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Role of Transhepatic Arterial Radioembolization in Metastatic Colorectal Cancer. Cardiovasc Intervent Radiol 2022; 45:1579-1589. [DOI: 10.1007/s00270-022-03268-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 08/25/2022] [Indexed: 11/28/2022]
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Jin JJ, Zheng T, Xu XX, Zheng L, Li FY, Li XX, Zhou L. Comprehensive analysis of the differential expression and prognostic value of COL1A2 in colon adenocarcinoma. Aging (Albany NY) 2022; 14:7390-7407. [PMID: 36057263 PMCID: PMC9550260 DOI: 10.18632/aging.204261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022]
Abstract
Background: Colon adenocarcinoma (COAD) is a highly heterogeneous disease, which is the second most common cancer in females and third in males. Collagen type I alpha 2 (COL1A2) has been documented to be involved in the carcinogenesis of multiple tumors; however, the expression and prognostic significance of COL1A2 and its underlying mechanism in COAD remains unclarified. Materials and Methods: The general profile of COL1A2, its expression pattern, and prognostic value were systematically assessed through various bioinformatics tools. The protein level of COL1A2 was verified in COAD patients using immunohistochemistry analysis. In addition, enrichment analyses were performed to explore the possible regulatory pathways of COL1A2 in COAD. Results: The mRNA and protein levels of COL1A2 were significantly increased in COAD than that in normal tissues (P < 0.05). The COL1A2 expression tended to increase along with cancer stages and nodal metastasis status in COAD, while the promoter methylation levels of COL1A2 might negatively related to its mRNA expression. Survival analysis showed that COL1A2 was a reliable predictor for distinguishing the status of disease-specific survival (DSS), overall survival (OS), and progression-free survival (PFS), and might serve as a robust independent prognostic biomarker for DSS and OS in COAD patients (P < 0.05). The enrichment analysis showed focal adhesion as the most possible regulatory pathway by COL1A2. Conclusion: Collectively, COL1A2 functioned as an independent prognostic biomarker and might be a potential therapeutic target in COAD.
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Affiliation(s)
- Jian-Jiang Jin
- Department of Medical Oncology, The First People's Hospital of Linping, Hangzhou 311103, Zhejiang, China
| | - Ting Zheng
- Department of Medical Oncology, The First People's Hospital of Linping, Hangzhou 311103, Zhejiang, China
| | - Xiao-Xia Xu
- Department of Medical Oncology, The First People's Hospital of Linping, Hangzhou 311103, Zhejiang, China
| | - Lei Zheng
- Department of Medical Oncology, The First People's Hospital of Linping, Hangzhou 311103, Zhejiang, China
| | - Fang-Yuan Li
- Department of Medical Oncology, The First People's Hospital of Linping, Hangzhou 311103, Zhejiang, China
| | - Xing-Xing Li
- Department of Medical Oncology, The First People's Hospital of Linping, Hangzhou 311103, Zhejiang, China
| | - Li Zhou
- Department of Medical Oncology, The First People's Hospital of Linping, Hangzhou 311103, Zhejiang, China
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Adnan A, Sheth RA, Tam A. Oligometastatic Disease in the Liver: The Role of Interventional Oncology. Br J Radiol 2022; 95:20211350. [PMID: 35230141 PMCID: PMC9815735 DOI: 10.1259/bjr.20211350] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 01/13/2023] Open
Abstract
Oligometastatic disease represents a clinically discrete intermediate stage of cancer progression and is an expanding area of research. While surgical metastatectomy has been recognized for decades as an effective treatment option in select patients, options for metastasis-directed therapy have broadened in scope with advancements in the armamentarium of non- and minimally invasive modalities. Recent preclinical studies investigating the immunology surrounding liver metastases demonstrate treatment resistance to immunotherapy in affected patients and show how locoregional therapy has the ability to overcome this resistance. In this paper, we review advancements in our understanding of oligometastatic disease, metastasis-directed therapy, effect of liver metastasis on response to immunotherapy, and the burgeoning role of image-guided interventions in complementing cancer immunotherapy at the exciting crossroads of interventional oncology and immuno-oncology.
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Affiliation(s)
- Ather Adnan
- Texas A&M University Health Sciences Center, College of Medicine, Houston, TX, United States
| | - Rahul Anil Sheth
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Alda Tam
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Sharma NK, Kappadath SC, Chuong M, Folkert M, Gibbs P, Jabbour SK, Jeyarajah DR, Kennedy A, Liu D, Meyer JE, Mikell J, Patel RS, Yang G, Mourtada F. The American Brachytherapy Society consensus statement for permanent implant brachytherapy using Yttrium-90 microsphere radioembolization for liver tumors. Brachytherapy 2022; 21:569-591. [PMID: 35599080 PMCID: PMC10868645 DOI: 10.1016/j.brachy.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/25/2022] [Accepted: 04/14/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To develop a multidisciplinary consensus for high quality multidisciplinary implementation of brachytherapy using Yttrium-90 (90Y) microspheres transarterial radioembolization (90Y TARE) for primary and metastatic cancers in the liver. METHODS AND MATERIALS Members of the American Brachytherapy Society (ABS) and colleagues with multidisciplinary expertise in liver tumor therapy formulated guidelines for 90Y TARE for unresectable primary liver malignancies and unresectable metastatic cancer to the liver. The consensus is provided on the most recent literature and clinical experience. RESULTS The ABS strongly recommends the use of 90Y microsphere brachytherapy for the definitive/palliative treatment of unresectable liver cancer when recommended by the multidisciplinary team. A quality management program must be implemented at the start of 90Y TARE program development and follow-up data should be tracked for efficacy and toxicity. Patient-specific dosimetry optimized for treatment intent is recommended when conducting 90Y TARE. Implementation in patients on systemic therapy should account for factors that may enhance treatment related toxicity without delaying treatment inappropriately. Further management and salvage therapy options including retreatment with 90Y TARE should be carefully considered. CONCLUSIONS ABS consensus for implementing a safe 90Y TARE program for liver cancer in the multidisciplinary setting is presented. It builds on previous guidelines to include recommendations for appropriate implementation based on current literature and practices in experienced centers. Practitioners and cooperative groups are encouraged to use this document as a guide to formulate their clinical practices and to adopt the most recent dose reporting policies that are critical for a unified outcome analysis of future effectiveness studies.
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Affiliation(s)
- Navesh K Sharma
- Department of Radiation Oncology, Penn State Hershey School of Medicine, Hershey, PA
| | - S Cheenu Kappadath
- Department of Imaging Physics, UT MD Anderson Cancer Center, Houston, TX
| | - Michael Chuong
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL
| | - Michael Folkert
- Northwell Health Cancer Institute, Radiation Medicine at the Center for Advanced Medicine, New Hyde Park, NY
| | - Peter Gibbs
- Personalised Oncology Division, Walter and Eliza Hall Institute, Melbourne, Victoria, Australia
| | - Salma K Jabbour
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | | | | | - David Liu
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | | | - Rahul S Patel
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gary Yang
- Loma Linda University, Loma Linda, CA
| | - Firas Mourtada
- Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, DE; Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA.
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Stavrovski T, Pereira P. Role of interventional oncology for treatment of liver metastases: evidence based best practice. Br J Radiol 2022; 95:20211376. [PMID: 35976260 PMCID: PMC9815747 DOI: 10.1259/bjr.20211376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 07/17/2022] [Accepted: 07/28/2022] [Indexed: 01/13/2023] Open
Abstract
The presence of liver metastases is associated with a poor prognosis in many cancer diseases. Multiple studies during the last decades aimed to find out the best multimodal therapy to achieve an ideal, safe and highly effective treatment. In addition to established therapies such as systemic therapy, surgery and radiation therapy, interventional oncology with thermal ablation, transarterial chemoembolisation and radioembolisation, is becoming the fourth pillar of cancer therapies and is part of a personalised treatments' strategy. This review informs about the most popular currently performed interventional oncological treatments in patients with liver metastases.
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Affiliation(s)
- Tomislav Stavrovski
- Zentrum für Radiologie, Minimal-Invasive Therapien und Nuklearmedizin, SLK-Kliniken Heilbronn GmbH, Am Gesundbrunnen, Heilbronn, Germany
| | - Philippe Pereira
- Zentrum für Radiologie, Minimal-Invasive Therapien und Nuklearmedizin, SLK-Kliniken Heilbronn GmbH, Am Gesundbrunnen, Heilbronn, Germany
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Roosen J, Westlund Gotby LEL, Arntz MJ, Fütterer JJ, Janssen MJR, Konijnenberg MW, van Wijk MWM, Overduin CG, Nijsen JFW. Intraprocedural MRI-based dosimetry during transarterial radioembolization of liver tumours with holmium-166 microspheres (EMERITUS-1): a phase I trial towards adaptive, image-controlled treatment delivery. Eur J Nucl Med Mol Imaging 2022; 49:4705-4715. [PMID: 35829749 DOI: 10.1007/s00259-022-05902-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/30/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Transarterial radioembolization (TARE) is a treatment for liver tumours based on injection of radioactive microspheres in the hepatic arterial system. It is crucial to achieve a maximum tumour dose for an optimal treatment response, while minimizing healthy liver dose to prevent toxicity. There is, however, no intraprocedural feedback on the dose distribution, as nuclear imaging can only be performed after treatment. As holmium-166 (166Ho) microspheres can be quantified with MRI, we investigate the feasibility and safety of performing 166Ho TARE within an MRI scanner and explore the potential of intraprocedural MRI-based dosimetry. METHODS Six patients were treated with 166Ho TARE in a hybrid operating room. Per injection position, a microcatheter was placed under angiography guidance, after which patients were transported to an adjacent 3-T MRI system. After MRI confirmation of unchanged catheter location, 166Ho microspheres were injected in four fractions, consisting of 10%, 30%, 30% and 30% of the planned activity, alternated with holmium-sensitive MRI acquisition to assess the microsphere distribution. After the procedures, MRI-based dose maps were calculated from each intraprocedural image series using a dedicated dosimetry software package for 166Ho TARE. RESULTS Administration of 166Ho microspheres within the MRI scanner was feasible in 9/11 (82%) injection positions. Intraprocedural holmium-sensitive MRI allowed for tumour dosimetry in 18/19 (95%) of treated tumours. Two CTCAE grade 3-4 toxicities were observed, and no adverse events were attributed to treatment in the MRI. Towards the last fraction, 4/18 tumours exhibited signs of saturation, while in 14/18 tumours, the microsphere uptake patterns did not deviate from the linear trend. CONCLUSION This study demonstrated feasibility and preliminary safety of a first in-human application of TARE within a clinical MRI system. Intraprocedural MRI-based dosimetry enabled dynamic insight in the microsphere distribution during TARE. This proof of concept yields unique possibilities to better understand microsphere distribution in vivo and to potentially optimize treatment efficacy through treatment personalization. REGISTRATION Clinicaltrials.gov, identifier NCT04269499, registered on February 13, 2020 (retrospectively registered).
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Affiliation(s)
- Joey Roosen
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Lovisa E L Westlund Gotby
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark J Arntz
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jurgen J Fütterer
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel J R Janssen
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark W Konijnenberg
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Meike W M van Wijk
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christiaan G Overduin
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Frank W Nijsen
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Randrian V, Pernot S, Le Malicot K, Catena V, Baumgaertner I, Tacher V, Forestier J, Hautefeuille V, Tabouret-Viaud C, Gagnaire A, Mitry E, Guiu B, Aparicio T, Smith D, Dhomps A, Tasu JP, Perdrisot R, Edeline J, Capron C, Cheze-Le Rest C, Emile JF, Laurent-Puig P, Bejan-Angoulvant T, Sokol H, Lepage C, Taieb J, Tougeron D. FFCD 1709-SIRTCI phase II trial: Selective internal radiation therapy plus Xelox, Bevacizumab and Atezolizumab in liver-dominant metastatic colorectal cancer. Dig Liver Dis 2022; 54:857-863. [PMID: 35610167 DOI: 10.1016/j.dld.2022.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/09/2022] [Accepted: 04/22/2022] [Indexed: 12/24/2022]
Abstract
Immune checkpoint inhibitors (ICI) have high efficacy in metastatic colorectal cancer (mCRC) with microsatellite instability (MSI) but not in microsatellite stable (MSS) tumour due to the low tumour mutational burden. Selective internal radiation therapy (SIRT) could enhance neoantigen production thus triggering systemic anti-tumoral immune response (abscopal effect). In addition, Oxalipatin can induce immunogenic cell death and Bevacizumab can decrease the exhaustion of tumour infiltrating lymphocyte. In combination, these treatments could act synergistically to sensitize MSS mCRCs to ICI SIRTCI is a prospective, multicentre, open-label, phase II, non-comparative single-arm study evaluating the efficacy and safety of SIRT plus Xelox, Bevacizumab and Atezolizumab (anti-programmed death-ligand 1) in patients with liver-dominant MSS mCRC. The primary objective is progression-free survival at 9 months. The main inclusion criteria are patients with MSS mCRC with liver-dominant disease, initially unresectable disease and with no prior oncologic treatment for metastatic disease. The trial started in November 2020 and has included 10 out of the 52 planned patients.
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Affiliation(s)
- Violaine Randrian
- Service d'Hépato-gastroentérologie, CHU de Poitiers et Université de Poitiers, Poitiers 86021, France
| | - Simon Pernot
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - Vittorio Catena
- Department of Radiology, Institut Bergonié, Bordeaux, France
| | | | - Vania Tacher
- University of Paris Est Créteil, Unité INSERM 955, Equipe 18, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil F-94010, France
| | - Julien Forestier
- Department of Medical Oncology, Hôpital Edouard Herriot, Lyon Cedex 03 69437, France
| | - Vincent Hautefeuille
- Department of Hepato-Gastroenterology and Digestive Oncology, Amiens University Hospital, Amiens, France
| | - Claire Tabouret-Viaud
- Department of Nuclear Medicine, Unicancer-Georges François Leclerc Cancer Center, Dijon, France
| | - Alice Gagnaire
- Department of Hepato-Gastroenterology and Digestive Oncology, Dijon University Hospital, BP 87900 21079 Dijon, EPICAD LNC-UMR1231, Burgundy and Franche-Comte University, Dijon, France
| | - Emmanuel Mitry
- Medical Oncology Department, Paoli-Calmettes Institut, Marseille, France
| | - Boris Guiu
- Hôpital St-Eloi (CHU Montpellier), Université de Montpellier, Montpellier, France
| | - Thomas Aparicio
- AP-HP, Gastroenterology and Digestive Oncology Department, Saint Louis Hospital, 1 avenue Claude Vellefaux, Université de Paris, Paris F-75010, France
| | - Denis Smith
- Service d'Oncologie médicale, Haut-Lévèque Hospital, CHU Bordeaux, Bordeaux, France
| | - Anthony Dhomps
- Nuclear Medicine, University Hospital of Lyon, Pierre Bénite, France
| | - Jean-Pierre Tasu
- Radiology Department, University Hospital Centre Poitiers, Poitiers, France; LATIM, INSERM UMR 1101, Université de Brest, CHU Morvan, 2 avenue FOCH, 29 609 Brest cedex, France
| | - Rémy Perdrisot
- Nuclear Medicine, Poitiers University Hospital, Poitiers France
| | - Julien Edeline
- Medical Oncology, Centre Eugène Marquis, Rennes 35000, France
| | - Claude Capron
- Service d'immunologie, AP-HP, Hôpital Ambroise Paré, Paris, France
| | - Catherine Cheze-Le Rest
- LATIM, INSERM UMR 1101, Université de Brest, CHU Morvan, 2 avenue FOCH, 29 609 Brest cedex, France; Nuclear Medicine, Poitiers University Hospital, Poitiers France
| | - Jean-François Emile
- Department of Pathology, APHP-Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Pierre Laurent-Puig
- Department of Biology, Georges Pompidou Hospital, APHP, Université de Paris, Paris, France
| | | | - Harry Sokol
- Sorbonne Université, INSERM UMRS-938, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Hôpital Saint-Antoine, Service de Gastroentérologie, Paris, Université Paris-Saclay, INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas and Center for Microbiome Medicine (PaCeMM) FHU, Paris, France
| | - Come Lepage
- Department of Hepato-Gastroenterology and Digestive Oncology, Dijon University Hospital, BP 87900 21079 Dijon, EPICAD LNC-UMR1231, Burgundy and Franche-Comte University, Dijon, France
| | - Julien Taieb
- Service de Gastroentérologie et d'Oncologie Digestive, Hôpital Européen George Pompidou, Université de Paris, AP-HP, Paris, France
| | - David Tougeron
- Service d'Hépato-gastroentérologie, CHU de Poitiers et Université de Poitiers, Poitiers 86021, France.
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Jethwa KR, Jin Z, Hallemeier CL. A Critical Review of the Role of Local Therapy for Oligometastatic Gastrointestinal Cancer. Int J Radiat Oncol Biol Phys 2022; 114:780-791. [DOI: 10.1016/j.ijrobp.2022.06.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/20/2022] [Accepted: 06/22/2022] [Indexed: 10/31/2022]
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Emmons EC, Bishay S, Du L, Krebs H, Gandhi RT, Collins ZS, O'Hara R, Akhter NM, Wang EA, Grilli C, Brower JS, Peck SR, Petroziello M, Abdel Aal AK, Golzarian J, Kennedy AS, Matsuoka L, Sze DY, Brown DB. Survival and Toxicities after 90Y Transarterial Radioembolization of Metastatic Colorectal Cancer in the RESIN Registry. Radiology 2022; 305:228-236. [PMID: 35762890 DOI: 10.1148/radiol.220387] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Patients with unresectable, chemorefractory hepatic metastases from colorectal cancer have considerable mortality. The role of transarterial radioembolization (TARE) with yttrium 90 (90Y) microspheres is not defined because most reports are from a single center with limited patient numbers. Purpose To report outcomes in participants with colorectal cancer metastases treated with resin 90Y microspheres from a prospective multicenter observational registry. Materials and Methods This study treated enrolled adult participants with TARE using resin microspheres for liver-dominant metastatic colorectal cancer at 42 centers, with enrollment from July 2015 through August 2020. TARE was used as the first-, second-, or third-line therapy or beyond. Overall survival (OS), progression-free survival (PFS), and toxicity outcomes were assessed by line of therapy by using Kaplan-Meier analysis for OS and PFS and Common Terminology Criteria for Adverse Events, version 5, for toxicities. Results A total of 498 participants (median age, 60 years [IQR, 52-69 years]; 298 men [60%]) were treated. TARE was used in first-line therapy in 74 of 442 participants (17%), second-line therapy in 180 participants (41%), and third-line therapy or beyond in 188 participants (43%). The median OS of the entire cohort was 15.0 months (95% CI: 13.3, 16.9). The median OS by line of therapy was 13.9 months for first-line therapy, 17.4 months for second-line therapy, and 12.5 months for third-line therapy (χ2 = 9.7; P = .002). Whole-group PFS was 7.4 months (95% CI: 6.4, 9.5). The median PFS by line of therapy was 7.9 months for first-line therapy, 10.0 months for second-line therapy, and 5.9 months for third-line therapy (χ2 = 8.3; P = .004). TARE-attributable grade 3 or 4 hepatic toxicities were 8.4% for bilirubin (29 of 347 participants) and 3.7% for albumin (13 of 347). Grade 3 and higher toxicities were greater with third-line therapy for bilirubin (P = .01) and albumin (P = .008). Conclusion Median overall survival (OS) after transarterial radioembolization (TARE) with yttrium 90 microspheres for liver-dominant metastatic colorectal cancer was 15.0 months. The longest OS was achieved when TARE was part of second-line therapy. Grade 3 or greater hepatic function toxicity rates were less than 10%. Clinical trial registration no. NCT02685631 Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Liddell in this issue.
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Affiliation(s)
- Erica C Emmons
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Steven Bishay
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Liping Du
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Henry Krebs
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Ripal T Gandhi
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Zachary S Collins
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Ryan O'Hara
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Nabeel M Akhter
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Eric A Wang
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Christopher Grilli
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Jayson S Brower
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Shannon R Peck
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Michael Petroziello
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Ahmed K Abdel Aal
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Jafar Golzarian
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Andrew S Kennedy
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Lea Matsuoka
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Daniel Y Sze
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
| | - Daniel B Brown
- From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.)
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Liddell RP. 90Y Transarterial Radioembolization for Metastatic Colorectal Cancer. Radiology 2022; 305:237-238. [PMID: 35762893 DOI: 10.1148/radiol.221345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Robert P Liddell
- From the Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Sheik Zayed Tower, Ste 7203, 1800 Orleans St, Baltimore, MD 21287
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Lebeck Lee CM, Ziogas IA, Agarwal R, Alexopoulos SP, Ciombor KK, Matsuoka LK, Brown DB, Eng C. A contemporary systematic review on liver transplantation for unresectable liver metastases of colorectal cancer. Cancer 2022; 128:2243-2257. [PMID: 35285949 PMCID: PMC9311758 DOI: 10.1002/cncr.34170] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/20/2022] [Accepted: 02/14/2022] [Indexed: 12/13/2022]
Abstract
The 5-year overall survival rate of a patient with unresectable metastatic colorectal cancer is poor at approximately 14%. Similarly, historical data on liver transplantation (LT) in those with colorectal liver metastases (CRLM) showed poor outcomes, with 5-year survival rates between 12% and 21%. More recently, limited data have shown improved outcomes in select patients with 5-year overall survival rates of approximately 60%. Despite these reported survival improvements, there is no significant improvement in disease-free survival. Given the uncertain benefit with this therapeutic approach and a renewed investigational interest, we aimed to conduct a contemporary systematic review on LT for CRLM. A systematic review of the literature was performed according to the preferred reporting items for systematic reviews and meta-analysis statement. English articles reporting on data regarding LT for CRLM were identified through the MEDLINE (via PubMed), Cochrane Library, and ClinicalTrials.gov databases (last search date: December 16th, 2021) by 2 researchers independently. A total of 58 studies (45 published and 13 ongoing) were included. Although early retrospective studies suggest the possibility that some carefully selected patients may benefit from LT, there is minimal prospective data on the topic and LT remains exploratory in the setting of CRLM. Additionally, several other challenges, such as the limited availability of deceased donor organs and defining appropriate selection criteria, remain when considering the implementation of LT for these patients. Further evidence from ongoing prospective trials is needed to determine if and to what extent there is a role for LT in patients with surgically unresectable CRLM.
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Affiliation(s)
- Cody M. Lebeck Lee
- Department of Internal MedicineVanderbilt University Medical CenterNashvilleTennessee
| | - Ioannis A. Ziogas
- Department of SurgeryDivision of Hepatobiliary Surgery and Liver TransplantationVanderbilt University Medical CenterNashvilleTennessee
| | - Rajiv Agarwal
- Department of MedicineDivision of Hematology and OncologyVanderbilt University Medical Center/Vanderbilt‐Ingram Cancer CenterNashvilleTennessee
| | - Sophoclis P. Alexopoulos
- Department of SurgeryDivision of Hepatobiliary Surgery and Liver TransplantationVanderbilt University Medical CenterNashvilleTennessee
| | - Kristen K. Ciombor
- Department of MedicineDivision of Hematology and OncologyVanderbilt University Medical Center/Vanderbilt‐Ingram Cancer CenterNashvilleTennessee
| | - Lea K. Matsuoka
- Department of SurgeryDivision of Hepatobiliary Surgery and Liver TransplantationVanderbilt University Medical CenterNashvilleTennessee
| | - Daniel B. Brown
- Department of Radiology and Radiologic SciencesDivision of Interventional RadiologyVanderbilt University Medical CenterNashvilleTennessee
| | - Cathy Eng
- Department of MedicineDivision of Hematology and OncologyVanderbilt University Medical Center/Vanderbilt‐Ingram Cancer CenterNashvilleTennessee
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Raphael MJ, Karanicolas PJ. Regional Therapy for Colorectal Cancer Liver Metastases: Which Modality and When? J Clin Oncol 2022; 40:2806-2817. [PMID: 35649228 DOI: 10.1200/jco.21.02505] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
For patients with unresectable colorectal liver metastases (uCRLM), regional therapies leverage the unique, dual blood supply to the liver; the hepatic artery is the main blood supply for liver tumors, whereas the portal vein supplies most normal hepatic parenchyma. Infusion of cancer therapies via the hepatic artery allows selective delivery to the tumors with relative sparing of normal liver tissue and little extrahepatic exposure, thus limiting systemic side effects. There is a paucity of randomized controlled trial evidence to inform the optimal integration of regional therapies into the management of CRLM. Hepatic arterial infusion pump (HAIP) chemotherapy has a potential survival benefit when used in the adjuvant setting after resection of CRLM. HAIP chemotherapy can be safely given with contemporary systemic therapies and is associated with a high objective response and rate of conversion to resectability in patients with uCRLM. Drug-eluting beads coated with irinotecan transarterial chemoembolization is associated with high objective response rates within the liver and has a well-established safety profile in patients with uCRLM. Transarterial radioembolization achieves high rates of response within the liver but is not associated with improvements in overall survival or quality of life in the first- or second-line setting for uCRLM. The best treatment approach is the one that most aligns with a given patients' values, preferences, and philosophy of care. In the first-line setting, HAIP could be offered to motivated patients who hope to achieve conversion to resectability. After progression on chemotherapy, HAIP, transarterial chemoembolization, and transarterial radioembolization are valuable treatment options to consider for patients with liver-limited or liver-predominant CRLM who seek to optimize response rates and regional control.
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Affiliation(s)
- Michael J Raphael
- Division of Medical Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul J Karanicolas
- Division of Surgical Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
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Hitchcock KE, Romesser PB, Miller ED. Local Therapies in Advanced Colorectal Cancer. Hematol Oncol Clin North Am 2022; 36:553-567. [PMID: 35562258 DOI: 10.1016/j.hoc.2022.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Curative intent surgical resection of colorectal metastases to the liver and lungs in eligible patients results in improved disease control and prolonged overall survival with the potential for cure in a subset of patients. Additional ablative and local therapies for use in the liver, lungs, and other body sites have been developed with emerging data on the utility and toxicity of these treatments. Future studies should focus on identification of appropriate candidates for treatment and determining the optimal modality and timing of treatment accounting for both patient and disease factors.
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Affiliation(s)
- Kathryn E Hitchcock
- Department of Radiation Oncology, University of Florida Health, Davis Cancer Pavilion, 1535 Gale Lemerand Drive, Gainesville, FL, USA
| | - Paul B Romesser
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box #22, New York, NY 10065, USA; Early Drug Development Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric D Miller
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA; Department of Radiation Oncology, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, 460 West 10th Avenue, Room A209, Columbus, OH 43210, USA.
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64
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Liu H, Xu C, Meng M, Li S, Sheng S, Zhang S, Ni W, Tian H, Wang Q. Metal-organic framework-mediated multifunctional nanoparticles for combined chemo-photothermal therapy and enhanced immunotherapy against colorectal cancer. Acta Biomater 2022; 144:132-141. [PMID: 35307591 DOI: 10.1016/j.actbio.2022.03.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 12/11/2022]
Abstract
Because of molecular heterogeneity in tumors, clinical outcomes of tumor treatment are not very satisfactory, and novel strategies are therefore needed to address this challenge. Combination therapy could efficiently enhance tumor treatment by stimulating multiple pathways, reducing the systemic toxicity of monotherapy, and regulating the tumor immune microenvironments. Herein, metal-organic framework MIL-100 (Fe) nanoparticles (NPs) were synthesized by a microwave-assisted method, and oxaliplatin (OXA) and indocyanine green (ICG) were then loaded into hyaluronic acid (HA)-modified MIL-100 NPs to obtain multifunctional nanoparticles (OIMH NPs). The OIMH NPs exhibited sensitive photoacoustic imaging (PAI) for imaging-guided therapy and showed a good synergistic effect by combining chemotherapy with photothermal therapy (PTT) to kill tumor cells. Immunogenic cell death (ICD) and activation of T cells induced by the chemo-photothermal therapy could sensitize for immune checkpoint blockade (aPD-L1) response, thus eliciting systemic antitumor immunity. Finally, tumor inhibition was observed, which could be attributed to the combination of chemotherapy, PTT, and aPD-L1. On the basis of the study findings, an innovative imaging-mediated combined therapeutic strategy involving multifunctional NPs was proposed, which might potentially offer a new clinical treatment for colorectal cancer. STATEMENT OF SIGNIFICANCE: The metal-organic framework-mediated chemo-photothermal therapy guided by photoacoustic imaging (PAI) is an accurate and effective approach for tumor inhibition, which can synergistically achieve immunogenic cell death and lead to an increasing infiltration of immune cells in the tumor microenvironment, thereby enhancing the sensitivity for immune checkpoint blockade (aPD-L1) therapy. This type of therapy can not only reduce the systemic toxicity caused by traditional treatment methods, but it can also solve the issue of low response of immune checkpoint blockade in colorectal cancer (CRC). Our study provides experimental evidence for using the combination of immunotherapy and chemo-photothermal therapy against CRC.
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65
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Ytrrium-90 transarterial radioembolization in patients with gastrointestinal malignancies. Clin Transl Oncol 2022; 24:796-808. [PMID: 35013882 DOI: 10.1007/s12094-021-02745-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
Transarterial radioembolization (TARE) with yttrium-90 (Y90) is a promising alternative strategy to treat liver tumors and liver metastasis from colorectal cancer (CRC), as it selectively delivers radioactive isotopes to the tumor via the hepatic artery, sparring surrounding liver tissue. The landscape of TARE indications is constantly evolving. This strategy is considered for patients with hepatocellular carcinoma (HCC) with liver-confined disease and preserved liver function in whom neither TACE nor systemic therapy is possible. In patients with liver metastases from CRC, TARE is advised when other chemotherapeutic options have failed. Recent phase III trials have not succeeded to prove benefit in overall survival; however, it has helped to better understand the patients that may benefit from TARE based on subgroup analysis. New strategies and treatment combinations are being investigated in ongoing clinical trials. The aim of this review is to summarize the clinical applications of TARE in patients with gastrointestinal malignancies.
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Weiss L. ESMO 2021-highlights in colorectal cancer. MEMO 2022; 15:114-116. [PMID: 35505999 PMCID: PMC9047589 DOI: 10.1007/s12254-022-00808-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
This short review reflects on a personal selection of three abstracts on colorectal cancer (CRC) presented at the 2021 ESMO Congress: (1) KRASG12C as a new therapeutic target in metastatic CRC, supported by data from the KRYSTAL‑1 and CodeBreaK101 trials, (2) positive phase 3 data on the possible role of selective internal radiotherapy (SIRT) in the second-line treatment of liver-limited metastatic CRC, and (3) the impact of the coronavirus disease 2019 (COVID-19) pandemic on CRC screening, management and mortality, now and in the upcoming years.
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Affiliation(s)
- Lukas Weiss
- IIIrd Medical Department, Paracelsus Medical University, Muellner Hauptstr. 48, 5020 Salzburg, Austria
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Entezari P, Gabr A, Salem R, Lewandowski RJ. Yttrium-90 for colorectal liver metastasis - the promising role of radiation segmentectomy as an alternative local cure. Int J Hyperthermia 2022; 39:620-626. [DOI: 10.1080/02656736.2021.1933215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Pouya Entezari
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Ahmed Gabr
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, IL, USA
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
| | - Robert J. Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, IL, USA
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
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68
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THINKING TOO FAST ABOUT CHEMOTHERAPY FOR RESECTABLE COLORECTAL CANCER LIVER METASTASES? Clin Colorectal Cancer 2022; 21:e187-e188. [DOI: 10.1016/j.clcc.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 11/22/2022]
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69
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Weber M, Lam M, Chiesa C, Konijnenberg M, Cremonesi M, Flamen P, Gnesin S, Bodei L, Kracmerova T, Luster M, Garin E, Herrmann K. EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds. Eur J Nucl Med Mol Imaging 2022; 49:1682-1699. [PMID: 35146577 PMCID: PMC8940802 DOI: 10.1007/s00259-021-05600-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/19/2021] [Indexed: 12/15/2022]
Abstract
Primary liver tumours (i.e. hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC)) are among the most frequent cancers worldwide. However, only 10-20% of patients are amenable to curative treatment, such as resection or transplant. Liver metastases are most frequently caused by colorectal cancer, which accounts for the second most cancer-related deaths in Europe. In both primary and secondary tumours, radioembolization has been shown to be a safe and effective treatment option. The vast potential of personalized dosimetry has also been shown, resulting in markedly increased response rates and overall survival. In a rapidly evolving therapeutic landscape, the role of radioembolization will be subject to changes. Therefore, the decision for radioembolization should be taken by a multidisciplinary tumour board in accordance with the current clinical guidelines. The purpose of this procedure guideline is to assist the nuclear medicine physician in treating and managing patients undergoing radioembolization treatment. PREAMBLE: The European Association of Nuclear Medicine (EANM) is a professional non-profit medical association that facilitates communication worldwide among individuals pursuing clinical and research excellence in nuclear medicine. The EANM was founded in 1985. These guidelines are intended to assist practitioners in providing appropriate nuclear medicine care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by medical professionals taking into account the unique circumstances of each case. Thus, there is no implication that an approach differing from the guidelines, standing alone, is below the standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set out in the guidelines when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources or advances in knowledge or technology subsequent to publication of the guidelines. The practice of medicine involves not only the science but also the art of dealing with the prevention, diagnosis, alleviation and treatment of disease. The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment. Therefore, it should be recognised that adherence to these guidelines will not ensure an accurate diagnosis or a successful outcome. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources and the needs of the patient to deliver effective and safe medical care. The sole purpose of these guidelines is to assist practitioners in achieving this objective.
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Affiliation(s)
- M Weber
- Department of Nuclear medicine, University clinic Essen, Essen, Germany.
| | - M Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - C Chiesa
- Nuclear Medicine, Foundation IRCCS National Tumour Institute, Milan, Italy
| | - M Konijnenberg
- Nuclear Medicine Department, Erasmus MC, Rotterdam, The Netherlands
| | - M Cremonesi
- Radiation Research Unit, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141, Milan, MI, Italy
| | - P Flamen
- Department of Nuclear Medicine, Institut Jules Bordet-Université Libre de Bruxelles (ULB), 1000, Brussels, Belgium
| | - S Gnesin
- Institute of Radiation physics, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - L Bodei
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - T Kracmerova
- Department of Medical Physics, Motol University Hospital, Prague, Czech Republic
| | - M Luster
- Department of Nuclear medicine, University hospital Marburg, Marburg, Germany
| | - E Garin
- Department of Nuclear Medicine, Cancer, Institute Eugène Marquis, Rennes, France
| | - K Herrmann
- Department of Nuclear medicine, University clinic Essen, Essen, Germany
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Jugovec V, Benedik J, Jeruc J, Popovic P. Long-term survival of a patient with liver metastases from clear cell gastric adenocarcinoma after multimodality treatment including interventional oncology techniques: case report. BMC Gastroenterol 2022; 22:103. [PMID: 35255812 PMCID: PMC8900438 DOI: 10.1186/s12876-022-02150-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 02/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background Gastric cancer (GC) is the fourth most common cancer and the third leading cancer-related cause of death worldwide since most patients are diagnosed at an advanced stage. The majority of GCs are adenocarcinomas (ACs), and the poorly characterized clear cell AC represents a unique subgroup of GCs and is an independent marker of poor prognosis. Even though the prognosis for patients with advanced GC is poor we present a report of a patient with long-term survival despite having liver metastases from clear cell gastric AC. Case presentation A 45-year-old male with clear cell gastric AC underwent subtotal gastrectomy and postoperative chemoradiation. Only a year and a half after his initial treatment the disease spread to his liver. He received two lines of chemotherapy treatment within the next two years before a right hepatectomy was suggested. Due to an initially insufficient future liver remnant (FLR), transarterial chemoembolization (TACE) and portal vein embolization (PVE) were performed, which made the surgical procedure possible. Shortly after a disease progression in the remaining liver was detected. In the following three years the patient was treated with a carefully planned combination of systemic therapy and different interventional oncology techniques including selective internal radiation therapy (SIRT) and TACE. And as illustrated, an attentive, patient-tailored, multimodality treatment approach can sometimes greatly benefit our patients as he had an overall survival of 88 months despite the poor prognosis of his disease.
Conclusion To the best of our knowledge, this report is the first to describe a patient with liver metastases from clear cell gastric AC treated with interventional oncology techniques (PVE, TACE, and SIRT) in combination with other locoregional and systemic therapies thereby presenting that these interventional oncology techniques can be successfully integrated into long-term management of non-conventional liver tumors.
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Affiliation(s)
- Vesna Jugovec
- Department of Radiology, Institute of Oncology Ljubljana, Zaloška Cesta 2, 1000, Ljubljana, Slovenia.
| | - Jernej Benedik
- Division of Medical Oncology, Institute of Oncology Ljubljana, Zaloška Cesta 2, 1000, Ljubljana, Slovenia
| | - Jera Jeruc
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia
| | - Peter Popovic
- Institute of Radiology, University Medical Centre Ljubljana, Zaloška Cesta 7, 1000, Ljubljana, Slovenia.,Department of Radiology, Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1000, Ljubljana, Slovenia
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71
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Radioembolization of Hepatocellular Carcinoma with 90Y Glass Microspheres: No Advantage of Voxel Dosimetry with Respect to Mean Dose in Dose-Response Analysis with Two Radiological Methods. Cancers (Basel) 2022; 14:cancers14040959. [PMID: 35205712 PMCID: PMC8869948 DOI: 10.3390/cancers14040959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary We confirmed that the non-uniformity of an intra-lesion dose distribution, which was introduced in calculations as voxel dosimetry, did not significantly improve the AUC values of the dose–response relationship with respect to the mean dose. This was probably derived from the strong correlations (all p < 0.0001) among all voxel-based dosimetric variables (minimum Spearman correlation coefficient: 0.67) caused by the limited spatial resolution of nuclear medicine images. Responses were assessed with mRECIST and with an experimental densitometric method with a response threshold optimized at 20% HU variation. Significant dose–response agreement was obtained only with the densitometric method and only with post-therapy 90Y-PET data. More unexpectedly, the injection of Theraspheres™ on day 8 from the reference date rather than on day 4 worsened the dose–response correlation and reduced the efficacy at high doses. This may be explained by the increased non-uniformity following the non-linear mega-clustering effect triggered by the higher number of microspheres/GBq injected on day 8. Abstract In this confirmatory study, we tested if a calculation that included the non-uniformity of dose deposition through a voxel-based dosimetric variable Ψ was able to improve the dose–response agreement with respect to the mean absorbed dose D. We performed dosimetry with 99mTc-MAA SPECT/CT and 90Y-PET/CT in 86 patients treated 8 instead of 4 days after the reference date with 2.8 times more 90Y glass microspheres/GBq than in our previous study. The lesion-by-lesion response was assessed with the mRECIST method and with an experimental densitometric criterion. A total of 106 lesions were studied. Considering Ψ as a prognostic response marker, having no Ψ provided a significantly higher AUC than D. The correlation, t-test, and AUC values were statistically significant only with the densitometric method and only with post-therapy dosimetry. In comparison with our previous study, the dose–response correlation and AUC values were poorer (maximum r = 0.43, R2 = 0.14, maximal AUC = 0.71), and the efficacy at a high dose did not reach 100%. The expected advantages of voxel dosimetry were nullified by the correlation between any Ψ and D due to the limited image spatial resolution. The lower AUC and efficacy may be explained by the mega-clustering effect triggered by the higher number of microspheres/GBq injected on day 8.
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Chen J, Wang H, Peng F, Qiao H, Liu L, Wang L, Shang B. Ano1 is a Prognostic Biomarker That is Correlated with Immune Infiltration in Colorectal Cancer. Int J Gen Med 2022; 15:1547-1564. [PMID: 35210827 PMCID: PMC8858027 DOI: 10.2147/ijgm.s348296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/21/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Jun Chen
- Laboratory Animal Center, Dalian Medical University, Dalian, 116044, Liaoning Province, People’s Republic of China
| | - Hongli Wang
- Cardiology Department, The Second Hospital of Dalian Medical University, Dalian, 116023, Liaoning Province, People’s Republic of China
| | - Fang Peng
- Pathology Department, The Second Hospital of Dalian Medical University, Dalian, 116023, Liaoning Province, People’s Republic of China
| | - Haiyan Qiao
- Laboratory Animal Center, Dalian Medical University, Dalian, 116044, Liaoning Province, People’s Republic of China
| | - Linfeng Liu
- Laboratory Animal Center, Dalian Medical University, Dalian, 116044, Liaoning Province, People’s Republic of China
| | - Liang Wang
- Laboratory Animal Center, Dalian Medical University, Dalian, 116044, Liaoning Province, People’s Republic of China
| | - Bingbing Shang
- Emergency Department, The Second Hospital of Dalian Medical University, Dalian, 116023, Liaoning Province, People’s Republic of China
- Correspondence: Bingbing Shang; Liang Wang, Tel +86-17709875175; +86-13332225676, Email ;
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Small-size (40 µm) Beads Loaded with Irinotecan in the Treatment of Patients with Colorectal Liver Metastases. Cardiovasc Intervent Radiol 2022; 45:770-779. [DOI: 10.1007/s00270-021-03039-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/29/2021] [Indexed: 12/14/2022]
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Efficacy and Safety of Trans-Arterial Yttrium-90 Radioembolization in Patients with Unresectable Liver-Dominant Metastatic or Primary Hepatic Soft Tissue Sarcomas. Cancers (Basel) 2022; 14:cancers14020324. [PMID: 35053486 PMCID: PMC8774147 DOI: 10.3390/cancers14020324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 12/31/2021] [Accepted: 01/07/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Sarcomas of the liver are a rare and aggressive group of malignancies for which surgery is the preferred treatment modality even though most patients are not surgical candidates and receive chemotherapy with poor outcomes. In these cases, trans-arterial liver-directed therapies are emerging as a new treatment option. Among these, radioembolization is a promising but understudied treatment option. In radioembolization, microbeads conjugated to a radioactive drug are injected into the blood vessels, nourishing the cancers and leading to cell death and tumor shrinkage. In this study, we retrospectively analyzed 35 patients with liver sarcomas receiving radioembolization at our institution. We found that those with disease control in the liver 6 months after the procedure had longer overall survival as well as patients with a liver progression-free interval post-procedure equal to or greater than 9 months. Patients with good performance status and normal liver function at baseline also had longer survival. The most common adverse reactions were nausea, fatigue, abdominal pain, and mild reversible abnormalities in liver function tests. Overall, our results suggest that radioembolization might be a safe and effective treatment option for patients with unresectable liver sarcomas. Abstract Patients with liver-dominant metastatic or primary hepatic soft tissue sarcomas (STS) have poor prognosis. Surgery can prolong survival, but most patients are not surgical candidates, and treatment response is limited with systemic chemotherapy. Liver-directed therapies have been increasingly employed in this setting, and Yttrium-90 trans-arterial radioembolization (TARE) is an understudied yet promising treatment option. This is a retrospective analysis of 35 patients with metastatic or primary hepatic STS who underwent TARE at a single institution between 2006 and 2020. The primary outcomes that were measured were overall survival (OS), liver progression-free survival (LPFS), and radiologic tumor response. Clinical and biochemical toxicities were assessed 3 months after the procedure. Median OS was 20 months (95% CI: 13.9–26.1 months), while median LPFS was 9 months (95% CI: 6.2–11.8 months). The objective response rate was 56.7%, and the disease control rate was 80.0% by mRECIST at 3 months. The following correlated with better OS post-TARE: liver disease control (DC) at 6 months (median OS: 40 vs. 17 months, p = 0.007); LPFS ≥ 9 months (median OS: 50 vs. 8 months, p < 0.0001); ECOG status 0–1 vs. 2 (median OS: 22 vs. 6 months, p = 0.042); CTP class A vs. B (median OS: 22 vs. 6 months, p = 0.018); and TACE post-progression (median OS: 99 vs. 16 months, p = 0.003). The absence of metastases at diagnosis was correlated with higher median LPFS (7 vs. 1 months, p = 0.036). Two grade 4 (5.7%) and ten grade 3 (28.6%) laboratory toxicities were identified at 3 months. There was one case of radioembolization-induced liver disease and two cases of radiation-induced peptic ulcer disease. We concluded that TARE could be an effective and safe treatment option for patients with metastatic or primary hepatic STS with good tumor response rates, low incidence of severe toxicity, and longer survival in patients with liver disease control post-TARE.
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Ruiz-Casado A, Gutiérrez Sanz L, Franco Pérez F, Sánchez Ruiz AC. Treatment of colorectal liver metastases with y-90: the problem is the toxicity. Rev Esp Med Nucl Imagen Mol 2022; 41:67-68. [PMID: 34991840 DOI: 10.1016/j.remnie.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Ana Ruiz-Casado
- Servicio de Oncología Médica, Hospital Puerta de Hierro-Majadahonda, Spain.
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Small Particle DEBIRI TACE as Salvage Therapy in Patients with Liver Dominant Colorectal Cancer Metastasis: Retrospective Analysis of Safety and Outcomes. Curr Oncol 2022; 29:209-220. [PMID: 35049694 PMCID: PMC8774320 DOI: 10.3390/curroncol29010020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/01/2022] [Accepted: 01/03/2022] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to examine the safety and efficacy of 40 µm and 75 µm calibrated irinotecan-eluting beads (DEBIRI-TACE) for the treatment of colorectal cancer metastases. We conducted a retrospective review of 36 patients with unresectable liver metastases from colorectal cancer who were treated with DEBIRI-TACE between 2017 to 2020. Patients who received at least one session of DEBIRI were included in our analysis. A total of 105 DEBIRI sessions were completed. 86% of patients (n = 31) underwent one round of treatment, 14% of patients (n = 5) underwent two distinct rounds of treatment. The majority of patients were discharged the next day (92%, n = 33 patients) with no 30-day post-DEBIRI mortality. Five high-grade adverse events occurred, including longer stay for pain management (n = 2), postembolization syndrome requiring readmission (n = 2), and liver abscess (n = 1). The average survival from diagnosis of metastatic disease was 33.3 months (range 11–95, median 28). Nine of 36 patients are still alive (December 2020) and have an average follow-up time of 36.8 months from T0 (range 12–63, median 39). Small particle DEBIRI is safe and well-tolerated in the salvage setting, with outcomes comparable to that of larger bead sizes.
