Skip to main content
SpringerLink
Log in

Radioembolization and systemic chemotherapy improves response and survival for unresectable colorectal liver metastases

  • Original Paper
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the role of radioembolization and systemic chemotherapy as a combined modality therapy for unresectable colorectal liver metastases.

Patients and methods

Prospective database of a major yttrium-90 microsphere radioembolization treatment center in Sydney, Australia, that included 140 patients with unresectable colorectal liver metastases was analyzed. Tumor response, overall survival, treatment-related complications and an evaluation of its role as a combined modality therapy with systemic chemotherapy were performed.

Results

One hundred and thirty-three patients (95%) had a single treatment, and seven patients (5%) had repeated treatments. Response following treatment was complete in two patients (1%), partial in 43 patients (31%), stable in 44 patients (31%), and 51 patients (37%) developed progressive disease. Combining chemotherapy with radioembolization was associated with a favorable treatment response (P = 0.007). The median overall survival was 9 (95% CI 6.4–11.3) months with a 1-, 2-, and 3-year survival rate of 42, 22, and 20%, respectively. Primary tumor site (P = 0.019), presence of extrahepatic disease (P = 0.033), and a favorable treatment response (P < 0.001) were identified as independent predictors for survival.

Conclusion

Combined modality therapy appears to improve tumor response rates. Survival is influenced by tumor site, presence of extrahepatic disease, and response to therapy. Yttrium-90 microsphere radioembolization is safe and may best be combined with systemic chemotherapy for patients with unresectable colorectal liver metastases.

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.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  • Adam R, Wicherts DA, de Haas RJ et al (2009) Patients with initially unresectable colorectal liver metastases: is there a possibility of cure? J Clin Oncol 27:1829–1835

    Article  PubMed  Google Scholar 

  • Allen PJ, Nissan A, Picon AI et al (2005) Technical complications and durability of hepatic artery infusion pumps for unresectable colorectal liver metastases: an institutional experience of 544 consecutive cases. J Am Coll Surg 201:57–65

    Article  PubMed  Google Scholar 

  • Bengmark S, Hafstrom L (1969) The natural history of primary and secondary malignant tumours of the liver. Cancer 23:198–202

    Article  PubMed  CAS  Google Scholar 

  • Bester L, Salem R (2007) Reduction of arteriohepatovenous shunting by temporary balloon occlusion in patients undergoing radioembolization. J Vasc Interv Radiol 18:1310–1314

    Article  PubMed  Google Scholar 

  • Campbell AM, Bailey IH, Burton MA (2001) Tumour dosimetry in human liver following hepatic 90Y microsphere therapy. Phys Med Biol 46:487–498

    Article  PubMed  CAS  Google Scholar 

  • Cassidy J, Clarke S, Diaz-Rubio E et al (2008) Randomized phase III study of capecitabine plus oxaliplatin compared with fluorouracil/folinic acid plus oxaliplatin as first-line therapy for metastatic colorectal cancer. J Clin Oncol 26:2006–2012

    Article  PubMed  CAS  Google Scholar 

  • Colucci G, Gebbia V, Paoletti G et al (2005) Phase III randomized trial of FOLFIRI versus FOLFOX4 in the treatment of advanced colorectal cancer: a multicenter study of the Gruppo Oncologico Dell’Italia Meridionale. J Clin Oncol 23:4866–4875

    Article  PubMed  CAS  Google Scholar 

  • Falcone A, Ricci S, Brunetti I et al (2007) Phase III trial of infusional fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) compared with infusional fluorouracil, leucovorin, and irinotecan (FOLFIRI) as first-line treatment for metastatic colorectal cancer: the Gruppo Oncologico Nord Ovest. J Clin Oncol 25:1670–1676

    Article  PubMed  CAS  Google Scholar 

  • Folprecht G, Gruenberger T, Bechstein WO et al (2010) Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial. Lancet Oncol 11:38–47

    Article  PubMed  CAS  Google Scholar 

  • Fong Y, Kemeny N, Paty P et al (1996) Treatment of colorectal cancer: hepatic metastasis. Semin Surg Oncol 12:219–252

    Article  PubMed  CAS  Google Scholar 

  • Giantonio BJ, Catalano PJ, Meropol NJ et al (2007) Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200. J Clin Oncol 25:1539–1544

    Article  PubMed  CAS  Google Scholar 

  • 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  PubMed  CAS  Google Scholar 

  • Hurwitz H, Fehrenbacher L, Novotny W et al (2004) Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer [see comment]. N Engl J Med 350:2335–2342

    Article  PubMed  CAS  Google Scholar 

  • Kemeny N, Fata F (1999) Arterial, portal or systemic chemotherapy for patients with hepatic metastasis of colorectal carcinoma. J Hepatobiliary Pancreat Surg 6:39–49

    Article  PubMed  CAS  Google Scholar 

  • Khatri VP, Petrelli NJ, Belghiti J (2005) Extending the frontiers of surgical therapy for hepatic colorectal metastases: is there a limit? J Clin Oncol 23:8490–8499

