. Semin Radiat Oncol 2005, 15:279–283.
Liang SX, Zhu XD, Xu ZY, et al.: Radiation-induced liver disease in three-dimensional conformal radiation therapy for primary liver carcinoma: the risk factors and hepatic radiation tolerance. Int J Radiat Oncol Biol Phys 2006, 65:426–434.
Lee IJ, Seong J, Shim SJ, Han KH: Radiotherapeutic parameters predictive of liver complications induced by liver tumor radiotherapy. Int J Radiat Oncol Biol Phys 2009, 73:154–158.
Dawson LA, Eccles C, Craig T: Individualized image guided iso-NTCP based liver cancer SBRT. Acta Oncol 2006, 45:856–864.
Schefter TE, Kavanagh BD, Timmerman RD, et al.: A phase I trial of stereotactic body radiation therapy (SBRT) for liver metastases. Int J Radiat Oncol Biol Phys 2005, 62:1371–1378.
Kavanagh BD, Schefter TE, Cardenes HR, et al.: Interim analysis of a prospective phase I/II trial of SBRT for liver metastases. Acta Oncol 2006, 45:848–855.
Wulf J, Guckenberger M, Haedinger U, et al.: Stereotactic radiotherapy of primary liver cancer and hepatic metastases. Acta Oncol 2006, 45:838–847.
Méndez Romero A, Wunderink W, Hussain SM, et al.: Stereotactic body radiation therapy for primary and metastatic liver tumors: a single institution phase i–ii study. Acta Oncol 2006, 45:831–837.
Hoyer M, Roed H, Traberg Hansen A, et al.: Phase II study on stereotactic body radiotherapy of colorectal metastases. Acta Oncol 2006, 45:823–830.
Katz AW, Carey-Sampson M, Muhs AG, et al.: Hypofractionated stereotactic body radiation therapy (SBRT) for limited hepatic metastases. Int J Radiat Oncol Biol Phys 2007, 67:793–798.
Tse RV, Hawkins M, Lockwood G, et al.: Phase I study of individualized stereotactic body radiotherapy for hepatocellular carcinoma and intrahepatic cholangiocarcinoma. J Clin Oncol 2008, 26:657–664. [Published erratum appears in J Clin Oncol 2008, 26:3911–3912.]
Cardenes H: Phase I trial of stereotactic body radiation therapy for primary hepatocellular carcinoma [abstract]. Int J Radiat Oncol Biol Phys 2008, 72(Suppl 1):S128–S129.
Muller JH, Rossier PH: Treatment of cancer of the lungs by artificial radioactivity. Experientia 1947, 3:75.
Muller JH, Rossier PH: A new method for the treatment of cancer of the lungs by means of artificial radioactivity. Acta Radiol 1951, 35:449–468.
Ariel I, Padula G: Irradiation of the spleen by the intra-arterial administration of 90 yttrium microspheres in patients with malignant lymphoma. Cancer 1973, 31:90–96.
Kennedy AS, Nutting C, Coldwell D, et al.: Pathologic response and microdosimetry of (90)Y microspheres in man: review of four explanted whole livers. Int J Radiat Oncol Biol Phys 2004, 60:1552–1563.
Kennedy AS, Salem R: Comparison of two 90Yttrium microsphere agents for hepatic artery brachytherapy. Proceedings of the 14th International Congress on Anti-Cancer Treatment. Paris, France; February 3, 2003.
Welsh JS, Kennedy AS, Thomadsen B: Selective Internal Radiation Therapy (SIRT) for liver metastases secondary to colorectal adenocarcinoma. Int J Radiat Oncol Biol Phys 2006, 66(2 Suppl):S62–S73.
Jakobs TF, Hoffmann RT, Dehm K, et al.: Hepatic yttrium-90 radioembolization of chemotherapy-refractory colorectal cancer liver metastases. J Vasc Interv Radiol 2008, 19:1187–1195.
King J, Quinn R, Glenn DM: Radioembolization with selective internal radiation microspheres for neuroendocrine liver metastases. Cancer 2008, 113:921–929.
Ibrahim S, Lewandowski RJ, Sato KT, et al.: Radioembolization for the treatment of unresectable hepatocellular carcinoma: a clinical review. World J Gastroenterol 2008, 14:1664–1669.
Gray B, Van Hazel G, Hope M, et al.: Randomised trial of SIR-spheres plus chemotherapy vs. chemotherapy alone for treating patients with liver metastases from primary large bowel cancer. Ann Oncol 2001, 12:1711–1720.
Kennedy AS, Coldwell D, Nutting C, et al.: Resin 90Y-microsphere brachytherapy for unresectable colorectal liver metastases: modern USA experience. Int J Radiat Oncol Biol Phys 2006, 65:412–425.
Sato K, Lewandowski RL, Mulcahy MF, et al.: Unresectable chemorefractory liver metastases: radioembolization with 90Y microspheres—safety, efficacy and survival. Radiology 2008, 247:507–515.
Van Hazel G, Blackwell A, Anderson J, et al.: Randomised phase 2 trial of SIR-Spheres plus fluorouracil/leucovorin chemotherapy versus fluorouracil/leucovorin chemotherapy alone in advanced colorectal cancer. J Surg Oncol 2004, 88:78–85.
Sharma RA, Van Hazel GA, Morgan B, et al.: Radioembolization of liver metastases from colorectal cancer using yttrium-90 microspheres with concomitant systemic oxaliplatin, fluorouracil, and leucovorin chemotherapy. J Clin Oncol 2007, 25:1099–1106.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Harris, S.L., Tepper, J.E. Radiation to the liver for hepatic metastases from colorectal cancer: Stereotactic radiotherapy and radioactive microspheres. Curr colorectal cancer rep 5, 140–147 (2009). https://doi.org/10.1007/s11888-009-0021-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11888-009-0021-x