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Ruiz-Casado A, Sanz LG, Pérez FF, Ruiz ACS. Tratamiento de las metástasis hepáticas de cáncer colorrectal con y-90: el problema es la toxicidad. Rev Esp Med Nucl Imagen Mol 2022. [DOI: 10.1016/j.remn.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wagemans ME, Braat AJ, Smits ML, Bruijnen RC, Lam MG. Nuclear medicine therapy of liver metastasis with radiolabelled spheres. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00178-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Acciuffi S, Meyer F, Bauschke A, Croner R, Settmacher U, Altendorf-Hofmann A. Solitary colorectal liver metastasis: overview of treatment strategies and role of prognostic factors. J Cancer Res Clin Oncol 2021; 148:657-665. [PMID: 34914005 PMCID: PMC8881245 DOI: 10.1007/s00432-021-03880-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 12/07/2021] [Indexed: 12/09/2022]
Abstract
The following is an overview of the treatment strategies and the prognostic factors to consider in the therapeutic choice of patients characterized by solitary colorectal liver metastasis. Liver resection is the only potential curative option; nevertheless, only 25% of the patients are considered to be eligible for surgery. To expand the potentially resectable pool of patients, surgeons developed multidisciplinary techniques like portal vein embolization, two-stage hepatectomy or associating liver partition and portal vein ligation for staged hepatectomy. Moreover, mini-invasive surgery is gaining support, since it offers lower post-operative complication rates and shorter hospital stay with no differences in long-term outcomes. In case of unresectable disease, various techniques of local ablation have been developed. Radiofrequency ablation is the most commonly used form of thermal ablation: it is widely used for unresectable patients and is trying to find its role in patients with small resectable metastasis. The identification of prognostic factors is crucial in the choice of the treatment strategy. Previous works that focused on patients with solitary colorectal liver metastasis obtained trustable negative predictive factors such as presence of lymph-node metastasis in the primary tumour, synchronous metastasis, R status, right-sided primary colon tumor, and additional presence of extrahepatic tumour lesion. Even the time factor could turn into a predictor of tumour biology as well as further clinical course, and could be helpful to discern patients with worse prognosis.
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Affiliation(s)
- S Acciuffi
- Department of General, Abdominal and Vascular Surgery, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - F Meyer
- Department of General, Abdominal and Vascular Surgery, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - A Bauschke
- Department of General, Abdominal and Vascular Surgery, University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - R Croner
- Department of General, Abdominal and Vascular Surgery, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - U Settmacher
- Department of General, Abdominal and Vascular Surgery, University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - A Altendorf-Hofmann
- Department of General, Abdominal and Vascular Surgery, University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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80
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Mulcahy MF, Mahvash A, Pracht M, Montazeri AH, Bandula S, Martin RCG, Herrmann K, Brown E, Zuckerman D, Wilson G, Kim TY, Weaver A, Ross P, Harris WP, Graham J, Mills J, Yubero Esteban A, Johnson MS, Sofocleous CT, Padia SA, Lewandowski RJ, Garin E, Sinclair P, Salem R. Radioembolization With Chemotherapy for Colorectal Liver Metastases: A Randomized, Open-Label, International, Multicenter, Phase III Trial. J Clin Oncol 2021; 39:3897-3907. [PMID: 34541864 PMCID: PMC8660005 DOI: 10.1200/jco.21.01839] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To study the impact of transarterial Yttrium-90 radioembolization (TARE) in combination with second-line systemic chemotherapy for colorectal liver metastases (CLM). METHODS In this international, multicenter, open-label phase III trial, patients with CLM who progressed on oxaliplatin- or irinotecan-based first-line therapy were randomly assigned 1:1 to receive second-line chemotherapy with or without TARE. The two primary end points were progression-free survival (PFS) and hepatic PFS (hPFS), assessed by blinded independent central review. Random assignment was performed using a web- or voice-based system stratified by unilobar or bilobar disease, oxaliplatin- or irinotecan-based first-line chemotherapy, and KRAS mutation status. RESULTS Four hundred twenty-eight patients from 95 centers in North America, Europe, and Asia were randomly assigned to chemotherapy with or without TARE; this represents the intention-to-treat population and included 215 patients in the TARE plus chemotherapy group and 213 patients in the chemotherapy alone group. The hazard ratio (HR) for PFS was 0.69 (95% CI, 0.54 to 0.88; 1-sided P = .0013), with a median PFS of 8.0 (95% CI, 7.2 to 9.2) and 7.2 (95% CI, 5.7 to 7.6) months, respectively. The HR for hPFS was 0.59 (95% CI, 0.46 to 0.77; 1-sided P < .0001), with a median hPFS of 9.1 (95% CI, 7.8 to 9.7) and 7.2 (95% CI, 5.7 to 7.6) months, respectively. Objective response rates were 34.0% (95% CI, 28.0 to 40.5) and 21.1% (95% CI, 16.2 to 27.1; 1-sided P = .0019) for the TARE and chemotherapy groups, respectively. Median overall survival was 14.0 (95% CI, 11.8 to 15.5) and 14.4 months (95% CI, 12.8 to 16.4; 1-sided P = .7229) with a HR of 1.07 (95% CI, 0.86 to 1.32) for TARE and chemotherapy groups, respectively. Grade 3 adverse events were reported more frequently with TARE (68.4% v 49.3%). Both groups received full chemotherapy dose intensity. CONCLUSION The addition of TARE to systemic therapy for second-line CLM led to longer PFS and hPFS. Further subset analyses are needed to better define the ideal patient population that would benefit from TARE.
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Affiliation(s)
- Mary F Mulcahy
- Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Armeen Mahvash
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX
| | - Marc Pracht
- Centre Eugene Marquis, Medical Oncology, Rennes, France
| | - Amir H Montazeri
- Clatterbridge Cancer Center NHS Foundation Trust, Liverpool, United Kingdom
| | - Steve Bandula
- University College London Hospital, London, United Kingdom
| | | | | | - Ewan Brown
- Western General Hospital, Edinburgh, Scotland
| | | | - Gregory Wilson
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Tae-You Kim
- Seoul National University, Seoul, South Korea
| | - Andrew Weaver
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Paul Ross
- Guy's Hospital, London, United Kingdom
| | | | - Janet Graham
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Jamie Mills
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | | | | | | | | | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL
| | - Etienne Garin
- Centre Eugene Marquis, Nuclear Medicine, Rennes, France
| | | | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL
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81
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Yao Y, Liu Z, Zhang H, Li J, Peng Z, Yu J, Cao B, Shen L. Serious Adverse Events Reporting in Phase III Randomized Clinical Trials of Colorectal Cancer Treatments: A Systematic Analysis. Front Pharmacol 2021; 12:754858. [PMID: 34867369 PMCID: PMC8636814 DOI: 10.3389/fphar.2021.754858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/25/2021] [Indexed: 12/22/2022] Open
Abstract
Objective: The occurrence, development, and prognosis of serious adverse events (SAEs) associated with anticancer drugs in clinical trials have important guiding significance for real-world clinical applications. However, to date, there have been no studies investigating SAEs reporting in randomized clinical trials of colorectal cancer treatments. This article systematically reviewed the SAEs reporting of phase III randomized clinical trials of colorectal cancer treatments and analyzed the influencing factors. Methods: We reviewed all articles about phase III randomized clinical trials of colorectal cancer treatments published in the PubMed, Embase, Medline, and New England Journal of Medicine databases from January 1, 1993, to December 31, 2018, and searched the registration information of clinical trials via the internet sites such as "clinicaltrials.gov". We analyzed the correlation between the reported proportion (RP) of SAEs in the literature and nine elements, including the clinical trial sponsor and the publication time. Chi-square tests and binary logistic regression were used to identify the factors associated with improved SAEs reports. This study was registered on PROSPERO. Results: Of 1560 articles identified, 160 were eligible, with an RP of SAEs of 25.5% (41/160). In forty-one publications reporting SAEs, only 14.6% (6/41) described the pattern of SAEs in detail. In clinical trials sponsored by pharmaceutical companies, the RP of SAEs was significantly higher than that in those sponsored by investigators (57.6 versus 20.7%, p < 0.001). From 1993 to 2018, the RP of SAEs gradually increased (none (0/6) before 2000, 17.1% (12/70) from 2000 to 2009, and 34.5% (29/84) after 2009). The average RP of SAEs published in the New England Journal of Medicine (N Engl J Med), the Lancet, the Journal of the American Medical Association (JAMA), the Lancet Oncology (Lancet Oncol), and the Journal of Clinical Oncology (J Clin Oncol) was significantly higher than that published in other journals (31.9 versus 16.7%, p = 0.030). In the clinical trials referenced by clinical guidelines, the RP of SAEs was higher than that in non-referenced clinical trials (32.0 versus 15.9%, p = 0.023). Binary logistic regression analysis showed that pharmaceutical company sponsorship, new drug research, and sample size greater than 1000 were positive influencing factors for SAEs reporting. Conclusion: Although the RP of SAEs increased over time, SAEs reporting in clinical trials needs to be further improved. The performance, outcomes and prognosis of SAEs should be reported in detail to guide clinical practice in the real world.
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Affiliation(s)
- Yanhong Yao
- Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing, China.,Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhentao Liu
- Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing, China
| | - Hua Zhang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Jian Li
- Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhi Peng
- Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jinyu Yu
- Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing, China
| | - Baoshan Cao
- Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing, China
| | - Lin Shen
- Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing, China
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82
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Filippi L, Braat AJ. Theragnostics in primary and secondary liver tumors: the need for a personalized approach. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2021; 65:353-370. [PMID: 34881847 DOI: 10.23736/s1824-4785.21.03407-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Primary and secondary hepatic tumors have a dramatic impact in oncology. Despite many advances in diagnosis and therapy, the management of hepatic malignancies is still challenging, ranging from various loco-regional approaches to system therapies. In this scenario, theragnostic approaches, based on the administration of a radiopharmaceuticals' pair, the first labeled with a radionuclide suitable for the diagnostic phase and the second one bound to radionuclide emitting particles for therapy, is gaining more and more importance. Selective internal radiation therapy (SIRT) with microspheres labeled with 90Y or 166Ho is widely used as a loco-regional treatment for primary and secondary hepatic tumors. While 166Ho presents both gamma and beta emission and can be therefore considered a real "theragnostic" agent, for 90Y-microspheres theragnostic approach is realized at the diagnostic phase through the utilization of macroaggregates of human albumin, labeled with 99mTc as "biosimilar" agent respect to microspheres. The aim of the present review was to cover theragnostic applications of 90Y/166Ho-labeled microspheres in clinical practice. Furthermore, we report the preliminary data concerning the potential role of some emerging theragnostic biomarkers for hepatocellular carcinoma, such as glypican-3 (GPC3) and prostate specific membrane antigen (PSMA).
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Affiliation(s)
- Luca Filippi
- Department of Nuclear Medicine, Santa Maria Goretti Hospital, Latina, Italy -
| | - Arthur J Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
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83
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The Role of Ablative Radiotherapy to Liver Oligometastases from Colorectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2021. [DOI: 10.1007/s11888-021-00472-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Abstract
Purpose of Review
This review describes recent data supporting locoregional ablative radiation in the treatment of oligometastatic colorectal cancer liver metastases.
Recent Findings
Stereotactic body radiotherapy (SBRT) demonstrates high rates of local control in colorectal cancer liver metastases when a biologically equivalent dose of > 100 Gy is delivered. Future innovations to improve the efficacy of SBRT include MRI-guided radiotherapy (MRgRT) to enhance target accuracy, systemic immune activation to treat extrahepatic disease, and genomic customization. Selective internal radiotherapy (SIRT) with y-90 is an intra-arterial therapy that delivers high doses to liver metastases internally which has shown to increase liver disease control in phase 3 trials. Advancements in transarterial radioembolization (TARE) dosimetry could improve local control and decrease toxicity.
