title: 90Y Radioembolization of Colorectal Hepatic Metastases Using Glass Microspheres: Safety and Survival Outcomes from a 531-Patient Multicenter Study.
abstract: Hepatic metastases of colorectal carcinoma are a leading cause of cancer-related mortality. Most colorectal liver metastases become refractory to chemotherapy and biologic agents, at which point the median overall survival declines to 4-5 mo. Radioembolization with (90)Y has been used in the salvage setting with favorable outcomes. This study reports the survival and safety outcomes of 531 patients treated with glass-based (90)Y microspheres at 8 institutions, making it the largest (90)Y study for patients with colorectal liver metastases.
  
  
  METHODS
  Data were retrospectively compiled from 8 institutions for all (90)Y glass microsphere treatments for colorectal liver metastases. Exposure to chemotherapeutic or biologic agents, prior liver therapies, biochemical parameters before and after treatment, radiation dosimetry, and complications were recorded. Uni- and multivariate analyses for predictors of survival were performed. Survival outcomes and clinical or biochemical adverse events were recorded.
  
  
  RESULTS
  In total, 531 patients received (90)Y radioembolization for colorectal liver metastases. The most common clinical adverse events were fatigue (55%), abdominal pain (34%), and nausea (19%). Grade 3 or 4 hyperbilirubinemia occurred in 13% of patients at any time. The median overall survival from the first (90)Y treatment was 10.6 mo (95% confidence interval, 8.8-12.4). Performance status, no more than 25% tumor burden, no extrahepatic metastases, albumin greater than 3 g/dL, and receipt of no more than 2 chemotherapeutic agents independently predicted better survival outcomes.
  
  
  CONCLUSIONS
  This multiinstitutional review of a large cohort of patients with colorectal liver metastases treated with (90)Y radioembolization using glass microspheres has demonstrated promising survival outcomes with low toxicity and low side effects. The outcomes were reproducible and consistent with prior reports of radioembolization.
authors.affiliation: Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Ryan
authors.initials: R
authors.lastname: Hickey
authors.affiliation: Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
authors.affiliation: Department of Interventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota.
authors.forename: Totianna
authors.initials: T
authors.lastname: Prudhomme
authors.affiliation: Department of Interventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Ehrenwald
authors.affiliation: Department of Radiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors.forename: Brian
authors.initials: B
authors.lastname: Baigorri
authors.affiliation: Department of Radiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Critchfield
authors.affiliation: Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kallini
authors.affiliation: Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Gabr
authors.affiliation: Interventional Radiology Center, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Boris
authors.initials: B
authors.lastname: Gorodetski
authors.affiliation: Interventional Radiology Center, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Geschwind
authors.affiliation: Department of Surgery, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Andrea
authors.initials: A
authors.lastname: Abbott
authors.affiliation: Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Ravi
authors.initials: R
authors.lastname: Shridhar
authors.affiliation: Division of Vascular/Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: White
authors.affiliation: Division of Vascular/Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: William S
authors.initials: WS
authors.lastname: Rilling
authors.affiliation: Department of Radiology, Miami Valley Hospital, Dayton, Ohio.
authors.forename: Brendan
authors.initials: B
authors.lastname: Boyer
authors.affiliation: Department of Radiology, Miami Valley Hospital, Dayton, Ohio.
authors.forename: Shannon
authors.initials: S
authors.lastname: Kauffman
authors.affiliation: Section of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington; and.
authors.forename: Sharon
authors.initials: S
authors.lastname: Kwan
authors.affiliation: Section of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington; and.
authors.forename: Siddarth A
authors.initials: SA
authors.lastname: Padia
authors.affiliation: Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Gates
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.
authors.forename: Mary
authors.initials: M
authors.lastname: Mulcahy
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.
authors.forename: Sheetal
authors.initials: S
authors.lastname: Kircher
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.
authors.forename: Halla
authors.initials: H
authors.lastname: Nimeiri
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.
authors.forename: Al B
authors.initials: AB
authors.lastname: Benson
authors.affiliation: Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois Division of Hematology and Oncology, Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois r-salem@northwestern.edu.
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D005898:Glass / Q000737:chemistry*; D006801:Humans; D008113:Liver Neoplasms / Q000378:metabolism / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D015999:Multivariate Analysis; D011874:Radiometry; D012189:Retrospective Studies; D012449:Safety; D016019:Survival Analysis; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*
chemical_list: D015021:Yttrium Radioisotopes
keywords: 90Y; colorectal metastases; radioembolization; survival