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Carconi C, Cerreti M, Roberto M, Arrivi G, D'Ambrosio G, De Felice F, Di Civita MA, Iafrate F, Lucatelli P, Magliocca FM, Picchetto A, Picone V, Catalano C, Cortesi E, Tombolini V, Mazzuca F, Tomao S. The Management of Oligometastatic Disease in Colorectal Cancer: Present Strategies and Future Perspectives. Crit Rev Oncol Hematol 2023; 186:103990. [PMID: 37061075 DOI: 10.1016/j.critrevonc.2023.103990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/29/2023] [Accepted: 04/11/2023] [Indexed: 04/17/2023] Open
Abstract
Oligometastatic disease has been described as an intermediate clinical state between localized cancer and systemically metastasized disease. Recent clinical studies have shown prolonged survival when aggressive locoregional approaches are added to systemic therapies in patients with oligometastases. The aim of this review is to outline the newest options to treat oligometastatic colorectal cancer (CRC), also considering its molecular patterns. We present an overview of the available local treatment strategies, including surgical procedures, stereotactic body radiation therapy (SBRT), thermal ablation, as well as trans-arterial chemoembolization (TACE) and selective internal radiotherapy (SIRT). Moreover, since imaging methods provide crucial information for the early diagnosis and management of oligometastatic CRC, we discuss the role of modern radiologic techniques in selecting patients that are amenable to potentially curative locoregional treatments.
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Affiliation(s)
- Catia Carconi
- Sant'Andrea University Hospital, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Micaela Cerreti
- Sant'Andrea University Hospital, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Michela Roberto
- UOC Oncologia A, Department of radiological, Oncological and Anathomo-patological Science, Policlinico Umberto I, "Sapienza" University of Rome, 00161 Rome, Italy.
| | - Giulia Arrivi
- Oncology Unit, Sant' Andrea University Hospital, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giancarlo D'Ambrosio
- Department of General Surgery, Surgical Specialties and Organ Transplantation, Policlinico Umberto I, "Sapienza" University of Rome, 00161 Rome, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Mattia Alberto Di Civita
- UOC Oncologia A, Department of radiological, Oncological and Anathomo-patological Science, Policlinico Umberto I, "Sapienza" University of Rome, 00161 Rome, Italy
| | - Franco Iafrate
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Pierleone Lucatelli
- Vascular and Interventional radiology Unit, Department of radiological, Oncological and Anathomo-patological Science, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Fabio Massimo Magliocca
- Vascular and Interventional radiology Unit, Department of radiological, Oncological and Anathomo-patological Science, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Picchetto
- Emergency Department, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Vincenzo Picone
- UOC Oncologia B, Department of radiological, Oncological and Anathomo-patological Science, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Carlo Catalano
- Vascular and Interventional radiology Unit, Department of radiological, Oncological and Anathomo-patological Science, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Enrico Cortesi
- UOC Oncologia B, Department of radiological, Oncological and Anathomo-patological Science, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Vincenzo Tombolini
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Federica Mazzuca
- Oncology Unit, Sant' Andrea University Hospital, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Silverio Tomao
- Oncology Unit, Sant' Andrea University Hospital, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
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Orcajo-Rincon J, Rodríguez-Fraile M. ¿Está todo dicho en el tratamiento de las metástasis hepáticas del cáncer colorrectal con radioembolización, tras los resultados del EPOCH? Rev Esp Med Nucl Imagen Mol 2022. [DOI: 10.1016/j.remn.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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3
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Is everything said in the treatment of colorectal cancer liver metastases with radioembolization, after the EPOCH results? Rev Esp Med Nucl Imagen Mol 2022; 41:69-70. [DOI: 10.1016/j.remnie.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 11/15/2022]
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4
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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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Bioprospecting and Applications of Fungi: A Game Changer in Present Scenario. Fungal Biol 2021. [DOI: 10.1007/978-3-030-68260-6_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wang DS, Louie JD, Sze DY. Evidence-Based Integration of Yttrium-90 Radioembolization in the Contemporary Management of Hepatic Metastases from Colorectal Cancer. Tech Vasc Interv Radiol 2019; 22:74-80. [DOI: 10.1053/j.tvir.2019.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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7
