title: Yttrium-90 radioembolization as salvage therapy for colorectal cancer with liver metastases.
abstract: BACKGROUND
  Few patients with metastatic colorectal cancer (mCRC) are candidates for resection of their hepatic disease. Yttrium-90 ((90)Y) radioembolization has promise in the treatment of unresectable mCRC. We conducted a retrospective study to assess the efficacy in patients with refractory mCRC who underwent (90)Y radioembolization.
  
  
  METHODS
  Patients with unresectable mCRC with liver metastases treated at The Ohio State University were included in this analysis. Demographic data, carcinoembryonic antigen (CEA) values, observed toxicities, and information on prior therapies were collected. Response was assessed by RECIST (Response Evaluation Criteria in Solid Tumors) 1.1 criteria. Overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan-Meier method.
  
  
  RESULTS
  Twenty-four patients (median age, 63 years) were included. Of the patients, 54% had extrahepatic disease; 67% had bilobar involvement. The patients had received a median of 3 prior therapies. No objective responses were observed. Five patients had a CEA response. Median PFS and OS were 3.9 months (95% CI, 2.4-4.8 months) and 8.9 months (95% CI, 4.2-16.7 months), respectively. Patients older than 65 years had improved PFS (4.6 vs. 2.4 months) and OS (14 vs. 5.5 months) vs. younger patients, likely due to receipt of (90)Y treatment earlier in their disease course. The presence of extrahepatic disease and the absence of CEA response appeared negatively predictive of efficacy. Toxicities were expected and manageable.
  
  
  CONCLUSIONS
  (90)Y radioembolization is active in select patients with refractory mCRC and with liver metastases, and is safe and well tolerated in the elderly. In patients with extensive extrahepatic disease, (90)Y should be used in combination with chemotherapy. CEA may be a predictor of efficacy.
authors.affiliation: Division of Hematology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH, USA.
authors.forename: Ludmila Katherine
authors.initials: LK
authors.lastname: Martin
authors.forename: Anthony
authors.initials: A
authors.lastname: Cucci
authors.forename: Lai
authors.initials: L
authors.lastname: Wei
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Rose
authors.forename: Marlo
authors.initials: M
authors.lastname: Blazer
authors.forename: Carl
authors.initials: C
authors.lastname: Schmidt
authors.forename: Hooman
authors.initials: H
authors.lastname: Khabiri
authors.forename: Mark
authors.initials: M
authors.lastname: Bloomston
authors.forename: Tanios
authors.initials: T
authors.lastname: Bekaii-Saab
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002272:Carcinoembryonic Antigen / Q000097:blood; D059248:Chemoradiotherapy; D015179:Colorectal Neoplasms / Q000097:blood / Q000473:pathology*; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000532:radiotherapy / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000009:adverse effects; D015021:Yttrium Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D002272:Carcinoembryonic Antigen; D015021:Yttrium Radioisotopes