title: Yttrium-90 radioembolization for the treatment of chemorefractory colorectal liver metastases: Technical results, clinical outcome and factors potentially influencing survival.
abstract: BACKGROUND
  The purpose of this study was to retrospectively assess the technical and clinical outcomes, overall survival and prognostic factors for prolonged survival after yttrium-90 ((90)Y) radioembolization as a salvage therapy for patients with chemorefractory liver-only or liver-dominant colorectal metastases.
  
  
  METHODS
  From January 2005 to January 2014, all the patients selected for (90)Y radioembolization to treat chemorefractory colorectal liver metastases were identified. Demographic, laboratory, imaging and dosimetry data were collected. Post-treatment technical and clinical outcomes were analyzed as well as overall survival; finally several factors potentially influencing survival were analyzed.
  
  
  RESULTS
  In total 88 patients were selected for angiographic workup; 71 patients (81%) finally underwent catheter-directed (90)Y microsphere infusion into the hepatic artery 25 days (standard deviation 13 days) after angiographic workup. Median infused activity was 1809 MBq; 30-day toxicity included: fatigue (n = 39; 55%), abdominal discomfort (n = 33; 47%), nausea (n = 5; 7%), fever (n = 14; 20%), diarrhea (n = 6; 9%), liver function abnormalities and elevated bilirubin (transient) (n = 3; 4%). Gastric ulcer was found in five patients (7%). A late complication was radioembolization-induced portal hypertension (REIPH) in three patients (4%). Median time to progression in the liver was 4.4 months. Estimated survival at six and 12 months was 65% and 30%, respectively, with a 50% estimated survival after 8.0 months in this group of chemorefractory patients. Prognostic factors for worse survival were high preprocedural bilirubin, alkaline phosphatase and tumor volume levels.
  
  
  CONCLUSIONS
  (90)Y microsphere radioembolization for chemorefractory colorectal liver metastases has an acceptable safety profile with a 50% estimated survival after 8.0 months. Pretreatment high bilirubin, alkaline phosphatase and tumor volume levels were associated with early death.
authors.affiliation: a Department of Radiology, University Hospitals Leuven, Department of Imaging & Pathology , KU Leuven , Belgium.
authors.forename: Geert
authors.initials: G
authors.lastname: Maleux
authors.affiliation: b Department of Nuclear Medicine , University Hospitals Leuven , Belgium.
authors.forename: Christophe
authors.initials: C
authors.lastname: Deroose
authors.affiliation: c Interuniversity Centre for Biostatistics and Statistical Bioinformatics, Catholic University of Leuven and University Hasselt , Belgium.
authors.forename: Annouschka
authors.initials: A
authors.lastname: Laenen
authors.affiliation: d Department of Gastroenterology , University Hospitals Leuven , Belgium.
authors.forename: Chris
authors.initials: C
authors.lastname: Verslype
authors.affiliation: a Department of Radiology, University Hospitals Leuven, Department of Imaging & Pathology , KU Leuven , Belgium.
authors.forename: Sam
authors.initials: S
authors.lastname: Heye
authors.affiliation: e Department of Radiation Oncology , University Hospitals Leuven , Belgium.
authors.forename: Karin
authors.initials: K
authors.lastname: Haustermans
authors.affiliation: f Department of Pathology , University Hospitals Leuven , Belgium.
authors.forename: Gert
authors.initials: G
authors.lastname: De Hertogh
authors.affiliation: f Department of Pathology , University Hospitals Leuven , Belgium.
authors.forename: Xavier
authors.initials: X
authors.lastname: Sagaert
authors.affiliation: g Department of Abdominal Surgery , University Hospitals Leuven , Belgium.
authors.forename: Baki
authors.initials: B
authors.lastname: Topal
authors.affiliation: g Department of Abdominal Surgery , University Hospitals Leuven , Belgium.
authors.forename: Raymond
authors.initials: R
authors.lastname: Aerts
authors.affiliation: d Department of Gastroenterology , University Hospitals Leuven , Belgium.
authors.forename: Hans
authors.initials: H
authors.lastname: Prenen
authors.affiliation: a Department of Radiology, University Hospitals Leuven, Department of Imaging & Pathology , KU Leuven , Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Vanbeckevoort
authors.affiliation: a Department of Radiology, University Hospitals Leuven, Department of Imaging & Pathology , KU Leuven , Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: Vandecaveye
authors.affiliation: d Department of Gastroenterology , University Hospitals Leuven , Belgium.
authors.forename: Eric
authors.initials: E
authors.lastname: Van Cutsem
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology; D007261:Infusions, Intra-Arterial / Q000009:adverse effects / Q000379:methods; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D015021:Yttrium Radioisotopes