Summary
SBRT and SIRT are both promising options in treating unresectable metastatic colorectal cancer liver metastases. Identification of oligometastatic patients who receive long-term disease control from either therapy is essential. Future advancements focusing on improving radiation design and customization could further improve efficacy and toxicity.
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84
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Torres-Jiménez J, Esteban-Villarrubia J, Ferreiro-Monteagudo R, Carrato A. Local Treatments in the Unresectable Patient with Colorectal Cancer Metastasis: A Review from the Point of View of the Medical Oncologist. Cancers (Basel) 2021; 13:5938. [PMID: 34885047 PMCID: PMC8656541 DOI: 10.3390/cancers13235938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 12/12/2022] Open
Abstract
For patients with isolated liver metastases from colorectal cancer who are not candidates for potentially curative resections, non-surgical local treatments may be useful. Non-surgical local treatments are classified according to how the treatment is administered. Local treatments are applied directly on hepatic parenchyma, such as radiofrequency, microwave hyperthermia and cryotherapy. Locoregional therapies are delivered through the hepatic artery, such as chemoinfusion, chemoembolization or selective internal radiation with Yttrium 90 radioembolization. The purpose of this review is to describe the different interventional therapies that are available for these patients in routine clinical practice, the most important clinical trials that have tried to demonstrate the effectiveness of each therapy and recommendations from principal medical oncologic societies.
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Affiliation(s)
- Javier Torres-Jiménez
- Medical Oncology Department, University Hospital Ramon y Cajal, 28034 Madrid, Spain; (J.E.-V.); (R.F.-M.)
| | - Jorge Esteban-Villarrubia
- Medical Oncology Department, University Hospital Ramon y Cajal, 28034 Madrid, Spain; (J.E.-V.); (R.F.-M.)
| | - Reyes Ferreiro-Monteagudo
- Medical Oncology Department, University Hospital Ramon y Cajal, 28034 Madrid, Spain; (J.E.-V.); (R.F.-M.)
| | - Alfredo Carrato
- Medical Oncology Department, Ramón y Cajal Health Research Institute (IRYCIS), CIBERONC, Alcalá University, University Hospital Ramon y Cajal, 28034 Madrid, Spain;
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85
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Moslim MA, Jeyarajah DR. Narrative review of the role of yttrium-90 selective internal radiation therapy in the surgical management of colorectal liver metastases. J Gastrointest Oncol 2021; 12:2438-2446. [PMID: 34790404 DOI: 10.21037/jgo-21-96] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/08/2021] [Indexed: 11/06/2022] Open
Abstract
The management of colorectal liver metastasis (CRLM) is complicated and benefits from a multidisciplinary team approach. Liver-directed therapy has been emerging as a modality for better progression-free control. In its early years, selective internal radiation therapy (SIRT) with yttrium-90 (Y-90) was confined as an end-of-line therapy. However, literature has supported other roles including: a first-line treatment for CRLM alone or in combination with systemic chemotherapy; an adjunct to second or third-line chemotherapy; and a salvage treatment for chemo-refractory disease. Although future liver remnant (FLR) hypertrophy may take 3-12 months, the SIRT effect on loco-regional disease control has rendered it to be a useful tool in some pathologies with certain strategic goals. This paper reviews the use of SIRT with Y-90 in a surgical treatment pathway. This includes: (I) an element of multidisciplinary treatment of low-volume CRLMs, (II) convert an R1 to R0 resection by sterilizing the margins of tumor near critical structures, and (III) radiation lobectomy to induce contralateral hypertrophy in order to aid in a safer resection. There are many opportunities to validate the role of SIRT as a first-line therapy along with surgical resection including an umbrella clinical trial design.
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86
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Haber Z, Lee EW, Price M, Wainberg Z, Hecht JR, Sayre J, Padia SA. Survival Advantage of Yttrium-90 Radioembolization to Systemic Therapy in Patients with Hepatic Metastases from Colorectal Cancer in the Salvage Setting: Results of a Matched Pair Study. Acad Radiol 2021; 28 Suppl 1:S210-S217. [PMID: 34099386 DOI: 10.1016/j.acra.2021.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/10/2021] [Accepted: 03/30/2021] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES Patients with hepatic metastases from colorectal cancer have a poor prognosis in the salvage setting. This study assessed the survival benefit of adding transarterial 90Y radioembolization in the salvage setting to systemic therapy. MATERIALS AND METHODS In this retrospective, matched-pair study, 21 patients who underwent radioembolization plus systemic therapy were matched with a cohort of 173 patients who received systemic chemotherapy alone in the salvage setting, defined as progression on at least two different regimens of systemic chemotherapy. Patients were matched one-to-one on Eastern Cooperative Oncology Group Performance Status, presence of extrahepatic disease, and presence of tumor KRAS mutation. Radioembolization patients underwent treatment using standard dosimetry to either a hepatic lobe or the whole liver. Survival data was analyzed using Kaplan-Meier analysis. RESULTS Patients who underwent radioembolization plus systemic therapy vs. those who had systemic therapy alone had similar demographics and exposure to prior systemic chemotherapies. Median survival from the date of primary diagnosis was 38 (95% CI 26 to 50) v 25 (95% CI 15 to 35) months in radioembolization with systemic therapy vs. systemic therapy alone (p = 0.17). Median survival from the date of hepatic metastases was 31 (95% CI 23.8 to 38.2) v 20 months (95% CI 10.2 to 29.8) in radioembolization with systemic therapy vs. systemic therapy alone (p = 0.03). CONCLUSION The addition of radioembolization to systemic therapy in patients with metastatic colorectal cancer to the liver may improve survival in the salvage setting.
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Affiliation(s)
- Zachary Haber
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at University of California, Los Angeles
| | - Edward Wolfgang Lee
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at University of California, Los Angeles
| | - Megan Price
- Division of Medical Oncology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Zev Wainberg
- Division of Medical Oncology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Joel Randolph Hecht
- Division of Medical Oncology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - James Sayre
- Department of Radiology, David Geffen School of Medicine at University of California, Los Angeles
| | - Siddharth A Padia
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at University of California, Los Angeles.
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87
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Sofocleous CT, D'Angelica MI. Intra-Arterial Therapy for Unresectable Colorectal Liver Metastases: Which and When? A Commentary on "Intra-Arterial Therapy for Unresectable Colorectal Liver Metastases: A Meta-Analysis". J Vasc Interv Radiol 2021; 32:1546-1547. [PMID: 34717833 DOI: 10.1016/j.jvir.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Constantinos T Sofocleous
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Michael I D'Angelica
- Division of Hepaticopancreaticobiliary Surgery/Department of General Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Weill-Cornell Medical College, Cornell University, New York, New York
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88
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Manchec B, Kokabi N, Narayanan G, Niekamp A, Peña C, Powell A, Schiro B, Gandhi R. Radioembolization of Secondary Hepatic Malignancies. Semin Intervent Radiol 2021; 38:445-452. [PMID: 34629712 DOI: 10.1055/s-0041-1732318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cancer has become the leading cause of mortality in America, and the majority of patients eventually develop hepatic metastasis. As liver metastases are frequently unresectable, the value of liver-directed therapies, such as transarterial radioembolization (TARE), has become increasingly recognized as an integral component of patient management. Outcomes after radioembolization of hepatic malignancies vary not only by location of primary malignancy but also by tumor histopathology. This article reviews the outcomes of TARE for the treatment of metastatic colorectal cancer, metastatic breast cancer, and metastatic neuroendocrine tumors, as well as special considerations when treating metastatic disease with TARE.
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Affiliation(s)
- Barbara Manchec
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida.,Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Nima Kokabi
- Division of Interventional Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - Govindarajan Narayanan
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida.,Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Andrew Niekamp
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida.,Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Constantino Peña
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida.,Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Alex Powell
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida.,Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Brian Schiro
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida.,Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Ripal Gandhi
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida.,Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
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89
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Abstract
90 Yttrium (Y90) radioembolization has been shown to improve outcomes for primary and metastatic liver cancers, but there is limited understanding of the optimal timing and safety of combining systemic therapies with Y90 treatment. Both therapeutic effects and toxicities could be synergistic depending on the timing and dosing of different coadministration paradigms. In particular, patients with liver-only or liver-dominant metastatic disease progression are often on systemic therapy when referred to interventional radiology for consideration of Y90 treatment. Interventional radiologists are frequently asked to offer insight into whether or not to hold systemic therapy, and for how long, prior to and following transarterial therapy. This study reviews the current evidence regarding the timing and safety of systemic therapy with Y90 treatment for hepatocellular carcinoma, metastatic colorectal carcinoma, intrahepatic cholangiocarcinoma, metastatic neuroendocrine tumors, and other hepatic metastases. A particular focus is placed on the timing, dosing, and toxicities of combined therapy.
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Affiliation(s)
- Tarub S Mabud
- Division of Vascular Interventional Radiology, Department of Radiology, NYU Langone Health, New York, New York
| | - Ryan Hickey
- Division of Vascular Interventional Radiology, Department of Radiology, NYU Langone Health, New York, New York
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90
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Sankhla T, Cheng B, Nezami N, Xing M, Sethi I, Bercu Z, Brandon D, Majdalany B, Schuster DM, Kokabi N. Role of Resin Microsphere Y90 Dosimetry in Predicting Objective Tumor Response, Survival and Treatment Related Toxicity in Surgically Unresectable Colorectal Liver Metastasis: A Retrospective Single Institution Study. Cancers (Basel) 2021; 13:cancers13194908. [PMID: 34638392 PMCID: PMC8508412 DOI: 10.3390/cancers13194908] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/27/2022] Open
Abstract
Simple Summary Colorectal liver metastases are difficult to treat, with only a minority of patients eligible for surgical resection. Yttrium-90 selective internal radiation therapy is an alternative treatment currently used for patients who have progressed on chemotherapy. A technique called dosimetry allows clinicians to analyze how much radiation was delivered to target lesions post-treatment. The aim of this study is to evaluate the relationship of various dosimetric parameters with objective tumor response, overall survival, and treatment related toxicity with the potential goal of optimizing Yttrium-90 treatment in this patient population. Additionally, other potential predictors of survival outcomes, including clinical and demographic factors, were also evaluated. We found that delivering a mean tumor dose ≥100 Gy when using resin microspheres was significantly associated with objective tumor response and prolonged overall survival. In this study, no mean non-tumoral liver dose threshold was found to predict treatment related toxicity. Abstract Purpose: To Evaluate the correlation between tumor dosimetric parameters with objective tumor response (OR) and overall survival (OS) in patients with surgically unresectable colorectal liver metastasis (CRLM) undergoing resin-based Ytrrium-90 selective internal radiation therapy (Y90 SIRT). Materials and Methods: 45 consecutive patients with CRLM underwent resin-based Y90 SIRT in one or both hepatic lobes (66 treated lobes total). Dose volume histograms were created with MIM Sureplan® v.6.9 using post-treatment SPECT/CT. Dosimetry analyses were based on the cumulative volume of the five largest tumors in each treatment session and non-tumoral liver (NTL) dose. Receiver operating characteristic (ROC) curve was used to evaluate tumor dosimetric factors in predicting OR by Response Evaluation Criteria for Solid Tumors at 3 months post-Y90. Additionally, ROC curve was used to evaluate non-tumoral liver dose as a predictor of grade ≥ 3 liver toxicity and radioembolization induced liver disease (REILD) 3 months post Y90. To minimize for potential confounding demographic and clinical factors, univariate and multivariate analysis of survival with mean tumor dose as one of the factors were also performed. Kaplan-Meier estimation was used for OS analysis from initial Y90 SIRT. Results: 26 out of 45 patients had OR with a median OS of 17.2 months versus 6.8 months for patients without OR (p < 0.001). Mean tumor dose (TD) of the five largest tumors was the strongest predictor of OR with an area under the curve of 0.73 (p < 0.001). Minimum TD, and TD to 30%, 50%, and 70% of tumor volume also predicted OR (p’s < 0.05). Mean TD ≥ 100 Gy predicted a significantly prolonged median OS of 19 vs. 11 months for those receiving TD < 100 Gy (p = 0.016). On univariate analysis, mean TD < 100 Gy, presence of any genomic mutation, presence of MAPK pathway mutation, bilobar hepatic metastases and diffuse metastatic disease (>10 lesions per liver lobe) were found to be predictors of shorter median OS. On multivariate analysis, mean TD < 100 Gy, presence of any genomic mutation, and diffuse hepatic metastatic disease were found to be independent predictors of shorter OS. Overall, six (13.3%) patients developed grade ≥ 3 liver toxicity post Y90 of whom two (4.4%) patients developed REILD. No dose threshold predicting grade ≥ 3 liver toxicity or REILD was identified. Conclusions: Mean TD ≥ 100 Gy in patients with unresectable CRLM undergoing resin-based Y90 SIRT predicts OR and prolonged OS.
