Special Communication
Transarterial Treatment of Colorectal Cancer Liver Metastases with Irinotecan-Loaded Drug-Eluting Beads: Technical Recommendations

https://doi.org/10.1016/j.jvir.2013.11.027Get rights and content

Abstract

Transcatheter hepatic arterial administration of irinotecan-loaded drug-eluting beads (DEBIRI) is used to treat liver-only or liver-dominant metastatic disease from colorectal cancer (CRC). Eligibility for DEBIRI should be established in each individual patient by a multidisciplinary team based on comprehensive clinical, imaging, and laboratory assessment. Standardization of DEBIRI technique and protocols would be expected to lead to improved efficacy and safety. The present article provides a set of technical recommendations for the use of DEBIRI in the treatment of hepatic CRC metastases.

Section snippets

The Panel

The group of physicians, all of whom had considerable experience in the field, included one surgical oncologist and eight interventional radiologists, practicing in different geographical regions (three in North America, one in South America, four in Europe, and one in Australia). The recommendations were collaboratively generated during a meeting held in April 2012.

Patient Selection

The proposed algorithm for the clinical management of patients with liver metastases from CRC is shown in the Figure. Patients who are not candidates for potentially curative treatment may be considered for locoregional therapy with DEBIRI or 90Y radioembolization if they have liver-only or liver-dominant metastatic disease and the level of hepatic parenchymal involvement does not exceed 60%. Liver-dominant metastatic disease is defined as 80% or more of the overall total body metastatic tumor

Final Remarks

The technical recommendations reported here are aimed at ensuring a consistent use of DEBIRI in the treatment of hepatic CRC metastases. However, given the many patient- and tumor-related variables that play a role in the decision-making process, this document is intended as no more than a general guideline. We fully acknowledge that, given the complexity of the disease, individual patient and tumor characteristics may require a different approach with respect to the one recommended here. For

Acknowledgments

The authors thank Research Analysis Library for recording the meeting and providing a draft based on the minutes. Assistance was supported by Biocompatibles UK.

References (21)

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R.G.-M. and G.N. are consultants for Biocompatibles UK (Farnham, United Kingdom). W.S.R. is a consultant for Cook (Bloomington, Indiana), B. Braun (Bethlehem, Pennsylvania), and AngioDynamics (Latham, New York), and receives research support from Nordion (Ottawa, Ontario, Canada), Sirtex (North Sydney, Australia), Biocompatibles UK, and B. Braun. None of the other authors have identified a conflict of interest.

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