title: Selective transarterial radioembolisation of unresectable liver-dominant colorectal cancer refractory to chemotherapy.
abstract: OBJECTIVE
  The target lesion response (according to the Choi criteria), safety and survival following selective or superselective transarterial radioembolisation using yttrium-90-resin microspheres ((90)Y-RE) were evaluated in patients with unresectable, chemotherapy-refractory colorectal cancer liver metastases (mCRC).
  
  
  METHODS
  A prospective case series evaluated 52 consecutive patients with mCRC who were treated at a single centre following a median of 2 lines of chemotherapy.
  
  
  RESULTS
  Nearly half (46.2 %) of the 52 patients had a prior resection of the liver. At baseline, mCRC was limited to the liver (in 56.9 %), liver plus extra-hepatic metastases (23.5 %) or liver plus lung micro-nodules (19.6 %). Disease control rates of target lesions (partial response plus stable disease) at 3 and 6 months post-(90)Y-RE were 59 and 29 %, respectively. Target lesions were sufficiently downsized in two patients for hepatic resection and in one patient for radiofrequency ablation. Median Kaplan-Meier survival was 11.0 months (95 % confidence interval: 8.0-14.0 months) overall and 12.0 months in liver-only disease (±lung micro-nodules). Determinants of prolonged survival were response at 3 months (P = 0.046), ≤5 liver nodules (P = 0.004), single-liver-lobe involvement (P = 0.037), tumour-to-whole liver ratio <25 % (P = 0.021) and absence of extrahepatic metastases (P = 0.045). Adverse events possibly related to the nontarget distribution of (90)Y-RE were grade 1 (90)Y-RE-induced liver disease (n = 1), grade 2 and 3 gastric ulcers (n = 2).
  
  
  CONCLUSIONS
  These results confirm the effectiveness and safety of selective (90)Y-RE in patients with chemotherapy-refractory mCRC, showing (90)Y-RE's potential as a bridging therapy to subsequent resection even in this end-stage population.
authors: Radiology Unit, Department of Digestive Diseases and Internal Medicine, Azienda Ospedaliero Universitaria, Policlinico S. Orsola-Malpighi, Via Massarenti 9, Bologna, Italy, rita.golfieri@aosp.bo.it.
authors: Rita
authors: R
authors: Golfieri
authors: Cristina
authors: C
authors: Mosconi
authors: Emanuela
authors: E
authors: Giampalma
authors: Alberta
authors: A
authors: Cappelli
authors: Maria Cristina
authors: MC
authors: Galaverni
authors: Cinzia
authors: C
authors: Pettinato
authors: Matteo
authors: M
authors: Renzulli
authors: Fabio
authors: F
authors: Monari
authors: Renzo
authors: R
authors: Mazzarotto
authors: Carmine
authors: C
authors: Pinto
authors: Bruna
authors: B
authors: Angelelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000473:pathology*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000556:secondary*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D015021:Yttrium Radioisotopes