Yttrium-90 Radioembolization as Salvage Therapy for Liver Metastases From Colorectal Cancer.
OBJECTIVE
To report safety and survival outcomes of Yttrium-90 (Y-90) radioembolization when used as salvage therapy for chemotherapy-resistant liver metastases from colorectal cancer.


METHODS
In this IRB-approved retrospective study, 45 patients with hepatic metastases from colorectal cancer underwent Y-90 radioembolization after failure of systemic chemotherapy. Toxicities were assessed as per NCI-CTCAE and response based on RECIST and PET. Kaplan-Meier survival analysis was performed to calculate median survival, prognostic factors on univariate analysis, and Cox regression analysis for independent predictors of survival.


RESULTS
Y-90 radioembolization was technically successful in all (100%). Twenty-three patients (51%) had no toxicities, whereas 6 patients (13%) had grade 3 toxicities, and no patients had grade 4 toxicity. Two patients died within 30 days of treatment from renal failure unrelated to the procedure. Per RECIST, 1 patient (2%) had partial response, 34 (71%) had stable disease, and 6 (13%) had progressive disease. PET response was seen in 46% of patients with 2 patients (4%) demonstrating complete and 22 (42%) demonstrating partial metabolic response. The median survival was 186 days (95% CI, 149-277 d). Response on PET was the only independent predictor of superior overall survival. Patients who had response on PET following Y-90 therapy had a median overall survival of 317 days (10.6 mo) (95% CI, 193-564 d), whereas patients with no response on PET had a median overall survival of 163 days (5.4 mo) (95% CI, 64-283 d).


CONCLUSIONS
Y-90 radioembolization as a salvage therapy for chemotherapy-resistant hepatic metastases from colon cancer was safe and resulted in disease stability. Response on PET was an independent predictor of superior overall survival.
*Interventional Radiology, UT Southwestern Medical Center, Dallas, TX †Department of Radiology, Kaiser Permanente, Redwood City, CA Departments of ‡Imaging ¶Hematology/Oncology, Massachusetts General Hospital, Boston, MA §Department of Radiology, University of Mississippi Medical Center, Jackson, MS ∥Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT.
Sanjeeva P
SP
Kalva
Rich S
RS
Rana
Raymond
R
Liu
Niranjan
N
Rachamreddy
Bhavika
B
Dave
Ashish
A
Sharma
Suvranu
S
Ganguli
Carlos
C
Rabito
Eunice
E
Kwak
Lawrence S
LS
Blaszkowsky
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology*; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals / Q000009:adverse effects / Q000627:therapeutic use*; D066066:Response Evaluation Criteria in Solid Tumors; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods*; D015996:Survival Rate; D015021:Yttrium Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*
D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes