Radioembolization as a Salvage Therapy for Heavily Pretreated Patients With Colorectal Cancer Liver Metastases: Factors That Affect Outcomes.
BACKGROUND
In this study we assessed the efficacy and factors that affect outcomes of radioembolization (RE) using yttrium-90 resin microspheres in patients with unresectable and chemorefractory colorectal cancer liver metastases (CLM).


METHODS
After an institutional review board waiver of approval, a review of a Health Insurance Portability and Accountability Act-registered, prospectively created and maintained database was performed. Data on patient demographic and disease characteristics, RE treatment parameters, and additional treatments were evaluated for significance in predicting overall survival (OS) and liver progression-free survival (LPFS). Complications were evaluated according to the National Cancer Institute Common Terminology Criteria for adverse events.


RESULTS
From September 2009 to September 2013, 53 patients underwent RE at a median of 35 months after CLM diagnosis. Median OS was 12.7 months. Multivariate analysis showed that carcinoembryonic antigen levels at the time of RE ≥ 90 ng/mL (P = .004) and microscopic lymphovascular invasion of the primary (P = .002) were independent predictors of decreased OS. Median LPFS was 4.7 months. At 4 to 8 and 12 to 16 weeks after RE, most patients (80% and 61%, respectively) according to Response Evaluation Criteria in Solid Tumors (RECIST) had stable disease; additional evaluation using PET Response Criteria in Solid Tumors (PERCIST) led to reclassification in 77% of these cases (response or progression). No deaths were noted within the first 30 days. Within the first 90 days after RE, 4 patients (8%) developed liver failure and 5 patients (9%) died, all with evidence of disease progression.


CONCLUSIONS
RE in the salvage setting was well-tolerated, and permitted the administration of additional therapies and led to a median OS of 12.7 months. Evaluation using PERCIST was more likely than RECIST to document response or progression compared with the baseline assessment before RE.
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: sofoclec@mskcc.org.
Constantinos T
CT
Sofocleous
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
Elena G
EG
Violari
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
Vlasios S
VS
Sotirchos
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
Waleed
W
Shady
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
Mithat
M
Gonen
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
Neeta
N
Pandit-Taskar
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
Elena N
EN
Petre
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
Lynn A
LA
Brody
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
William
W
Alago
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
Richard K
RK
Do
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Michael I
MI
D'Angelica
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
Joseph R
JR
Osborne
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
Neil H
NH
Segal
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
Jorge A
JA
Carrasquillo
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
Nancy E
NE
Kemeny
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002272:Carcinoembryonic Antigen / Q000097:blood; D015179:Colorectal Neoplasms / Q000473:pathology / Q000628:therapy*; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult; D015021:Yttrium Radioisotopes / Q000008:administration & dosage
D002272:Carcinoembryonic Antigen; D015021:Yttrium Radioisotopes
Arterially directed therapies; Hepatic malignancy; SIRT; Selective internal radiation therapy; Yttrium-90