Yttrium-90 radioembolization for colorectal cancer liver metastases: a single institution experience

Abstract

Purpose. We sought to evaluate our experience using yttrium-90 ((90)Y) resin microsphere hepatic radioembolization as salvage therapy for liver-dominant metastatic colorectal cancer (mCRC). Methods. A retrospective review of consecutive patients with unresectable mCRC who were treated with (90)Y after failing first and second line systemic chemotherapy. Demographics, treatment dose, biochemical and radiographic response, toxicities, and survival were examined. Results. Fifty-one patients underwent (90)Y treatments of which 69% were male. All patients had previously undergone extensive chemotherapy, 31% had undergone previous liver-directed therapy and 24% had a prior liver resection. Using RECIST criteria, either stable disease or a partial response was seen in 77% of patients. Overall median survival from the time of first (90)Y treatment was 10.2 months (95% CI = 7.5-13.0). The absence of extrahepatic disease at the time of treatment with (90)Y was associated with an improved survival, median survival of 17.0 months (95% CI = 6.4-27.6), compared to those with extrahepatic disease at the time of treatment with (90)Y, 6.7 months (95% CI = 2.7-10.6 CONCLUSION: (90)Y therapy is a safe locoregional therapy that provides an important therapeutic option to patients who have failed first and second line chemotherapy and have adequate liver function and performance status.

Figure 2

Kaplan-Meier survival curve for all patients (n = 51) treated with ⁹⁰Y radioembolization. Survival was calculated from time of the first treatment with⁹⁰Y. Median survival was estimated to be 10.2 months. The 95% confidence-interval is 7.5–13.0 months.

Figure 1

Kaplan-Meier survival curve comparing those with extrahepatic disease at the time of treatment versus those with disease localized to liver. The estimated median survival was 17.0 months for those without extrahepatic disease compared to 6.7 months. This difference was found not to be significant when using log-rank analysis, P-value of  .07.

Figure 3

Kaplan-Meier survival curve comparing those with CEA response, as indicated by a decrease of ≥50% from baseline, to those who did not have a CEA response posttreatment. The estimated median survival was 19.1 months for those with a CEA response compared to 9.3 months. This difference was not found to be significant when using log-rank analysis P-value of  .36.