    Article  PubMed  Google Scholar 

  • Kim GP, Sargent DJ, Mahoney MR et al (2009) Phase III noninferiority trial comparing irinotecan with oxaliplatin, fluorouracil, and leucovorin in patients with advanced colorectal carcinoma previously treated with fluorouracil: N9841. J Clin Oncol 27:2848–2854

    Article  PubMed  CAS  Google Scholar 

  • Kuebler JP (2009) Radioembolization of liver metastases in patients with colorectal cancer: a nonsurgical treatment with combined modality potential. J Clin Oncol 27:4041–4042

    Article  PubMed  CAS  Google Scholar 

  • Mary FM, Robert JL, Saad MI et al (2009) Radioembolization of colorectal hepatic metastases using yttrium-90 microspheres. Cancer 115:1849–1858

    Article  Google Scholar 

  • Nicolay NH, Berry DP, Sharma RA (2009) Liver metastases from colorectal cancer: radioembolization with systemic therapy. Nat Rev Clin Oncol 6:687–697

    Article  PubMed  CAS  Google Scholar 

  • Pawlik TM, Schulick RD, Choti MA (2008) Expanding criteria for resectability of colorectal liver metastases. Oncologist 13:51–64

    Article  PubMed  Google Scholar 

  • Porschen R, Arkenau H-T, Kubicka S et al (2007) Phase III study of capecitabine plus oxaliplatin compared with fluorouracil and leucovorin plus oxaliplatin in metastatic colorectal cancer: a final report of the AIO Colorectal Study Group. J Clin Oncol 25:4217–4223

    Article  PubMed  CAS  Google Scholar 

  • Salem R, Thurston KG (2006) Radioembolization with 90Yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 1: technical and methodologic considerations. J Vasc Interv Radiol 17:1251–1278

    Article  PubMed  Google Scholar 

  • Saltz LB, Cox JV, Blanke C et al (2000) Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. Irinotecan Study Group [see comment]. N Engl J Med 343:905–914

    Article  PubMed  CAS  Google Scholar 

  • Saltz LB, Rosen LS, Marshall JL et al (2007) Phase II trial of sunitinib in patients with metastatic colorectal cancer after failure of standard therapy. J Clin Oncol 25:4793–4799

    Article  PubMed  CAS  Google Scholar 

  • Saltz LB, Clarke S, Diaz-Rubio E et al (2008) Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol 26:2013–2019

    Article  PubMed  CAS  Google Scholar 

  • Sobrero AF, Maurel J, Fehrenbacher L et al (2008) EPIC: phase III trial of cetuximab plus irinotecan after fluoropyrimidine and oxaliplatin failure in patients with metastatic colorectal cancer. J Clin Oncol 26:2311–2319

    Article  PubMed  CAS  Google Scholar 

  • Steele GJ, Ravikumar TS (1989) Resection of hepatic metastases from colorectal metastases: biologic perspectives. Ann Surg 210

  • 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. ANZ J Surg 76:696–703

    Article  PubMed  Google Scholar 

  • Therasse P, Arbuck SG, Eisenhauer EA et al (2000) New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92:205–216

    Article  PubMed  CAS  Google Scholar 

  • Tomlinson JS, Jarnagin WR, DeMatteo RP et al (2007) Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol 25:4575–4580

    Article  PubMed  Google Scholar 

  • Vente MA, Wondergem M, van der Tweel I et al (2009) Yttrium-90 microsphere radioembolization for the treatment of liver malignancies: a structured meta-analysis. Eur Radiol 19:951–959

    Article  PubMed  CAS  Google Scholar 

  • Viganò L, Ferrero A, Lo Tesoriere R et al (2008) Liver surgery for colorectal metastases: results after 10 years of follow-up. Long-term survivors, late recurrences, and prognostic role of morbidity. Ann Surg Oncol 15:2458–2464

    Article  PubMed  Google Scholar 

  • Wagner JS, Adson MA, Van Heerden JA et al (1984) The natural history of hepatic metastases from colorectal cancer. A comparison with resective treatment. Ann Surg 199:502–508

    Article  PubMed  CAS  Google Scholar 

  • Wood CB, Gillis CR, Blumgart LH (1976) A retrospective study of the natural history of patients with liver metastases from colorectal cancer. Clin Oncol 2:285–288

    PubMed  CAS  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Hepatobiliary and Surgical Oncology Unit, Department of Surgery, University of New South Wales, St. George Hospital, Sydney, NSW, Australia

    Terence C. Chua, Akshat Saxena & David L. Morris

  2. Interventional Oncology, Department of Radiology, University of New South Wales, St. Vincent’s Hospital, Sydney, NSW, Australia

    Lourens Bester

Authors
  1. Terence C. Chua
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lourens Bester
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akshat Saxena
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David L. Morris
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David L. Morris.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chua, T.C., Bester, L., Saxena, A. et al. Radioembolization and systemic chemotherapy improves response and survival for unresectable colorectal liver metastases. J Cancer Res Clin Oncol 137, 865–873 (2011). https://doi.org/10.1007/s00432-010-0948-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-010-0948-y

Keywords

Search

Navigation