Skip to main content

Advertisement

SpringerLink
Log in

Outcomes of Radioembolization in Patients with Chemorefractory Colorectal Cancer Liver Metastasis: a Single-Center Experience

  • Original Research
  • Published:
Journal of Gastrointestinal Cancer Aims and scope Submit manuscript

Abstract

Purpose

We aimed to evaluate the efficacy and outcomes of radioembolization with Yttrium-90 (Y-90) microspheres in patients with unresectable and chemorefractory colorectal cancer liver metastasis (CRCLM).

Methods

This single-center study included 43 patients (34 male, 9 female) who underwent radioembolization with Y-90 for unresectable, chemorefractory CRCLM between September 2008 and July 2014. Overall survival (OS), liver progression-free survival (LPFS), overall response rate (ORR), local disease control rate (LDCR), and relations of these parameters with patient disease characteristics were evaluated. OS and LPFS rates were compared according to microspheres. Survival rates were calculated with Kaplan-Meier method, and potential prognostic variables were evaluated on univariate analyses.

Results

Post-procedural median OS was 12.8 months. LPFS was 5.6 months. ORR was 33%, LDCR was 67% on 3rd month follow-up. Low tumor burden (< 25%) was associated with higher median OS after radioembolization (< 25 vs > 25–50% p < 0.0001 and < 25 vs > 50% p = 0.005). Patients with left colon tumors exhibited significantly longer median OS after metastasis than right colon tumors (p = 0.046). Extrahepatic disease and synchronicity showed poorer survival parameters; however, the difference was not significant (p = 0.1 and p = 0.3, respectively). In subgroup analyses, the distribution of patient number and characteristics showed heterogeneity as number of patients with low tumor burden was higher in resin Y-90 group. Resin Y-90 group exhibited significantly higher median OS and LPFS compared to glass Y-90 group (16.5 vs. 7 months, p = 0.001; 6.73 vs. 3.38 months, p = 0.023, respectively).

Conclusion

Radioembolization is a safe local-regional treatment option in chemorefractory, inoperable CRCLM. Radioembolization at earlier stages may lead to more favorable results especially with lower tumor burden patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Jemal A, Bray F, Center MM, et al. Global cancer statistics. Cancer. 2011;61:69–90.

    Google Scholar 

  2. Lewandowski RJ, Memon K, Mulcahy MF, Hickey R, Marshall K, Williams M, et al. Twelve-year experience of radioembolization for colorectal hepatic metastases in 214 patients: survival by era and chemotherapy. Eur J Nucl Med Mol Imaging. 2014;41(10):1861–9. https://doi.org/10.1007/s00259-014-2799-2.

    Article  CAS  PubMed  Google Scholar 

  3. Seo SI, Lim SB, Yoon YS, Kim CW, Yu CS, Kim TW, et al. Comparison of recurrence patterns between ≤5 years and >5 years after curative operations in colorectal cancer patients. J Surg Oncol. 2013;108(1):9–13. https://doi.org/10.1002/jso.23349.

    Article  PubMed  Google Scholar 

  4. Kemeny N, Kemeny M, Lawrence T. Liver metastases. In: Abeloff M, Armitage J, Niederhuber J, Lichter A, editors. Clinical oncology. 3rd ed. Philadelphia, PA: Elsevier Clinical Oncology; 2004. p. 1141–78.

    Google Scholar 

  5. Manfredi S, Bouvier AM, Lepage C, Hatem C, Dancourt V, Faivre J. Incidence and patterns of recurrence after resection for cure of colonic cancer in a well defined population. Br J Surg. 2006;93(9):1115–22. https://doi.org/10.1002/bjs.5349.

    Article  CAS  PubMed  Google Scholar 

  6. Geoghegan JG, Scheele J. Treatment of colorectal liver metastasis. Br J Surg. 1999;86(2):158–69. https://doi.org/10.1046/j.1365-2168.1999.01013.x.

    Article  CAS  PubMed  Google Scholar 

  7. Xing M, Koooby DA, El-Rayes BF, et al. Locoregional therapies for metastatic colorectal carcinoma to the liver--an evidence-based review. J Surg Oncol. 2014;110(2):182–96. https://doi.org/10.1002/jso.23619.

