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Twelve-year experience of radioembolization for colorectal hepatic metastases in 214 patients: survival by era and chemotherapy

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to analyze the safety, treatment characteristics and survival outcomes of Yttrium-90 (Y90) radioembolization for unresectable colorectal carcinoma (CRC) liver metastases refractory to standard of care therapy.

Methods

A total of 214 patients with CRC metastases were treated with Y90 radioembolization over 12 years. Toxicity was assessed using National Cancer Institute common terminology criteria. Overall survival was analyzed from date of diagnosis of primary cancer, hepatic metastases and from the first Y90. Uni/multivariate analyses were performed. Substratification by era of chemotherapeutics was performed.

Results

Most patients were male (60 %) and <65 years old (61 %). Of them, 98 % had been exposed to chemotherapy. Grade 3 lymphocyte, bilirubin, albumin, ALP and AST toxicities were observed in 39 %, 11 %, 10 %, 8 % and 4 % of patients, respectively. Grade 4 lymphocyte and ALP toxicities were observed in 5 % and 3 % of patients, respectively. Median overall survival was 43.0, 34.6, and 10.6 months from date of diagnosis of primary cancer, hepatic metastases and first Y90, respectively. Survival was significantly longer in patients: (1) who received ≤2 cytotoxic drugs (n = 104) than those who received 3 (n = 110) (15.2 vs. 7.5 months, p = 0.0001); and (2) who received no biologic agents (n = 52) compared with those that did (n = 162) (18.6 vs. 9.4 months, p = 0.0001). Multivariate analyses identified ≤2 cytotoxic agents, no exposure to biologics, ECOG 0, tumor burden <25 %, lack of extrahepatic disease and albumin >3 g/dL as independent predictors of survival.

Conclusion

In this largest metastatic CRC series published to date, Y90 radioembolization was found to be safe; survival varied by prior therapy. Further studies are required to further refine the role of Y90 in metastatic CRC.

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Role of funding

There was no funding provided for this study.

Conflict of interest

RJL, MFM, ABB, and RS are advisors to BTG. None of the other authors have any conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA

    Robert J. Lewandowski, Khairuddin Memon, Ryan Hickey, Karen Marshall, Melissa Williams, Krystina Salzig, Vanessa L. Gates, Bassel Atassi, Michael Vouche, Rohi Atassi, Kush Desai, Elias Hohlastos, Kent Sato, Ali Habib & Riad Salem

  2. Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA

    Mary F. Mulcahy, Karen Marshall, Melissa Williams, Krystina Salzig, Sheetal Kircher, Steven B. Newman, Halla Nimeiri, Al B. Benson & Riad Salem

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  1. Robert J. Lewandowski
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  2. Khairuddin Memon
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  14. Kent Sato
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  19. Al B. Benson
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  20. Riad Salem
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Correspondence to Riad Salem.

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Lewandowski, R.J., Memon, K., Mulcahy, M.F. 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 41, 1861–1869 (2014). https://doi.org/10.1007/s00259-014-2799-2

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  • DOI: https://doi.org/10.1007/s00259-014-2799-2

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