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Carter R, Cheraghchi-Bashi A, Westhorpe A, Yu S, Shanneik Y, Seraia E, Ouaret D, Inoue Y, Koch C, Wilding J, Ebner D, Ryan AJ, Buffa FM, Sharma RA. Identification of anticancer drugs to radiosensitise BRAF-wild-type and mutant colorectal cancer. Cancer Biol Med 2019; 16:234-246. [PMID: 31516745 PMCID: PMC6713640 DOI: 10.20892/j.issn.2095-3941.2018.0284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/21/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Patients with BRAF-mutant colorectal cancer (CRC) have a poor prognosis. Molecular status is not currently used to select which drug to use in combination with radiotherapy. Our aim was to identify drugs that radiosensitise CRC cells with known BRAF status. METHODS We screened 298 oncological drugs with and without ionising radiation in colorectal cancer cells isogenic for BRAF. Hits from rank product analysis were validated in a 16-cell line panel of human CRC cell lines, using clonogenic survival assays and xenograft models in vivo. RESULTS Most consistently identified hits were drugs targeting cell growth/proliferation or DNA damage repair. The most effective class of drugs that radiosensitised wild-type and mutant cell lines was PARP inhibitors. In clonogenic survival assays, talazoparib produced a radiation enhancement ratio of 1.9 in DLD1 (BRAF-wildtype) cells and 1.8 in RKO (BRAF V600E) cells. In DLD1 xenografts, talazoparib significantly increased the inhibitory effect of radiation on tumour growth (P ≤ 0.01). CONCLUSIONS Our method for screening large drug libraries for radiosensitisation has identified PARP inhibitors as promising radiosensitisers of colorectal cancer cells with wild-type and mutant BRAF backgrounds.
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Affiliation(s)
- Rebecca Carter
- NIHR University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College London, London WC1E 6DD, UK
- NIHR Oxford Biomedical Research Centre, Department of Oncology, University of Oxford, Oxford OX1 2JD, UK
| | - Azadeh Cheraghchi-Bashi
- NIHR Oxford Biomedical Research Centre, Department of Oncology, University of Oxford, Oxford OX1 2JD, UK
| | - Adam Westhorpe
- NIHR University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College London, London WC1E 6DD, UK
- NIHR Oxford Biomedical Research Centre, Department of Oncology, University of Oxford, Oxford OX1 2JD, UK
| | - Sheng Yu
- Computational Biology and Integrative Genomics, University of Oxford, Oxford OX1 2JD, UK
| | - Yasmin Shanneik
- NIHR Oxford Biomedical Research Centre, Department of Oncology, University of Oxford, Oxford OX1 2JD, UK
| | - Elena Seraia
- NDM Research Building, Nuffield Department of Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Djamila Ouaret
- Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX1 2JD, UK
| | - Yasuhiro Inoue
- Mie University, Graduate School of Medicine, Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Edobashi 2-174, Tsu, Japan
| | - Catherine Koch
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142, USA
| | - Jenny Wilding
- Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX1 2JD, UK
| | - Daniel Ebner
- Target Discovery Institute, National Phenotypic Screening Centre, Nuffield Department of Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Anderson J. Ryan
- CRUK & MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford OX1 2JD, UK
| | - Francesca M. Buffa
- CRUK & MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford OX1 2JD, UK
| | - Ricky A. Sharma
- NIHR University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College London, London WC1E 6DD, UK
- NIHR Oxford Biomedical Research Centre, Department of Oncology, University of Oxford, Oxford OX1 2JD, UK
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Desmoplastic Small Round Cell Tumor: Imaging Pattern of Disease at Presentation. AJR Am J Roentgenol 2019; 212:W45-W54. [PMID: 30673334 DOI: 10.2214/ajr.18.20179] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this study is to evaluate the clinical, pathologic, and multimodality cross-sectional imaging features of a cohort of 94 patients with desmoplastic small round cell tumor (DSRCT). MATERIALS AND METHODS This retrospective study of 94 patients with pathologically verified DSRCT was conducted at a tertiary cancer center between 2001 and 2013. Epidemiologic, clinical, pathologic, and imaging findings were recorded. Tumor size, location, and shape and the distribution pattern of metastases at presentation were analyzed. RESULTS DSRCT most often occurred in young patients (median age, 21.5 years; range, 5-53 years), showing a marked predominance in male patients (86 male patients vs eight female patients). Eighty nine-patients (95%) were white (defined in this study as white or Hispanic), four were African American, and one was of Asian descent. Most patients had symptoms, with abdominal pain noted as the most common symptom. At initial presentation, 85 patients (90%) had multifocal disease, nodular disease, diffuse omental and peritoneal disease, or a combination of these conditions. Thirty-eight patients (40%) had diaphragmatic involvement. Thirty-two patients (34%) had liver metastases, and 49 patients (52%) had retroperitoneal involvement in the form of implants, tumoral extension, or nodal involvement. With regard to thoracic findings, 33 patients (35%) had nodal disease, 17 (18%) had pleural effusions, and only two (2%) had lung metastases at presentation. Twelve patients (13%) had calcified lesions. CONCLUSION DSRCT is a rare, multifocal peritoneal malignancy with frequently disseminated abdominal disease at presentation. In the abdomen, disease most commonly involves the omentum and peritoneum, followed by the retroperitoneum. The liver is the most common solid visceral metastatic site. A substantial number of patients have diaphragmatic involvement. In the thorax, nodal and pleural involvement is more common than lung involvement.