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Affiliation(s)
- Tina Sankhla
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30308, USA; (T.S.); (N.N.); (M.X.); (Z.B.); (B.M.)
| | - Bernard Cheng
- Morehouse School of Medicine, Atlanta, GA 30310, USA;
| | - Nariman Nezami
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30308, USA; (T.S.); (N.N.); (M.X.); (Z.B.); (B.M.)
| | - Minzhi Xing
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30308, USA; (T.S.); (N.N.); (M.X.); (Z.B.); (B.M.)
| | - Ila Sethi
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30308, USA; (I.S.); (D.B.); (D.M.S.)
| | - Zachary Bercu
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30308, USA; (T.S.); (N.N.); (M.X.); (Z.B.); (B.M.)
| | - David Brandon
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30308, USA; (I.S.); (D.B.); (D.M.S.)
| | - Bill Majdalany
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30308, USA; (T.S.); (N.N.); (M.X.); (Z.B.); (B.M.)
| | - David M. Schuster
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30308, USA; (I.S.); (D.B.); (D.M.S.)
| | - Nima Kokabi
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30308, USA; (T.S.); (N.N.); (M.X.); (Z.B.); (B.M.)
- Emory University Hospital Midtown, 550 Peachtree Street NE, Atlanta, GA 30308, USA
- Correspondence: ; Tel.: +1-404-686-8715; Fax: +1-404-686-0104
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Management of Liver Tumors during the COVID-19 Pandemic: The Added Value of Selective Internal Radiation Therapy (SIRT). J Clin Med 2021; 10:jcm10194315. [PMID: 34640332 PMCID: PMC8509348 DOI: 10.3390/jcm10194315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/14/2021] [Accepted: 09/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background: In the context of the coronavirus disease 2019 (COVID-19) pandemic, liver-directed therapies (LDTs) may offer minimally invasive integrative tools for tumor control. Among them, selective internal radiation therapy (SIRT) represents a safe, flexible and effective treatment. Purpose of this study is to present our experience with SIRT during the first wave of COVID-19 pandemic and provide an overview of the indications and challenges of SIRT in this scenario. Methods: We retrospectively analyzed the number of patients evaluated by Multidisciplinary Liver Tumor Board (MLTB) and who were undergoing LDTs between March and July 2020 and compared it with 2019. For patients treated with SIRT, clinical data, treatment details and the best radiological response were collected. Results: Compared to 2019, we observed a 27.5% reduction in the number of patients referred to MLTB and a 28.3% decrease in percutaneous ablations; transarterial chemoembolizations were stable, while SIRT increased by 64%. The majority of SIRT patients (75%) had primary tumors, mostly HCC. The best objective response and disease control rates were 56.7% and 72.2%, respectively. Conclusion: The first wave of the COVID-19 pandemic was characterized by an increased demand for SIRT, which represents a safe, flexible and effective treatment, whose manageability will further improve by simplifying the treatment workflow, developing user-friendly and reliable tools for personalized dosimetry and improving interdisciplinary communication.
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92
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Craig AJ, Murray I, Denis-Bacelar AM, Rojas B, Gear JI, Hossen L, Maenhout A, Khan N, Flux GD. Comparison of 90Y SIRT predicted and delivered absorbed doses using a PSF conversion method. Phys Med 2021; 89:1-10. [PMID: 34339928 PMCID: PMC8501309 DOI: 10.1016/j.ejmp.2021.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/23/2021] [Accepted: 07/19/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The aims of this study were to develop and apply a method to correct for the differences in partial volume effects of pre-therapy Technetium-99 m (99mTc)-MAA SPECT and post-therapy Yttrium-90 (90Y) bremsstrahlung SPECT imaging in selective internal radiation therapy, and to use this method to improve quantitative comparison of predicted and delivered 90Y absorbed doses. METHODS The spatial resolution of 99mTc SPECT data was converted to that of 90Y SPECT data using a function calculated from 99mTc and 90Y point spread functions. This resolution conversion method (RCM) was first applied to 99mTc and 90Y SPECT phantom data to validate the method, and then to clinical data to assess the power of 99mTc SPECT imaging to predict the therapeutic absorbed dose. RESULTS The maximum difference between absorbed doses to phantom spheres was 178%. This was reduced to 27% after the RCM was applied. The clinical data demonstrated differences within 38% for mean absorbed doses delivered to the normal liver, which were reduced to 20% after application of the RCM. Analysis of clinical data showed that therapeutic absorbed doses delivered to tumours greater than 100 cm3 were predicted to within 52%, although there were differences of up to 210% for smaller tumours, even after the RCM was applied. CONCLUSIONS The RCM was successfully verified using phantom data. Analysis of the clinical data established that the 99mTc pre-therapy imaging was predictive of the 90Y absorbed dose to the normal liver to within 20%, but had poor predictability for tumours smaller than 100 cm3.
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Affiliation(s)
- Allison J. Craig
- Joint Department of Physics, Royal Marsden NHSFT, Sutton, United Kingdom,The Institute of Cancer Research, London, United Kingdom,Corresponding author.
| | - Iain Murray
- Joint Department of Physics, Royal Marsden NHSFT, Sutton, United Kingdom,The Institute of Cancer Research, London, United Kingdom
| | | | - Bruno Rojas
- Joint Department of Physics, Royal Marsden NHSFT, Sutton, United Kingdom,The Institute of Cancer Research, London, United Kingdom
| | - Jonathan I. Gear
- Joint Department of Physics, Royal Marsden NHSFT, Sutton, United Kingdom,The Institute of Cancer Research, London, United Kingdom
| | - Lucy Hossen
- Royal Brompton & Harefield NHSFT, London, United Kingdom
| | | | - Nasir Khan
- Chelsea & Westminster NHSFT, London, United Kingdom
| | - Glenn D. Flux
- Joint Department of Physics, Royal Marsden NHSFT, Sutton, United Kingdom,The Institute of Cancer Research, London, United Kingdom
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93
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Bi-Centric Independent Validation of Outcome Prediction after Radioembolization of Primary and Secondary Liver Cancer. J Clin Med 2021; 10:jcm10163668. [PMID: 34441964 PMCID: PMC8396945 DOI: 10.3390/jcm10163668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Yttrium-90 radioembolization (RE) plays an important role in the treatment of liver malignancies. Optimal patient selection is crucial for an effective and safe treatment. In this study, we aim to validate the prognostic performance of a previously established random survival forest (RSF) with an external validation cohort from a different national center. Furthermore, we compare outcome prediction models with different established metrics. METHODS A previously established RSF model, trained on a consecutive cohort of 366 patients who had received RE due to primary or secondary liver tumor at a national center (center 1), was used to predict the outcome of an independent consecutive cohort of 202 patients from a different national center (center 2) and vice versa. Prognostic performance was evaluated using the concordance index (C-index) and the integrated Brier score (IBS). The prognostic importance of designated baseline parameters was measured with the minimal depth concept, and the influence on the predicted outcome was analyzed with accumulated local effects plots. RSF values were compared to conventional cox proportional hazards models in terms of C-index and IBS. RESULTS The established RSF model achieved a C-index of 0.67 for center 2, comparable to the results obtained for center 1, which it was trained on (0.66). The RSF model trained on center 2 achieved a C-index of 0.68 on center 2 data and 0.66 on center 1 data. CPH models showed comparable results on both cohorts, with C-index ranging from 0.68 to 0.72. IBS validation showed more differentiated results depending on which cohort was trained on and which cohort was predicted (range: 0.08 to 0.20). Baseline cholinesterase was the most important variable for survival prediction. CONCLUSION The previously developed predictive RSF model was successfully validated with an independent external cohort. C-index and IBS are suitable metrics to compare outcome prediction models, with IBS showing more differentiated results. The findings corroborate that survival after RE is critically determined by functional hepatic reserve and thus baseline liver function should play a key role in patient selection.
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94
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Hendlisz A, Sclafani F. Editorial: Radioembolization for metastatic colorectal cancer: towards maturity, at last? Curr Opin Oncol 2021; 33:351-352. [PMID: 33966002 DOI: 10.1097/cco.0000000000000749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Alain Hendlisz
- Gastrointestinal Unit, Department of Medical Oncology, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
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95
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Tchelebi LT, Goodman KA. Mature Experiences Using Local Therapy for Oligometastases. Semin Radiat Oncol 2021; 31:180-185. [PMID: 34090644 DOI: 10.1016/j.semradonc.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Cancer is a heterogeneous disease, consisting of a spectrum of disorders ranging from local-only disease to those that are widely metastatic from their onset. The oligometastatic state, in which tumors harbor a limited number of metastases, may be curable in a subset of patients. The early success of surgical resection of hepatic metastases from colorectal cancer led to investigations into metastatectomy of other sites and, more recently, into the use of stereotactic ablative radiotherapy (SABR) for oligometastatic disease. This article reviews the data establishing the role of surgery for managing limited metastatic disease. Further, we review recent experiences using alternative local therapies, such as SABR, for oligometastases. This review also discusses ongoing trials evaluating local therapies for patients with a limited burden of metastatic cancer.
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Affiliation(s)
- Leila T Tchelebi
- Department of Radiation Oncology, Penn State College of Medicine, Hershey, PA.
| | - Karyn A Goodman
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
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96
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Zhao JJ, Tan E, Sultana R, Syn NL, Da Zhuang K, Leong S, Tai DWM, Too CW. Intra-arterial therapy for unresectable colorectal liver metastases: A meta-analysis. J Vasc Interv Radiol 2021; 32:1536-1545.e38. [PMID: 34166803 DOI: 10.1016/j.jvir.2021.05.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 05/09/2021] [Accepted: 05/31/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate the efficacy of hepatic arterial infusion (HAI), conventional trans-arterial chemoembolization (cTACE), drug-eluting embolic trans-arterial chemoembolization (DEE-TACE), trans-arterial radioembolization (TARE) and their combinations with systemic chemotherapy (SCT) for unresectable colorectal liver metastases. METHODS A search was conducted on EMBASE, Scopus, PubMed and Web of Science for prospective non-randomized studies and randomized controlled trials (RCTs) from inception to 20th June 2020. Survival data of patients were recovered from original Kaplan-Meier curves by exploiting a graphical reconstructive algorithm. One-stage meta-analyses were conducted for median overall survival (OS), survival rates (SR), and restricted mean survival time (RMST), while two-stage meta-analyses of proportions were conducted to determine response rates (RR) and conversion-to-resection rates (CRR). RESULTS 71 prospective non-randomized studies and 21 RCTs were identified comprising 6,695 patients. Among patients treated beyond first line, DEE-TACE+SCT (n=152) had the best survival outcomes of median OS of 26.5 (95%-CI: 22.5-29.1) months and 3-year RMST of 23.6 (95%-CI: 21.8-25.5) months. Upon further stratification by publication year, DEE-TACE+SCT appears to consistently have the highest pooled survival rates at 1-year (81.9%) and 2-years (66.1%) in recent publications (2015-2020). DEE-TACE+SCT and HAI+SCT had the highest pooled-RRs of 56.7% (I2=0.90) and 62.6% (I2=0.87) respectively and pooled-CRRs of 35.5% (I2=0.00) and 30.3% (I2=0.80) respectively. CONCLUSION Albeit significant heterogeneity, paucity of high-quality evidence and the non-comparative nature of all analyses, the overall evidence suggests that patients treated with DEE-TACE+SCT may have the best oncological outcomes and greatest potential to be converted for resection.
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Affiliation(s)
- Joseph J Zhao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Eelin Tan
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences; Radiological Sciences Academic Clinical Program, SingHealth- Duke-National University of Singapore Academic Medical, Singapore General Hospital, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-National University of Singapore Graduate Medical School, Singapore
| | - Nicholas L Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kun Da Zhuang
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences; Radiological Sciences Academic Clinical Program, SingHealth- Duke-National University of Singapore Academic Medical, Singapore General Hospital, Singapore
| | - Sum Leong
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences; Radiological Sciences Academic Clinical Program, SingHealth- Duke-National University of Singapore Academic Medical, Singapore General Hospital, Singapore
| | - David W M Tai
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Chow Wei Too
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences; Radiological Sciences Academic Clinical Program, SingHealth- Duke-National University of Singapore Academic Medical, Singapore General Hospital, Singapore.
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97
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Wang Y, Xu X, Li R, Zhang L, Kang J, Xiao D, Hu X, Wang X. Impact of Chinese respiratory physicians participating in smoking cessation and mobile health: A randomised feasibility trial. CLINICAL RESPIRATORY JOURNAL 2021; 15:1003-1011. [PMID: 34087057 DOI: 10.1111/crj.13404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION People who are eager to quit smoking often lack long-term, daily smoking cessation guidance. In addition, advances in mobile communication technology offer promising ways for providing tobacco dependence treatment. However, it is unclear whether the doctor-WeChat network can improve the smoking cessation rate of nicotine-dependent patients. METHODS In this prospective single-blind cohort study, 250 smokers were enrolled from May 2018 to October 2018. They were randomly divided into two groups, with or without doctors' active smoking cessation service, and followed up for 6 months. The smoking cessation rate and characteristics of successful smoking cessation groups were compared. The reasons for relapse were also analysed. RESULTS After smoking cessation for 3 months, the success rate of the group involving active respiratory physicians was 65.0% (80/123), whereas the success rate of the control group was 34.7% (34/98). After 6 months, the success rate of the group involving active respiratory physicians was 55.3% (68/123), while that of the control group was only 11.2% (11/98). There was no difference in the weight change of the participants between the two groups. Subgroup analysis showed that doctors' participation had a greater impact on the success of smoking cessation in men younger than 45 years or unemployed. CONCLUSIONS Doctors in mobile smoking cessation services played a very important role in improving quit rates. Our research provided methodological guidance for further clinical trials and a template for further real-world applications of smoking cessation services.
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Affiliation(s)
- Yizhe Wang
- Department of Gerontology and Geriatrics, The First Hospital of China Medical University, Shenyang, China
| | - Xi Xu
- Department of Gerontology and Geriatrics, The First Hospital of China Medical University, Shenyang, China
| | - Rong Li
- Department of Gerontology and Geriatrics, The First Hospital of China Medical University, Shenyang, China
| | - Li Zhang
- Department of Gerontology and Geriatrics, The First Hospital of China Medical University, Shenyang, China
| | - Jian Kang
- Departmnet of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Dan Xiao
- Department of National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Xuejun Hu
- Department of Gerontology and Geriatrics, The First Hospital of China Medical University, Shenyang, China
| | - Xiaonan Wang
- Department of Gerontology and Geriatrics, The First Hospital of China Medical University, Shenyang, China
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Temraz S, Mukherji D, Nassar F, Moukalled N, Shamseddine A. Treatment sequencing of metastatic colorectal cancer based on primary tumor location. Semin Oncol 2021; 48:119-129. [PMID: 34120762 DOI: 10.1053/j.seminoncol.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/15/2021] [Accepted: 05/13/2021] [Indexed: 01/09/2023]
Abstract
Colorectal cancer is a heterogeneous disease with various clinical, molecular, and embryological differences related to the origin of the tumor from the right or left colon. Recent studies have demonstrated that tumor sidedness has both a prognostic and predictive value in metastatic colorectal cancer . Patients whose primary tumor originates from the left side of the colon and whose tumor's genome encodes wild-type RAS and BRAF should be offered cetuximab or panitumumab in the first-line treatment of metastatic disease or in subsequent lines. For tumors originating from the right side of the colon, anti-angiogenic treatment, particularly bevacizumab, is an option for this poor prognostic group until better options become available. Specifically, an aggressive initial approach with FOLFOXIRI plus bevacizumab is a treatment option in right-sided tumors under investigation. This report reviews the available data for the treatment of metastatic colorectal cancer according to the location of the primary tumor and proposes the optimal treatment sequencing strategy incorporating the site of origin of the tumor and molecular information into the decision-making process.
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Affiliation(s)
- Sally Temraz
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Deborah Mukherji
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Farah Nassar
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nour Moukalled
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Shamseddine
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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99
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Bi Y, Shi X, Ren J, Yi M, Han X, Song M. Transarterial chemoembolization with doxorubicin-loaded beads for inoperable or recurrent colorectal cancer. Abdom Radiol (NY) 2021; 46:2833-2838. [PMID: 33386908 DOI: 10.1007/s00261-020-02877-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/14/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE We aimed to assess the safety and efficacy of transarterial chemoembolization (TACE) with doxorubicin-loaded CalliSpheres® beads (DEB-TACE) for the treatment of patients with inoperable or recurrent colorectal cancer (CRC). METHODS This retrospective study recruited 12 consecutive patients with histology confirmation of CRC who received DEB-TACE between August 2017 and April 2020. There were 9 male and 3 female, with a mean age 62.5 ± 14.9 (range 29-84). Patients' characteristics, medical imaging data, complications and DEB-TACE procedure were retrospectively reviewed. The disease control rate was defined as the sum of complete response, partial response and stable disease. RESULTS DEB-TACE was successfully performed in all patients. All patients showed local disease control 1 month after DEB-TACE. Disease control rates were 90.9% and 70.0% at 3 and 6 months after DEB-TACE procedure, respectively. Disease-free interval was 11.0 to 81.8 months. Five patients (41.7%) received prior chemotherapy treatments. No severe complications or procedure-related deaths were observed. The median overall survival was 15.9 months, and median progression-free survival was 13.4 months. CONCLUSION DEB-TACE is a safe and effective treatment and could be a option for patients with inoperable or recurred CRC.
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100
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Mauri G, Monfardini L, Garnero A, Zampino MG, Orsi F, Della Vigna P, Bonomo G, Varano GM, Busso M, Gazzera C, Fonio P, Veltri A, Calandri M. Optimizing Loco Regional Management of Oligometastatic Colorectal Cancer: Technical Aspects and Biomarkers, Two Sides of the Same Coin. Cancers (Basel) 2021; 13:cancers13112617. [PMID: 34073585 PMCID: PMC8198296 DOI: 10.3390/cancers13112617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 11/23/2022] Open
Abstract
Simple Summary The treatments for patients with oligometastatic colorectal carcinoma are rapidly evolving. The present review focuses on the role of minimally invasive techniques since they can now be used as an alternative to surgical management in selected cases in association with systemic therapies according to ESMO and NCCN guidelines. In recent years, biomarkers (both at molecular and imaging level) have emerged as a relevant and potential criteria for treatment strategy decision and will be crucial in the future for patients selection. Tumor molecular profile impacts on local outcome of image guide ablation as well as metabolic imaging which predicts the outcome of both percutaneous and trans-arterial treatments. Oncologists should be aware of advantages and disadvantages of those treatments options as well as the potential role of molecular profile for a better patient selection. Abstract Colorectal cancer (CRC) is the third most common cancer worldwide and has a high rate of metastatic disease which is the main cause of CRC-related death. Oligometastatic disease is a clinical condition recently included in ESMO guidelines that can benefit from a more aggressive locoregional approach. This review focuses the attention on colorectal liver metastases (CRLM) and highlights recommendations and therapeutic locoregional strategies drawn from the current literature and consensus conferences. The different percutaneous therapies (radiofrequency ablation, microwave ablation, irreversible electroporation) as well as trans-arterial approaches (chemoembolization and radioembolization) are discussed. Ablation margins, the choice of the imaging guidance as well as characteristics of the different ablation techniques and other technical aspects are analyzed. A specific attention is then paid to the increasing role of biomarkers (in particular molecular profiling) and their role in the selection of the proper treatment for the right patient. In conclusion, in this review an up-to-date state of the art of the application of locoregional treatments on CRLM is provided, highlighting both technical aspects and the role of biomarkers, two sides of the same coin.
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Affiliation(s)
- Giovanni Mauri
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, IRCCS, 20141 Milan, Italy; (G.M.); (F.O.); (P.D.V.); (G.B.); (G.M.V.)
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, 20122 Milan, Italy
| | - Lorenzo Monfardini
- Divisione di Radiologia, Fondazione Poliambulanza, 25124 Brescia, Italy
- Correspondence: or
| | - Andrea Garnero
- Radiodiagnostica 1 U. A.O.U., San Luigi Gonzaga di Orbassano, Regione Gonzole 10, 10043 Orbassano, Torino, Italy; (A.G.); (M.B.); (A.V.); (M.C.)
- Department of Surgical Sciences, University of Turin, 10124 Torino, Italy;
| | - Maria Giulia Zampino
- Divisione di Oncologia Medica Gastrointestinale e Tumori Neuroendocrini, Istituto Europeo di Oncologia, IRCCS, 20141 Milan, Italy;
| | - Franco Orsi
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, IRCCS, 20141 Milan, Italy; (G.M.); (F.O.); (P.D.V.); (G.B.); (G.M.V.)
| | - Paolo Della Vigna
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, IRCCS, 20141 Milan, Italy; (G.M.); (F.O.); (P.D.V.); (G.B.); (G.M.V.)
| | - Guido Bonomo
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, IRCCS, 20141 Milan, Italy; (G.M.); (F.O.); (P.D.V.); (G.B.); (G.M.V.)
| | - Gianluca Maria Varano
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, IRCCS, 20141 Milan, Italy; (G.M.); (F.O.); (P.D.V.); (G.B.); (G.M.V.)
| | - Marco Busso
- Radiodiagnostica 1 U. A.O.U., San Luigi Gonzaga di Orbassano, Regione Gonzole 10, 10043 Orbassano, Torino, Italy; (A.G.); (M.B.); (A.V.); (M.C.)
| | - Carlo Gazzera
- Radiodiagnostica 1 U, A.O.U. Città della Scienza e della Salute, 10126 Torino, Italy;
| | - Paolo Fonio
- Department of Surgical Sciences, University of Turin, 10124 Torino, Italy;
- Radiodiagnostica 1 U, A.O.U. Città della Scienza e della Salute, 10126 Torino, Italy;
| | - Andrea Veltri
- Radiodiagnostica 1 U. A.O.U., San Luigi Gonzaga di Orbassano, Regione Gonzole 10, 10043 Orbassano, Torino, Italy; (A.G.); (M.B.); (A.V.); (M.C.)
- Department of Oncology, University of Turin, 10124 Torino, Italy
| | - Marco Calandri
- Radiodiagnostica 1 U. A.O.U., San Luigi Gonzaga di Orbassano, Regione Gonzole 10, 10043 Orbassano, Torino, Italy; (A.G.); (M.B.); (A.V.); (M.C.)
- Department of Oncology, University of Turin, 10124 Torino, Italy
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