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Robust evidence for long-term survival with 90Y radioembolization in chemorefractory liver-predominant metastatic colorectal cancer

  • Interventional
  • Published:
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Abstract

Objectives

Our aim was to provide further evidence for the efficacy/safety of radioembolization using yttrium-90-resin microspheres for unresectable chemorefractory liver metastases from colorectal cancer (mCRC).

Methods

We followed 104 consecutively treated patients until death. Overall survival (OS) was calculated from the day of the first radioembolization procedure. Response was defined by changes in tumour volume as defined by Response Evaluation Criteria in Solid Tumours (RECIST) v1.0 and/or a ≥30 % reduction in serum carcinoembryonic antigen (CEA) at 3 months.

Results

Survival varied between 23 months in patients who had a complete response to prior chemotherapy and 13 months in patients with a partial response or stable disease. Median OS also significantly improved (from 5.8 months to 17.1 months) if response durability to radioembolization extended beyond 6 months. Patients with a positive trend in CEA serum levels (≥30 % reduction) at 3 months post-radioembolization also had a survival advantage compared with those who did not: 15.0 vs 6.7 months. Radioembolization was well tolerated. Grade 3 increases in bilirubin were reported in 5.0 % of patients at 3 months postprocedure.

Conclusions

After multiple chemotherapies, many patients still have a good performance status and are eligible for radioembolization. This single procedure can achieve meaningful survivals and is generally well tolerated.

Key Points

• After multiple chemotherapies, many patients are still eligible for radioembolization (RE).

• RE can achieve meaningful survival in patients with chemorefractory liver-predominant metastatic colorectal cancer (mCRC).

• Tumour responsiveness to prior systemic treatments is a significant determinant of overall survival (OS) after RE.

• Radioembolization in patients with a good performance status is generally well tolerated.

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Acknowledgments

The scientific guarantor of this publication is PD Dr. med. Tobias Jakobs. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding.

Prof. Wieland Sommer (MPH) kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was obtained from all patients. Methodology: retrospective, observational, performed at one institution.

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Author notes

    Authors and Affiliations

    1. Department of Diagnostic and Interventional Radiology, Barmherzige Brueder Munich, Romanstraße 93, 80639, Munich, Germany

      T. F. Jakobs

    2. Department of Clinical Radiology, LMU - University of Munich, Munich, Germany

      K. J. Paprottka, F. Raeßler, F. Strobl, C. G. Trumm, W. Sommer & P. M. Paprottka

    3. Department of Nuclear Medicine, LMU - University of Munich, Munich, Germany

      S. Lehner, H. Ilhan & W. P. Fendler

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    1. T. F. Jakobs
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    Correspondence to T. F. Jakobs.

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    T. F. Jakobs and K. J. Paprottka contributed equally to this work.

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    Jakobs, T.F., Paprottka, K.J., Raeßler, F. et al. Robust evidence for long-term survival with 90Y radioembolization in chemorefractory liver-predominant metastatic colorectal cancer. Eur Radiol 27, 113–119 (2017). https://doi.org/10.1007/s00330-016-4345-z

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