title: Radioembolization in combination with systemic chemotherapy as first-line therapy for liver metastases from colorectal cancer.
abstract: OBJECTIVE
  To report clinical experience with radioembolization (RE) plus systemic chemotherapy as a first-line treatment for liver metastases from colorectal cancer (CRC).
  
  
  METHODS
  Clinical outcomes were evaluated retrospectively among 19 patients with unresectable liver metastases from CRC who had a good performance status and a low burden of extrahepatic disease (EHD) and were eligible for RE. Most (74%) had disease confined to the liver. Concurrent treatment with 5-fluorourail/leucovorin (n = 7) or 5-fluorourail/leucovorin/oxaliplatin (FOLFOX; n = 12) was started 3-4 days before single treatment with RE.
  
  
  RESULTS
  Overall response rate according to the Response Evaluation Criteria in Solid Tumors was 84% (two complete responses and 14 partial responses). Median progression-free survival (PFS) time was 10.4 months and median overall survival (OS) time was 29.4 months. For patients with disease confined to the liver, PFS improved (10.7 mo vs 3.6 mo; P = .09), with significant prolongation of OS (median, 37.8 mo vs 13.4 mo; P = .03) compared with those who had EHD. Nine patients, including three long-term (> 3 y) survivors, remained alive after a median follow-up of 18.6 months. Serious treatment-related toxicities included febrile neutropenia with concurrent FOLFOX treatment, a perforated duodenal ulcer, and one death from hepatic toxicity.
  
  
  CONCLUSIONS
  The present findings confirm the effectiveness of RE plus systemic chemotherapy for metastatic CRC. Patients with liver-confined disease derived the greatest benefit, with median survival times beyond 36 months. Larger datasets from ongoing phase III trials are needed to further define the safety and efficacy of RE in the first-line setting.
authors.affiliation: BioGrid Australia, Level 6 North, Royal Melbourne Hospital, Grattan St., Parkville, Victoria 3050, Australia. suzanne.kosmider@mh.org.au
authors.forename: Suzanne
authors.initials: S
authors.lastname: Kosmider
authors.forename: Thean H
authors.initials: TH
authors.lastname: Tan
authors.forename: Desmond
authors.initials: D
authors.lastname: Yip
authors.forename: Richard
authors.initials: R
authors.lastname: Dowling
authors.forename: Meir
authors.initials: M
authors.lastname: Lichtenstein
authors.forename: Peter
authors.initials: P
authors.lastname: Gibbs
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D001315:Australia; D001918:Brachytherapy / Q000009:adverse effects / Q000401:mortality; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D002955:Leucovorin / Q000008:administration & dosage / Q000009:adverse effects; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D009944:Organoplatinum Compounds; D015021:Yttrium Radioisotopes; D002955:Leucovorin; D005472:Fluorouracil