Hepatic yttrium-90 radioembolization of chemotherapy-refractory colorectal cancer liver metastases.
OBJECTIVE
To present data for radioembolization with yttrium-90 ((90)Y) resin microspheres in patients with colorectal cancer liver metastases in whom currently available therapies had failed.


METHODS
Retrospective review was conducted of case files of patients with colorectal cancer liver metastases in whom chemotherapy had failed, prompting hepatic (90)Y radioembolization administered as a single-session, whole-liver treatment. Imaging and laboratory follow-up results were available for 36 patients. Response and toxicity were assessed by computed tomography/magnetic resonance imaging with the Response Evaluation Criteria in Solid Tumors and the National Cancer Institute's Common Terminology Criteria for Adverse Events, version 3.0.


RESULTS
Forty-one patients (mean age, 61 years; 30 men) received hepatic (90)Y radioembolization with resin microspheres (mean activity, 1.9 GBq). At a median interval of 2.9 months after radioembolization, partial response, stable disease, and progressive disease were demonstrated in seven, 25, and four patients, respectively. Median overall survival was 10.5 months, with improved survival for patients with a decrease in carcinoembryonic antigen level (19.1 months vs 5.4 months) and imaging response (29.3 months vs 4.3 months; P = .0001). Except for one instance of treatment-associated cholecystitis (grade 4 toxicity) and two gastric ulcers (grade 2 toxicity), no severe toxicities were observed.


CONCLUSIONS
Hepatic (90)Y radioembolization can be performed with manageable toxicity in patients with colorectal cancer liver metastases whose disease is refractory to chemotherapy. The antitumoral effect is supported by imaging and tumor marker responses. Further investigation is warranted to determine the optimal use of this emerging therapeutic modality.
Jakobs
Tobias F
TF
Department of Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany. tobias.jakobs@med.unimuenchen.de
Hoffmann
Ralf-Thorsten
RT
Dehm
Kristina
K
Trumm
Christoph
C
Stemmler
Hans-Joachim
HJ
Tatsch
Klaus
K
La Fougere
Christian
C
Murthy
Ravi
R
Helmberger
Thomas K
TK
Reiser
Maximilian F
MF
D000970:Antineoplastic Agents / Q000627:therapeutic use; D001918:Brachytherapy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000556:secondary; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
D000970:Antineoplastic Agents; D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes