title: Patterns of failure in colorectal patients with liver metastases after yttrium-90 radioembolization.
abstract: OBJECTIVE
  To assess patterns of failure and factors affecting recurrence patterns in colorectal cancer patients treated with Y-labeled resin microspheres for metastatic liver disease.
  
  
  METHODS
  We retrospectively reviewed 30 colorectal patients treated with Yttrium-90 radioembolization and assessed follow-up computed tomography scans and positron emission tomography scans to determine disease outcomes. All patients were included in survival analysis. Twenty-six patients with hepatic metastases were assessed for patterns of failure after radioembolization treatment and grouped into 3 patterns: (1) hepatic; (2) extrahepatic; and (3) intrahepatic and extrahepatic.
  
  
  RESULTS
  The median overall survival and progression-free survival for all colorectal patients treated with radioembolization was 9.4 and 3.2 months, respectively. Overall survival and progression-free survival were not significantly different between patterns of failure (P=0.43 and 0.26, respectively). Logistic regression analysis demonstrated a trend toward the predictive value of tumor volume in determining patterns of failure. Smaller tumor volumes had a higher predictive probability for extrahepatic failure than larger tumor volumes (P=0.057). Tumor volumes <300 mL were predictive for extrahepatic failure patterns compared with hepatic recurrence (P=0.046).
  
  
  CONCLUSIONS
  Radioembolization with Y-labeled resin microspheres continues to be an effective salvage treatment for colorectal liver metastases. Analysis of patterns of radiologic failure demonstrated that patients treated by radioembolization develop a greater proportion of extrahepatic failure. Tumor volumes >300 mL were predictive for hepatic recurrence, suggesting that increased dosing or retreatment of these lesions may lead to improved hepatic control of disease and better patient outcomes.
authors.affiliation: Departments of *Radiation Oncology †Radiology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ.
authors.forename: Caitlin A
authors.initials: CA
authors.lastname: Schonewolf
authors.forename: Bhavik
authors.initials: B
authors.lastname: Patel
authors.forename: Rebekah H
authors.initials: RH
authors.lastname: Gensure
authors.forename: Venkat
authors.initials: V
authors.lastname: Narra
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Haffty
authors.forename: John L
authors.initials: JL
authors.lastname: Nosher
authors.forename: Salma K
authors.initials: SK
authors.lastname: Jabbour
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D049268:Positron-Emission Tomography; D012117:Resins, Synthetic / Q000008:administration & dosage*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016879:Salvage Therapy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D015021:Yttrium Radioisotopes / Q000008:administration & dosage*
chemical_list: D012117:Resins, Synthetic; D015021:Yttrium Radioisotopes