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Selective Internal Radiation Therapy with SIR-Spheres for the Treatment of Unresectable Colorectal Hepatic Metastases

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Abstract

The purpose of this study was to evaluate the effectiveness of colorectal cancer (CRC) liver metastasis radioembolization with yttrium-90 (Y90), assessing toxicity and survival rates in patients with no response to chemotherapy through our 3-year experience. From February 2005 to January 2008, we treated 41 patients affected by CRC from a cohort of selective internal radiation therapy patients treated at our institution. All patients examined showed disease progression and arrived for our observation with an abdominal CT, a body PET, and a hepatic angiography followed by gastroduodenal artery coiling previously performed by us. We excluded patients with a bilirubin level >1.8 mg/dl and pulmonary shunt >20% but not patients with minor extrahepatic metastases. On treatment day, under fluoroscopic guidance, we implanted a dose of Y90 microspheres calculated on the basis of liver tumoral involvement and the body surface area formula. All patients were discharged the day after treatment. We obtained, according to Response Evaluation Criteria on Solid Tumors, a complete response in 2 patients, a partial response in 17 patients, stable disease in 14 patients, and progressive disease in 8 patients. In all cases, we obtained a carcinoembryonic antigen level decrease, especially in the week 8 evaluation. Technical success rate was 98% and technical effectiveness estimated at 3 months after treatment was 80.5%. Side effects graded by Common Terminology Criteria on Adverse Events were represented by one grade 4 hepatic failure, two grade 2 gastritis, and one grade 2 cholecystitis. The median survival and the progression-free survival calculated by Kaplan–Meier analysis were 354 and 279 days, respectively. In conclusion, according to our 3-year experience, Y90 SIR-Spheres radioembolization is a feasible and safe method to treat CRC liver metastases, with an acceptable level of complications and a good response rate.

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References

  1. Pisani P, Parkin DM, Bray F et al (1999) Estimates of the worldwide mortality from 25 cancers in 1990. Int J Cancer 83:18–29

    Article  CAS  PubMed  Google Scholar 

  2. Weiss L, Grundmann E, Torhorst J et al (1986) Haematogenus metastasis patterns in colonic carcinoma: an analysis of 1541 necropsies. J Pathol 150:195–203

    Article  CAS  PubMed  Google Scholar 

  3. Schlag PM, Benhidjeb T, Stroszczynski C (2002) Resection and local therapy for liver metastases. Best Pract Res Clin Gastroenterol 16:299–317

    Article  CAS  PubMed  Google Scholar 

  4. Stubbs RS, O’Brien I, Correia MM (2006) Selective internal radiation therapy with 90Y microspheres for colorectal liver metastases: single-centre experience with 100 patients. Aust NZ J Surg 76(8):696–703

    Article  Google Scholar 

  5. Breedis C, Young G (1954) The blood supply of neoplasms in the liver. Am J Pathol 30(5):969–977

    CAS  PubMed  Google Scholar 

  6. Ingold JA, Reed GB, Kaplan HS et al (1965) Radiation hepatitis. Am J Roentgenol Radium Ther Nucl Med 03:200–208

    Google Scholar 

  7. Kennedy AS, Nutting C, Coldwell D et al (2004) Pathologic response and microdosimetry of (90)Y microspheres in man: review of four explanted whole livers. Int J Radiat Oncol Biol Phys 60(5):1552–1563

    CAS  PubMed  Google Scholar 

  8. Lawrence TS, Robertson JM, Anscher MS et al (1995) Hepatic toxicity resulting from cancer treatment. Int J Radiat Oncol Biol Phys 31:1237–1248

    CAS  PubMed  Google Scholar 

  9. Ariel IM (1964) Radioactive isotopes for adjuvant cancer therapy. Arch Surg 89:244–249

    CAS  PubMed  Google Scholar 

  10. Grady ED, Sale WT, Rollins LC (1963) Localization of radioactivity by intravascular injection of large radioactive particles. Ann Surg 157:97–114

    Article  CAS  PubMed  Google Scholar 

  11. Nolan T, Grady ED, Crumbley AJ (1973) Regional internal radiation for hepatic cancer. Minerva Oncol 1:104–106

    Google Scholar 

  12. Nolan T, Grady ED, Crumbley AJ et al (1975) Internal hepatic radiotherapy: I. Organ distribution of colloidal Cr32 PO4 injected into a peripheral vein, the portal vein, or the arterial supply of the gastrointestinal tract in the rat. Am J Roentgenol Radium Ther Nucl Med 124:590–595

