title: Pretreatment tumor volume as a prognostic factor in metastatic colorectal cancer treated with selective internal radiation to the liver using yttrium-90 resin microspheres.
abstract: BACKGROUND
  Yttrium-90 (90Y)-resin microspheres can prolong intrahepatic disease control and improve overall survival (OS) in patients with metastatic colorectal cancer (CRC). Prognostic factors for improved outcomes in patients undergoing selective internal radiation therapy (SIRT) have been studied, but the relationship between pre-SIRT liver tumor volume and outcomes has not well described.
  
  
  METHODS
  We retrospectively reviewed the records of patients with metastatic CRC who were treated at our institution with90Y-resin microspheres. Each patient underwent either MR or CT imaging of the liver with intravenous (IV) contrast before and within ~2-3 months after SIRT. Imaging data were transferred into our treatment planning system. Each metastatic liver lesion was contoured, and the volume of each lesion was summed to determine the total liver tumor volume at a given time point. We evaluated whether pretreatment liver tumor volume was related to OS. We also evaluated the relationship between pre-SIRT tumor volume and radiographic treatment response by either unidimensional Response Evaluation Criteria in Solid Tumors (RECIST) or three-dimensional volumetric criteria.
  
  
  RESULTS
  We included 60 patients with a median age of 59 years (range, 38-97 years); 60% of patients received sequential lobar treatment. The median number of chemotherapy cycles received prior to SIRT was 2. Median follow-up from first SIRT was 8.9 months. Pre- and post-SIRT tumor volumes were primarily calculated on CT (87%). The median pre-SIRT tumor volume was 77 cc (range, 4.5-2,170.4 cc). The median intervals between the first SIRT and the first, second, and third follow-up scans were 2.2, 4.4, and 7.7 months, respectively. No patient experienced a radiographic complete response. Pretreatment volume was a significant predictor for estimating the odds of a patient having stable disease or partial response using volumetric response criteria at first (P=0.016), second (P=0.023), and third (P=0.015) follow-ups. For each unit increase in log volume, a patient's odds of having a stable or partial response were 0.57, 0.63, and 0.61 times as likely at first, second, and third follow-up, respectively. OS was not significantly associated with pretreatment tumor volume.
  
  
  CONCLUSIONS
  Patients with metastatic CRC with larger overall pretreatment liver tumor volumes, regardless of number of individual liver lesions, are less likely to have radiographic evidence of stable disease or partial response following SIRT using volumetric response criteria. However, pretreatment volume was not significantly associated with OS, and thus SIRT should be considered for patients with larger pretreatment volumetric tumor burden.
authors.affiliation: Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland, USA.
authors.forename: Neha
authors.initials: N
authors.lastname: Bhooshan
authors.affiliation: Penn State Hershey Cancer Institute, Hershey, Pennsylvania, USA.
authors.forename: Navesh K
authors.initials: NK
authors.lastname: Sharma
authors.forename: Shahed
authors.initials: S
authors.lastname: Badiyan
authors.forename: Adeel
authors.initials: A
authors.lastname: Kaiser
authors.forename: Fred M
authors.initials: FM
authors.lastname: Moeslein
authors.forename: Young
authors.initials: Y
authors.lastname: Kwok
authors.forename: Pradip P
authors.initials: PP
authors.lastname: Amin
authors.affiliation: Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland, USA.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Kudryasheva
authors.forename: Michael D
authors.initials: MD
authors.lastname: Chuong
keywords: Selective internal radiation therapy (SIRT); colorectal cancer (CRC); liver metastases; prognosis