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Chauhan N, Mulcahy MF, Salem R, Benson Iii AB, Boucher E, Bukovcan J, Cosgrove D, Laframboise C, Lewandowski RJ, Master F, El-Rayes B, Strosberg JR, Sze DY, Sharma RA. TheraSphere Yttrium-90 Glass Microspheres Combined With Chemotherapy Versus Chemotherapy Alone in Second-Line Treatment of Patients With Metastatic Colorectal Carcinoma of the Liver: Protocol for the EPOCH Phase 3 Randomized Clinical Trial. JMIR Res Protoc 2019; 8:e11545. [PMID: 30664496 PMCID: PMC6354199 DOI: 10.2196/11545] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/09/2018] [Accepted: 11/09/2018] [Indexed: 12/21/2022] Open
Abstract
Background Colorectal cancer is one of the most common cancers and causes of cancer-related death. Up to approximately 70% of patients with metastatic colorectal cancer (mCRC) have metastases to the liver at initial diagnosis. Second-line systemic treatment in mCRC can prolong survival after development of disease progression during or after first-line treatment and in those who are intolerant to first-line treatment. Objective The objective of this study is to evaluate the efficacy and safety of transarterial radioembolization (TARE) with TheraSphere yttrium-90 (90Y) glass microspheres combined with second-line therapy in patients with mCRC of the liver who had disease progression during or after first-line chemotherapy. Methods EPOCH is an open-label, prospective, multicenter, randomized, phase 3 trial being conducted at up to 100 sites in the United States, Canada, Europe, and Asia. Eligible patients have mCRC of the liver and disease progression after first-line chemotherapy with either an oxaliplatin-based or irinotecan-based regimen and are eligible for second-line chemotherapy with the alternate regimen. Patients were randomized 1:1 to the TARE group (chemotherapy with TARE in place of the second chemotherapy infusion and subsequent resumption of chemotherapy) or the control group (chemotherapy alone). The addition of targeted agents is permitted. The primary end points are progression-free survival and hepatic progression-free survival. The study objective will be considered achieved if at least one primary end point is statistically significant. Secondary end points are overall survival, time to symptomatic progression defined as Eastern Cooperative Oncology Group Performance Status score of 2 or higher, objective response rate, disease control rate, quality-of-life assessment by the Functional Assessment of Cancer Therapy-Colorectal Cancer questionnaire, and adverse events. The study is an adaptive trial, comprising a group sequential design with 2 interim analyses with a planned maximum of 420 patients. The study is designed to detect a 2.5-month increase in median progression-free survival, from 6 months in the control group to 8.5 months in the TARE group (hazard ratio [HR] 0.71), and a 3.5-month increase in median hepatic progression-free survival time, from 6.5 months in the control group to 10 months in the TARE group (HR 0.65). On the basis of simulations, the power to detect the target difference in either progression-free survival or hepatic progression-free survival is >90%, and the power to detect the target difference in each end point alone is >80%. Results Patient enrollment ended in October 2018. The first interim analysis in June 2018 resulted in continuation of the study without any changes. Conclusions The EPOCH study may contribute toward the establishment of the role of combination therapy with TARE and oxaliplatin- or irinotecan-based chemotherapy in the second-line treatment of mCRC of the liver. Trial Registration ClinicalTrials.gov NCT01483027; https://clinicaltrials.gov/ct2/show/NCT01483027 (Archived by WebCite at http://www.webcitation.org/734A6PAYW) International Registered Report Identifier (IRRID) RR1-10.2196/11545
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Affiliation(s)
- Nikhil Chauhan
- Research and Development, BTG International group companies, London, United Kingdom
| | - Mary F Mulcahy
- Division of Hematology and Oncology, Department of Medicine, Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, United States
