title: Twelve-year experience of radioembolization for colorectal hepatic metastases in 214 patients: survival by era and chemotherapy.
abstract: OBJECTIVE
  The aim of this study was to analyze the safety, treatment characteristics and survival outcomes of Yttrium-90 (Y90) radioembolization for unresectable colorectal carcinoma (CRC) liver metastases refractory to standard of care therapy.
  
  
  METHODS
  A total of 214 patients with CRC metastases were treated with Y90 radioembolization over 12 years. Toxicity was assessed using National Cancer Institute common terminology criteria. Overall survival was analyzed from date of diagnosis of primary cancer, hepatic metastases and from the first Y90. Uni/multivariate analyses were performed. Substratification by era of chemotherapeutics was performed.
  
  
  RESULTS
  Most patients were male (60 %) and <65 years old (61 %). Of them, 98 % had been exposed to chemotherapy. Grade 3 lymphocyte, bilirubin, albumin, ALP and AST toxicities were observed in 39 %, 11 %, 10 %, 8 % and 4 % of patients, respectively. Grade 4 lymphocyte and ALP toxicities were observed in 5 % and 3 % of patients, respectively. Median overall survival was 43.0, 34.6, and 10.6 months from date of diagnosis of primary cancer, hepatic metastases and first Y90, respectively. Survival was significantly longer in patients: (1) who received ≤2 cytotoxic drugs (n = 104) than those who received 3 (n = 110) (15.2 vs. 7.5 months, p = 0.0001); and (2) who received no biologic agents (n = 52) compared with those that did (n = 162) (18.6 vs. 9.4 months, p = 0.0001). Multivariate analyses identified ≤2 cytotoxic agents, no exposure to biologics, ECOG 0, tumor burden <25 %, lack of extrahepatic disease and albumin >3 g/dL as independent predictors of survival.
  
  
  CONCLUSIONS
  In this largest metastatic CRC series published to date, Y90 radioembolization was found to be safe; survival varied by prior therapy. Further studies are required to further refine the role of Y90 in metastatic CRC.
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
authors.forename: Khairuddin
authors.initials: K
authors.lastname: Memon
authors.forename: Mary F
authors.initials: MF
authors.lastname: Mulcahy
authors.forename: Ryan
authors.initials: R
authors.lastname: Hickey
authors.forename: Karen
authors.initials: K
authors.lastname: Marshall
authors.forename: Melissa
authors.initials: M
authors.lastname: Williams
authors.forename: Krystina
authors.initials: K
authors.lastname: Salzig
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Gates
authors.forename: Bassel
authors.initials: B
authors.lastname: Atassi
authors.forename: Michael
authors.initials: M
authors.lastname: Vouche
authors.forename: Rohi
authors.initials: R
authors.lastname: Atassi
authors.forename: Kush
authors.initials: K
authors.lastname: Desai
authors.forename: Elias
authors.initials: E
authors.lastname: Hohlastos
authors.forename: Kent
authors.initials: K
authors.lastname: Sato
authors.forename: Ali
authors.initials: A
authors.lastname: Habib
authors.forename: Sheetal
authors.initials: S
authors.lastname: Kircher
authors.forename: Steven B
authors.initials: SB
authors.lastname: Newman
authors.forename: Halla
authors.initials: H
authors.lastname: Nimeiri
authors.forename: Al B
authors.initials: AB
authors.lastname: Benson
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000556:secondary*; D059248:Chemoradiotherapy; D015179:Colorectal Neoplasms / Q000556:secondary*; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals / Q000009:adverse effects / Q000627:therapeutic use*; D016019:Survival Analysis; D015021:Yttrium Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes