title: High lung shunt fraction in colorectal liver tumors is associated with distant metastasis and decreased survival.
abstract: OBJECTIVE
  To assess how intratumoral shunting relates to liver metastasis and to clinical outcome.
  
  
  METHODS
  Lung shunt fraction (LSF) was calculated from macroaggregated albumin scan after transcatheter injection of radioactive particles in 62 patients with colorectal cancer and liver metastases evaluated for selective internal radiation therapy (SIRT) from May 2007 to August 2012. Assessment was performed of how LSF, liver tumor burden, and systemic chemotherapy relate to survival and the presence of lung metastases. LSF and tumor burden were also assessed in a subset of patients who underwent genetic profiling with SNaPshot analysis.
  
  
  RESULTS
  Patients with higher LSF were more likely to have lung metastases and decreased survival, whereas tumor burden was not associated with these outcomes. Patients with genetic mutations had significantly higher LSF than patients with no mutations. Patients who received chemotherapy before SIRT and had low LSF had the longest survival after SIRT.
  
  
  CONCLUSIONS
  LSF may be a more robust marker of metastasis than tumor size. Increased LSF secondary to vascular shunting within liver metastasis is an indicator of distant lesions and is associated with decreased survival after SIRT. Intratumoral shunting may provide a conduit for circulating tumor cells to access more remote organs, bypassing filtration by liver parenchyma, and may be an important factor in metastasis from colorectal cancer.
authors.affiliation: Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 290 Gray/Bigelow, Boston, MA 02114.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Deipolyi
authors.affiliation: Division of Molecular Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 290 Gray/Bigelow, Boston, MA 02114.
authors.forename: A John
authors.initials: AJ
authors.lastname: Iafrate
authors.affiliation: Division of Hematology/Oncology, Center for Liver Cancer, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 290 Gray/Bigelow, Boston, MA 02114.
authors.forename: Andrew X
authors.initials: AX
authors.lastname: Zhu
authors.affiliation: Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 290 Gray/Bigelow, Boston, MA 02114.
authors.forename: Emel A
authors.initials: EA
authors.lastname: Ergul
authors.affiliation: Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 290 Gray/Bigelow, Boston, MA 02114.
authors.forename: Suvranu
authors.initials: S
authors.lastname: Ganguli
authors.affiliation: Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 290 Gray/Bigelow, Boston, MA 02114.. Electronic address: roklu@mgh.harvard.edu.
authors.forename: Rahmi
authors.initials: R
authors.lastname: Oklu
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000235:genetics; D015179:Colorectal Neoplasms / Q000235:genetics / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008102:Liver Circulation; D008113:Liver Neoplasms / Q000098:blood supply* / Q000235:genetics / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary*; D008175:Lung Neoplasms / Q000098:blood supply* / Q000235:genetics / Q000401:mortality / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009360:Neoplastic Cells, Circulating / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D011652:Pulmonary Circulation; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012307:Risk Factors; D013668:Technetium Tc 99m Aggregated Albumin; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D047368:Tumor Burden
chemical_list: D014408:Biomarkers, Tumor; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin
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