    Article  PubMed  Google Scholar 

  8. Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC intergroup trial 40983): a randomised controlled trial. Lancet. 2008;371:1007–16.

    Article  CAS  Google Scholar 

  9. Kalva SP, Thabet A, Wicky S. Recent advances in transarterial therapy of primary and secondary liver malignancies. Radiographics. 2008;28(1):101–17.

    Article  Google Scholar 

  10. Sato KT, Lewandowski R, Mulcahy MF, et al. Unresectable chemorefractory liver metastases: radioembolization with 90Y microspheres- safety, efficacy, and survival. Radiology. 2008;247(2):507–15.

    Article  Google Scholar 

  11. Andrews JC, Walker SC, Ackermann RJ, Cotton LA, Ensminger WD, Shapiro B. Hepatic radioembolization with yttrium-90 containing glass microspheres: preliminary results and clinical follow-up. J Nucl Med. 1994;35(10):1637–44.

    CAS  PubMed  Google Scholar 

  12. Lewandowski RJ, Thurston KG, Goin JE, Wong CYO, Gates VL, Buskirk MV, et al. 90Y microsphere (TheraSphere) treatment for unresectable colorectal cancer metastases of the liver: response to treatment at targeted doses of 135-150 Gy as measured by [18F]fluorodeoxyglucose positron emission tomography and computed tomographic imaging. J Vasc Interv Radiol. 2005;16(12):1641–51. https://doi.org/10.1097/01.RVI.0000179815.44868.66.

    Article  PubMed  Google Scholar 

  13. Kennedy AS, Coldwell D, Nutting C, et al. Resin Y90-microsphere brachytherapy for unresectable colorectal liver metastases: modern USA experience. Int J Radiat Oncol Biol Phys. 2006;65(2):412–25.

    Article  CAS  Google Scholar 

  14. Jakobs TF, Hoffmann R, Dehm K, et al. Hepatic yttrium-90 radioembolization of chemotherapy-refractory colorectal cancer liver metastases. J Vasc Interv Radiol. 2008;19(8):1187–95.

    Article  Google Scholar 

  15. 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. 2009;32(6):1179–86.

    Article  Google Scholar 

  16. Cosimelli M, Golfieri R, Cagol PP, et al. Multi-centre phase II clinical trial of yttrium-90 resin microspheres alone in unresectable, chemotherapy refractory colorectal liver metastases. Br J Cancer. 2010;103(3):324–31.

    Article  CAS  Google Scholar 

  17. Nace GW, Steel JL, Amesur N, et al. Yttrium-90 radioembolization for colorectal cancer liver metastases: a single institution experience. Int J Surg Oncol. 2011;2011:571261.

    PubMed  PubMed Central  Google Scholar 

  18. Bester L, Meteling B, Pocock N, et al. Radioembolisation with Yttrium-90 microspheres: an effective treatment modality for unresectable liver metastases. J Med Imaging Radiat Oncol. 2013;57(1):72–80.

    Article  Google Scholar 

  19. Van Cutsem E, Cervantes A, Adam R, et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol. 2016;27(8):1386–422.

    Article  Google Scholar 

  20. Kalva SP, Rana RS, Liu R, Rachamreddy N, Dave B, Sharma A, et al. Yttrium-90 radioembolization as salvage therapy for liver metastases from colorectal cancer. Am J Clin Oncol. 2017;40(3):288–93. https://doi.org/10.1097/COC.0000000000000151.

    Article  PubMed  Google Scholar 

  21. Saxena A, Meteling B, Kapoor J, et al. Is yttrium-90 radioembolization a viable treatment option for unresectable, chemorefractory colorectal cancer liver metastases? A large single-center experience of 302 patients. Ann Surg Oncol. 2015;22(3):794–802.

    Article  Google Scholar 

  22. Martin LK, Cucci A, Wei L, et al. Yttrium-90 radioembolization as salvage therapy for colorectal cancer with liver metastases. Clin Colorectal Cancer. 2012;11(3):195–9.

    Article  Google Scholar 

  23. Bester L, Meteling B, Pocock N, et al. Radioembolization versus standard care of hepatic metastases: comparative retrospective cohort study of survival outcomes and adverse events in salvage patients. J Vasc Interv Radiol. 2012;23(1):96–105.

    Article  Google Scholar 

  24. Seidensticker R, Denecke T, Kraus P, et al. Matched-pair comparison of radioembolization plus best supportive care versus best supportive care alone for chemotherapy refractory liver-dominant colorectal metastases. Cardiovasc Intervent Radiol. 2012;35(5):1066–73.

    Article  Google Scholar 

  25. Kennedy AS, Ball D, Cohen SJ, et al. Multicenter evaluation of the safety and efficacy of radioembolization in patients with unresectable colorectal liver metastases selected as candidates for (90)Y resin microspheres. J Gastrointest Oncol. 2015;6(2):134–42.

    PubMed  PubMed Central  Google Scholar 

  26. Hickey R, Lewandowski RJ, Prudhomme T, Ehrenwald E, Baigorri B, Critchfield J, et al. 90Y radioembolization of colorectal hepatic metastases using glass microspheres: safety and survival outcomes from a 531-patient multicenter study. J Nucl Med. 2016;57(5):665–71. https://doi.org/10.2967/jnumed.115.166082.

    Article  CAS  PubMed  Google Scholar 

  27. Van Hazel GA, Heinemann V, Sharma NK, et al. SIRFLOX: randomized phase III trial comparing first-line mFOLFOX6 (plus or minus bevacizumab) versus mFOLFOX6 (plus or minus bevacizumab) plus selective internal radiation therapy in patients with metastatic colorectal cancer. J Clin Oncol. 2016;34(15):1723–31.

    Article  Google Scholar 

  28. 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  Google Scholar 

  29. Chua TC, Bester L, Saxena A, Morris DL. Radioembolization and systemic chemotherapy improves response and survival for unresectable colorectal liver metastases. J Cancer Res Clin Oncol. 2011;137(5):865–73. https://doi.org/10.1007/s00432-010-0948-y.

    Article  CAS  PubMed  Google Scholar 

  30. Sharma RA, Van Hazel GA, Morgan B, Berry DP, Blanshard K, Price D, et al. Radioembolization of liver metastases from colorectal cancer using Yttrium-90 microspheres with concomittant systemic oxaliplatin, fluorouracil, and leucovorin chemotherapy. J Clin Oncol. 2007;25(9):1099–106. https://doi.org/10.1200/JCO.2006.08.7916.

    Article  CAS  PubMed  Google Scholar 

  31. Lee G, Malietzis G, Askari A, et al. Is right-sided colon cancer different to left-sided colorectal cancer? – a systematic review. Eur J Surg Oncol. 2015;41(3):300–8.

    Article  CAS  Google Scholar 

  32. Modest DP, Stintzing S, von Weikerstal LF, et al. Exploring the effect of primary tumor sidedness on therapeutic efficacy across treatment lines in patients with metastatic colorectalcancer: analysis of FIRE-3 (AIOKRK0306). Oncotarget. 2017;8(62):105749–60.

    Article  Google Scholar 

Download references

Author information

Author notes

  1. Gamze Türk

    Present address: Department of Radiology, Kayseri Training and Research Hospital, Kayseri, Turkey

Authors and Affiliations

  1. Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey

    Gamze Türk, Gonca Eldem, Barbaros Erhan Çil, Bora Peynircioğlu & Ferhun Balkancı

  2. Hacettepe University Cancer Institute, Ankara, Turkey

    Saadettin Kılıçkap & Şuayip Yalçın

  3. Department of Nuclear Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey

    Fani Murat Bozkurt & Bilge Volkan Salancı

Authors
  1. Gamze Türk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gonca Eldem
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Saadettin Kılıçkap
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fani Murat Bozkurt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bilge Volkan Salancı
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Barbaros Erhan Çil
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bora Peynircioğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Şuayip Yalçın
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ferhun Balkancı
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gamze Türk.

Ethics declarations

This retrospective study was approved by Institutional Ethical Commission Review Board.

Conflict of Interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Türk, G., Eldem, G., Kılıçkap, S. et al. Outcomes of Radioembolization in Patients with Chemorefractory Colorectal Cancer Liver Metastasis: a Single-Center Experience. J Gastrointest Canc 50, 236–243 (2019). https://doi.org/10.1007/s12029-018-0053-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12029-018-0053-z

Keywords

Search

Navigation