    CAS  PubMed  Google Scholar 

  13. Grady ED, Nolan T, Larose JH et al (1975) Internal hepatic radiotherapy: II. Intra-arterial radiocolloid therapy for hepatic tumors. Am J Roentgenol Ther Nucl Med 124:596–599

    CAS  Google Scholar 

  14. Grady ED (1979) Internal radiation therapy of hepatic cancer. Dis Colon Rectum 22:371–375

    Article  CAS  PubMed  Google Scholar 

  15. Ariel IM (1965) Treatment of inoperable primary pancreatic and liver cancer by the intraarterial administration of radioactive isotopes (Y90 radiating microspheres). Ann Surg 162:267–278

    Article  CAS  PubMed  Google Scholar 

  16. Ariel IM, Pack GT (1967) Treatment of inoperable cancer of the liver by intra-arterial radioactive isotopes and chemotherapy. Cancer 20:793–804

    Article  CAS  PubMed  Google Scholar 

  17. Mantravadi RV, Spigos DG, Tan WS et al (1982) Intraarterial yttrium 90 in the treatment of hepatic malignancy. Radiology 142:783–786

    CAS  PubMed  Google Scholar 

  18. Ariel IM, Padula G (1982) Treatment of asymptomatic metastatic cancer to the liver from primary colon and rectal cancer by the intraarterial administration of chemotherapy and radioactive isotopes. J Surg Oncol 20:151–156

    Article  CAS  PubMed  Google Scholar 

  19. Blanchard RJW (1983) Treatment of liver tumours with yttrium-90 microspheres. Can J Surg 26:442–443

    Google Scholar 

  20. Gyves JW, Ziessman HA, Ensminger WD et al (1984) Definition of hepatic tumor microcirculation by single photon emission computerized tomography (SPECT). J Nucl Med 25:972–977

    CAS  PubMed  Google Scholar 

  21. Sasson AR, Sigurdson ER (2002) Surgical treatment of liver metastases. Semin Oncol 29(2):107–118

    Article  PubMed  Google Scholar 

  22. Kennedy AS, Coldwell D, Nutting C et al (2006) Resin Y90 microspheres brachytherapy for unresectable colorectal liver metastases: modern USA experience Int. J Radiat Oncol Biol Phys 65(2):412–425

    Article  CAS  Google Scholar 

  23. Sailer SL (2000) Three dimensional conformal radiotherapy. In: Gunderson L, Tepper J (eds) Clinical radiation oncology. Churchhill Livingstone, Philadelphia, pp 236–255

    Google Scholar 

  24. Fox RA, Klemp PFB, Egan B et al (1991) Dose distribution following selective internal radiation therapy. Int J Radiat Oncol Biol Phys 21:463–467

    CAS  PubMed  Google Scholar 

  25. Herfarth KK, Debus J, Lohr F et al (2001) Stereotactic single-dose radiation therapy of liver tumors: results of a phase I/II trial. J Clin Oncol 19:164–170

    CAS  PubMed  Google Scholar 

  26. Gulec SA, Fong Y (2007) Yttrium 90 microspheres selective internal radiation treatment of hepatic colorectal metastases. Arch Surg 142(7):675–682

    Article  CAS  PubMed  Google Scholar 

  27. Dancey JE, Shepherd FA, Paul K (2000) Treatment of nonresectable hepatocellular carcinoma with intrahepatic Y90 microspheres. J Nucl Med 41(10):1673–1681

    CAS  PubMed  Google Scholar 

  28. Jakobs TF, Hoffmann RT, Dehm,f chemtherapy–refractory colorectal cancer liver metastases. J Vasc Interv Radiol 19(8):1187–1195

  29. Mancini R, Carpanese L, Cosimelli M et al (2006) A multicentric phase II clinical trial on intra-arterial hepatic radiotherapy with 90yttrium SIR–spheres in unresectable, colorectal liver metastases refractory to i.v. chemotherapy: rates. In Vivo 20(6A):711–714

    CAS  PubMed  Google Scholar 

  30. Park JO, Lee SI, Song SY et al (2003) Measuring response in solid tumors: comparison of RECIST and WHO response criteria. Jpn J Clin Oncol 33(10):533–537

