Clinical study
Radioembolization versus Standard Care of Hepatic Metastases: Comparative Retrospective Cohort Study of Survival Outcomes and Adverse Events in Salvage Patients

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Abstract

Purpose

To retrospectively evaluate the safety and survival of patients with chemotherapy-refractory liver metastases treated with yttrium-90 (90Y) resin microspheres, and to compare survival in this patient group versus survival after standard/supportive care to assess whether radioembolization contributes to survival gains in the salvage setting.

Materials And Methods

While 339 patients with chemotherapy-refractory liver metastases underwent 90Y microspheres radioembolization at a single institution between 2006 and 2011, 51 patients were referred back to their treating physician for conservative treatment or best supportive care. Adverse events were assessed at the time of treatment and at 1 and 3 months after treatment. Overall survival (OS) was calculated by the Kaplan–Meier method for the radioembolization cohort (as a whole and according to two subcohorts: patients with colorectal primary cancer and patients with all other primary cancers, eg, breast or neuroendocrine) and the standard-care cohort.

Results

The median OS after 90Y radioembolization (339 patients) was 12.0 months, versus 6.3 months for the standard-care cohort (51 patients; P < .001). The median OS times for the two subcohorts were 11.9 months and 12.7 months, respectively. At the 3-month follow-up, the incidence of more serious adverse events was low, with 11 cases (3%) of ulceration, 10 cases (2.9%) of radiation-induced liver disease, and six complications (1.8%) involving the gallbladder (eg, cholecystitis).

Conclusions

The present study suggests that radioembolization shows promise as an effective and safe treatment for patients with chemotherapy-refractory hepatic metastases and improves overall survival in a select population of patients in a salvage setting compared with best supportive care alone.

Section snippets

Materials and Methods

This retrospective study investigating the survival of patients who underwent 90Y microsphere radioembolization was approved by our hospital's institutional review board, and data were supplied by cancer council and cancer registries. Informed consent was obtained from all patients to participate in this retrospective study. Patients entered into the retrospective analysis were all referred to our center for consideration of radioembolization with 90Y resin microspheres (Sirtex Medical, Sydney,

Patient Characteristics

The patient characteristics are summarized in Table 4. Of note, the median age of the 339 patients in the treated cohort was 67 years (range, 27–90 years), and 206 (61%) were men. The median age for the standard-care cohort patients was 66 years (range, 27–88 y), and 35 (69%) were men. Of all patients treated by radioembolization, 25 received multiple 90Y microsphere treatments (the highest number of treatments for any one patient was four [26]), equating to a total of 364 treatments. For

Discussion

Earlier studies have suggested that radioembolization with 90Y microspheres represents a valuable treatment option for the management of secondary liver tumors. Therapeutic benefits appear to be greatest when radioembolization is used as an earlier line of therapy or is combined with chemotherapy (14, 15, 18, 27). Retrospective and prospective clinical studies have shown consistent clinical benefits with the use of radioembolization for chemotherapy-refractory hepatic metastases in the salvage

Acknowledgments

The authors acknowledge Val Gebski at Data Analysis and Research Technologies, Sydney, Australia, for the statistical analysis.

References (34)

  • R. Salem et al.

    Radioembolization with 90yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignanciesPart 1: technical and methodologic considerations

    J Vasc Interv Radiol

    (2006)
  • A.S. Kennedy et al.

    Recommendations for radioembolization of hepatic malignancies using yttrium-90 microsphere brachytherapy: a consensus panel report from the radioembolization brachytherapy oncology consortium

    Int J Radiat Oncol Biol Phys

    (2007)
  • S. Kosmider et al.

    Radioembolization in combination with systemic chemotherapy as first-line therapy for liver metastases from colorectal cancer

    J Vasc Interv Radiol

    (2011)
  • A. Kennedy et al.

    Treatment parameters and outcome in 680 treatments of internal radiation with resin 90Y-microspheres for unresectable hepatic tumors

    Int J Radiat Oncol Biol Phys

    (2009)
  • K. Hess et al.

    Metastatic patterns in adenocarcinoma

    Cancer

    (2006)
  • J. Leporrier et al.

    A population-based study of the incidence, management and prognosis of hepatic metastases from colorectal cancer

    Br J Surg

    (2006)
  • H. Hurwitz et al.

    Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer

    N Engl J Med

    (2004)

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    L.B. is a paid consultant for Sirtex Medical, Sydney, Australia. None of the other authors have identified a conflict of interest.

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