| | - Riad Salem
- Division of Hematology and Oncology, Department of Medicine, Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, United States.,Section of Interventional Radiology, Department of Radiology, Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, United States.,Division of Transplant Surgery, Department of Surgery, Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, United States
| | - Al B Benson Iii
- Division of Hematology and Oncology, Department of Medicine, Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, United States.,Northwestern Medical Group, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Eveline Boucher
- Research and Development, BTG International group companies, London, United Kingdom
| | - Janet Bukovcan
- Research and Development, BTG International group companies, London, United Kingdom
| | - David Cosgrove
- Division of Medical Oncology, Vancouver Cancer Center, Compass Oncology, Vancouver, WA, United States
| | - Chantal Laframboise
- Research and Development, BTG International group companies, London, United Kingdom
| | - Robert J Lewandowski
- Division of Hematology and Oncology, Department of Medicine, Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, United States.,Section of Interventional Radiology, Department of Radiology, Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, United States.,Division of Transplant Surgery, Department of Surgery, Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, United States
| | - Fayaz Master
- Research and Development, BTG International group companies, London, United Kingdom
| | - Bassel El-Rayes
- Winship Cancer Institute, Emory University, Atlanta, GA, United States.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | | | - Daniel Y Sze
- Interventional Radiology, Stanford University Medical Center, Stanford, CA, United States
| | - Ricky A Sharma
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, London, United Kingdom
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Coretti S, Rumi F, Sacchini D, Cicchetti A. SIR-Spheres ® Y-90 resin microspheres in chemotherapy refractory or intolerant patients with metastatic colorectal cancer. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2019. [DOI: 10.1177/2284240319847446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Selective internal radiation therapy is a form of intra-arterial brachytherapy used to treat primary liver cancer and liver metastases. This article aims to provide an overview of the clinical, economic, organizational legal, social and ethical impact of selective internal radiation therapy using SIR-Spheres Y-90 resin microspheres in the treatment of patients with unresectable, liver-dominant metastatic colorectal cancer who are refractory to or intolerant of chemotherapy. A systematic literature review was performed by querying PubMed, Scopus, EBSCO, CRD and GIN. Two reviewers blindly screened the records retrieved against predefined inclusion/exclusion criteria. The selected studies where summarized following a simplified version of the EuNetHTA Core Model® 2.1. The studies included evaluated selective internal radiation therapy in first-line or further-line treatment and showed a good safety and tolerability profile and significant improvement in efficacy expressed as time to liver progression, progression-free survival and overall survival. Selective internal radiation therapy should be provided in specialized centres and administered by a multidisciplinary team. A hub-and-spoke network could be a viable option to guarantee access to this technology across jurisdictions. The lack of a specific diagnosis-related group tariff accounting for the cost of the device could be seen as the major obstacle to a fair diffusion of this technology. The economic evaluations currently available show the cost-effectiveness of this technology in the population under study. Selective internal radiation therapy using SIR-Spheres Y-90 resin microspheres appears to be a clinically effective and cost-effective option in the treatment of metastatic colorectal cancer patients who are chemotherapy refractory or chemotherapy intolerant.
