title: Y90 Radioembolization in chemo-refractory metastastic, liver dominant colorectal cancer patients: outcome assessment applying a predictive scoring system.
abstract: In treatment-refractory liver dominant metastatic colorectal cancer, the role of liver directed therapies still is unclear. We sought to determine a prognostic score for Y90 radioembolization in these patients.
  
  
  
  We analyzed 106 patients with refractory liver dominant mCRC who had undergone a total of 178 Y90 radioembolizations with resin microspheres was collected. Potential factors influencing survival were analyzed using a Cox regression. The Log rank test served to establish prognostic factors and to form a clinical score for outcome prediction after Y90 radioembolization.
  
  
  
  Median survival of all patients was 6.7 months. Neither age nor prior surgical or systemic therapy nor metastatic spread had an effect on survival. In contrast, hepatic tumor load, Karnofsky index as well as CEA and CA19-9 serums level had a significant influence (p < 0.001, p = 0.037, p = 0.023 and p < 0.001, respectively). These three factors formed a score with 1 point each for tumor load >20 %, CEA >130 ng/ml or CA19-9 > 200U/ml and Karnofsky index <80 %. Patients with a score of 0 and 1 displayed a median OS of 10.4 months. Patients with a score of 2 and 3 demonstrated a median OS of 5.1 months only (p < 0.001).
  
  
  
  Overaggressive patient selection for Y90 radioembolization of liver dominant chemorefractory mCRC is of questionable benefit. A scoring system comprising hepatic tumor load, CEA and CA19-9 serum levels and Karnofsky index (TuCK-score) may support an improved patient selection. In our cohort of liver only versus liver dominant disease, extrahepatic lung or lymphatic metastases did not significantly alter the prognosis.
authors.affiliation: Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Damm
authors.affiliation: Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.|Deutsche Akademie für Mikrotherapie e.V., Magdeburg, Germany.
authors.forename: Ricarda
authors.initials: R
authors.lastname: Seidensticker
authors.affiliation: Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Ulrich
authors.affiliation: Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
authors.forename: Leonie
authors.initials: L
authors.lastname: Breier
authors.affiliation: Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
authors.forename: Ingo G
authors.initials: IG
authors.lastname: Steffen
authors.affiliation: Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.|Deutsche Akademie für Mikrotherapie e.V., Magdeburg, Germany.
authors.forename: Max
authors.initials: M
authors.lastname: Seidensticker
authors.affiliation: Department of General and Visceral Surgery, University of Magdeburg, Magdeburg, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Garlipp
authors.affiliation: Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.|Deutsche Akademie für Mikrotherapie e.V., Magdeburg, Germany.
authors.forename: Konrad
authors.initials: K
authors.lastname: Mohnike
authors.affiliation: Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.|Deutsche Akademie für Mikrotherapie e.V., Magdeburg, Germany.
authors.forename: Maciej
authors.initials: M
authors.lastname: Pech
authors.affiliation: Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.|Deutsche Akademie für Mikrotherapie e.V., Magdeburg, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Amthauer
authors.affiliation: Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany. Jens.Ricke@med.ovgu.de.|Deutsche Akademie für Mikrotherapie e.V., Magdeburg, Germany. Jens.Ricke@med.ovgu.de.
authors.forename: Jens
authors.initials: J
authors.lastname: Ricke
mesh_terms: D000328:Adult; D000368:Aged; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D015179:Colorectal Neoplasms / Q000473:pathology / Q000628:therapy*; D019008:Drug Resistance, Neoplasm; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; D015021:Yttrium Radioisotopes
keywords: Colorectal cancer; Liver metastases; Prognostic score; Salvage patients; Y90 radioembolization