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Radiation to the liver for hepatic metastases from colorectal cancer: Stereotactic radiotherapy and radioactive microspheres

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Current Colorectal Cancer Reports

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.

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References and Recommended Reading

  1. Jemal A, Siegel R, Ward E, et al.: Cancer statistics, 2008. CA Cancer J Clin 2008, 58:71–96.

    Article  PubMed  Google Scholar 

  2. 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.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  CAS  Google Scholar 

  4. 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.

    Article  PubMed  CAS  Google Scholar 

  5. Scheele J, Stang R, Altendorf-Hofmann A, Paul M: Resection of colorectal liver metastases. World J Surg 1995, 19:59–71.

    Article  PubMed  CAS  Google Scholar 

  6. 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.

    Article  PubMed  CAS  Google Scholar 

  7. Timmerman RD, Kavanagh BD, Cho LC, et al.: Stereotactic body radiation therapy in multiple organ sites. J Clin Oncol 2007, 25:947–952.

    Article  PubMed  Google Scholar 

  8. 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.

    PubMed  CAS  Google Scholar 

  9. 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.]

    PubMed  Google Scholar 

  10. Dawson LA, Ten Haken TK: Partial volume tolerance of the liver to radiation. Semin Radiat Oncol 2005, 15:279–283.

    Article  PubMed  Google Scholar 

  11. 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.

    PubMed  Google Scholar 

  12. 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.

    PubMed  Google Scholar 

  13. Dawson LA, Eccles C, Craig T: Individualized image guided iso-NTCP based liver cancer SBRT. Acta Oncol 2006, 45:856–864.

    Article  PubMed  Google Scholar 

  14. 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.

    PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. Wulf J, Guckenberger M, Haedinger U, et al.: Stereotactic radiotherapy of primary liver cancer and hepatic metastases. Acta Oncol 2006, 45:838–847.

    Article  PubMed  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. 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.

    Article  PubMed  Google Scholar 

  19. 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.

    PubMed  Google Scholar 

  20. 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.]

    Article  PubMed  Google Scholar 

  21. 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.

    Google Scholar 

  22. Muller JH, Rossier PH: Treatment of cancer of the lungs by artificial radioactivity. Experientia 1947, 3:75.

    Article  CAS  Google Scholar 

  23. 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.

    Article  PubMed  CAS  Google Scholar 

  24. 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.

    Article  PubMed  CAS  Google Scholar 

  25. 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.

    PubMed  CAS  Google Scholar 

  26. 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.

  27. 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.

    PubMed  CAS  Google Scholar 

  28. 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.

    Article  PubMed  Google Scholar 

  29. King J, Quinn R, Glenn DM: Radioembolization with selective internal radiation microspheres for neuroendocrine liver metastases. Cancer 2008, 113:921–929.

    Article  PubMed  Google Scholar 

  30. 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.

    Article  PubMed  Google Scholar 

  31. 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.

    Article  PubMed  CAS  Google Scholar 

  32. 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.

    PubMed  CAS  Google Scholar 

  33. 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.

    Article  PubMed  Google Scholar 

  34. 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.

    Article  PubMed  Google Scholar 

  35. 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.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Joel E. Tepper.

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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

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  • DOI: https://doi.org/10.1007/s11888-009-0021-x

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