    Article  PubMed  Google Scholar 

  31. Atassi B, Bangash A, Bahrani A et al (2008) Multimodality imaging following 90Y radioembolization: a comprehensive review and pictorial essay. Radiographics 28:81–99

    Article  PubMed  Google Scholar 

  32. Bienert M, McCook B, Carr B et al (2005) Y90 microsphere treatment of unresectable liver metastases: changes in (18)F-FDG ptake and tumour size on PET/CT. Eur J Nucl Med Mol Imaging 32:778–787

    Article  CAS  PubMed  Google Scholar 

  33. Wong C, Qing F, Savin M et al (2005) Reduction of metastatic load to liver after intraarterial hepatic yttrium-90 radioembolization as evaluated by [18F] fluorodeoxyglucose positron emission tomographic imaging. J Vasc Interv Radiol 16:1101–1106

    PubMed  Google Scholar 

  34. Kwee TC, Takahara T, Ochiai R et al (2008) Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS): features and potential applications in oncology. Eur Radiol 18:1937–1952

    Article  PubMed  Google Scholar 

  35. Gray B, Van Hazel G, Hope M et al (2001) Randomised trial of SIR-Spheres plus chemotherapy vs. chemotherapy alone for treating patients with liver metastases from primary large bowel cancer. Ann Oncol 12:1711–1720

    Article  CAS  PubMed  Google Scholar 

  36. Jakobs TF, Hoffmann RT, Schmitz A et al (2006) Treatment of extensive metastatic liver disease with intrahepatic yttrium 90 microspheres: toxicity assessment. Presented at SIR Annual Meeting, Toronto, Canada, 30 March–4 April

  37. Van Hazel G, Price D, Bower G et al (2005) Selective internal radiation therapy (SIRT) plus systemic chemotherapy with oxaliplatin, 5-fluorouracil and leucovorin: a phase I dose escalation study. Proceedings of ASCO GI Cancers Symposium 2005:133 (abstract)

  38. Van Hazel G, Blackwell A, Andersonn J et al (2004) Randomized phase II trial of SIR-spheres plus fluorouracil/leucovorin chemotherapy versus fluorouracil/leucovorin chemotherapy alone in advanced colorectal cancer J. Surg Oncol 88(2):75–85

    Google Scholar 

  39. Lewandowski RJ, Sato KT, Atassi B, Ryu RK, Nemcek AA Jr, Kulik L, Geschwind JF, Murthy R, Rilling W, Liu D, Bester L, Bilbao JI, Kennedy AS, Omary RA, Salem R (2007) Radioembolization with 90Y microspheres:angiographic and technical considerations. Cardiovasc Interv Radiol 30(4):571–592

    Article  Google Scholar 

  40. de Luis E, Bilbao JI, de Ciércoles JA et al (2008) In vivo evaluation of a new embolic spherical particle (HepaSphere) in a kidney animal model. Cardiovasc Interv Radiol 31(2):367–376

    Article  Google Scholar 

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Authors and Affiliations

  1. Diagnostic and Interventional Radiology Department, S. M. Goretti General Hospital, Via G. Reni, 04100, Latina, Italy

    Roberto Cianni, Carlo Urigo, Ermanno Notarianni, Adelchi Saltarelli & Valerio Pasqualini

  2. Nuclear Medicine Department, S. M. Goretti General Hospital, Via G. Reni, 04100, Latina, Italy

    Rita Salvatori

  3. University “La Sapienza”, Viale del Policlinico 155, 00161, Roma, Italy

    Tracie Dornbusch

  4. Oncology Department, Policlinico Umberto I, University “La Sapienza”, Viale del Policlinico 155, 00161, Roma, Italy

    Enrico Cortesi

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  1. Roberto Cianni
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  2. Carlo Urigo
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  3. Ermanno Notarianni
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Correspondence to Carlo Urigo.

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Cianni, R., Urigo, C., Notarianni, E. et al. Selective Internal Radiation Therapy with SIR-Spheres for the Treatment of Unresectable Colorectal Hepatic Metastases. Cardiovasc Intervent Radiol 32, 1179–1186 (2009). https://doi.org/10.1007/s00270-009-9658-8

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  • DOI: https://doi.org/10.1007/s00270-009-9658-8

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