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Affiliation(s)
- Silvia Coretti
- Graduate School of Health Economics and Management, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Rumi
- Graduate School of Health Economics and Management, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dario Sacchini
- Institute of Bioethics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Americo Cicchetti
- Graduate School of Health Economics and Management, Università Cattolica del Sacro Cuore, Rome, Italy
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White J, Carolan-Rees G, Dale M, Morgan HE, Patrick HE, See TC, Beeton EL, Swinson DEB, Bell JK, Manas DM, Crellin A, Slevin NJ, Sharma RA. Analysis of a National Programme for Selective Internal Radiation Therapy for Colorectal Cancer Liver Metastases. Clin Oncol (R Coll Radiol) 2018; 31:58-66. [PMID: 30297164 DOI: 10.1016/j.clon.2018.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 12/20/2022]
Abstract
AIMS Patients with chemotherapy-refractory colorectal cancer liver metastases have limited therapeutic options. Selective internal radiation therapy (SIRT) delivers yttrium 90 microspheres as a minimally invasive procedure. This prospective, single-arm, observational, service-evaluation study was part of National Health Service England Commissioning through Evaluation. METHODS Patients eligible for treatment had histologically confirmed carcinoma with liver-only/liver-dominant metastases with clinical progression during or following oxaliplatin-based and irinotecan-based chemotherapy. All patients received SIRT plus standard of care. The primary outcome was overall survival; secondary outcomes included safety, progression-free survival (PFS) and liver-specific PFS (LPFS). RESULTS Between December 2013 and March 2017, 399 patients were treated in 10 centres with a median follow-up of 14.3 months (95% confidence interval 9.2-19.4). The median overall survival was 7.6 months (95% confidence interval 6.9-8.3). The median PFS and LPFS were 3.0 months (95% confidence interval 2.8-3.1) and 3.7 months (95% confidence interval 3.2-4.3), respectively. During the follow-up period, 143 patients experienced an adverse event and 8% of the events were grade 3. CONCLUSION Survival estimates from this pragmatic study show clinical outcomes attainable in the National Health Service comparable with previously published data. This study shows the value of a registry-based commissioning model to aid national commissioning decisions for highly specialist cancer treatments.
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Affiliation(s)
- J White
- Cedar, Cardiff & Vale University Health Board, Cardiff Medicentre, Cardiff, UK
| | - G Carolan-Rees
- Cedar, Cardiff & Vale University Health Board, Cardiff Medicentre, Cardiff, UK
| | - M Dale
- Cedar, Cardiff & Vale University Health Board, Cardiff Medicentre, Cardiff, UK
| | - H E Morgan
- Cedar, Cardiff University, Cardiff Medicentre, Cardiff, UK
| | - H E Patrick
- Centre for Health Technology Evaluation, National Institute for Health and Care Excellence, London, UK
| | - T C See
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - E L Beeton
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D E B Swinson
- Leeds Teaching Hospitals NHS Trust, St James's Hospital, Leeds, UK
| | - J K Bell
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - D M Manas
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - A Crellin
- NHS England, Institute of Oncology, St James's University Hospital, Leeds, UK
| | - N J Slevin
- The Christie NHS Foundation Trust, Withington, Manchester, UK
| | - R A Sharma
- NIHR University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College London, London, UK.
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12
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Levillain H, Duran Derijckere I, Marin G, Guiot T, Vouche M, Reynaert N, Hendlisz A, Vanderlinden B, Flamen P. 90Y-PET/CT-based dosimetry after selective internal radiation therapy predicts outcome in patients with liver metastases from colorectal cancer. EJNMMI Res 2018; 8:60. [PMID: 30006851 PMCID: PMC6045565 DOI: 10.1186/s13550-018-0419-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/27/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The aim of this work was to confirm that post-selective internal radiation therapy (SIRT) 90Y-PET/CT-based dosimetry correlates with lesion metabolic response and to determine its correlation with overall survival (OS) in liver-only metastases from colorectal cancer (mCRC) patients treated with SIRT. Twenty-four mCRC patients underwent pre/post-SIRT FDG-PET/CT and post-SIRT 90Y-PET/CT. Lesions delineated on pre/post-SIRT FDG-PET/CT were classified as non-metabolic responders (total lesion glycolysis (TLG)-decrease < 15%) and high-metabolic responders (TLG-decrease ≥ 50%). Lesion delineations were projected on the anatomically registered 90Y-PET/CT. Voxel-based 3D dosimetrywas performed on the 90Y-PET/CT and lesions' mean absorbed dose (Dmean) was measured. The coefficient of correlation between Dmean and TLG-decrease was calculated. The ability of lesion Dmean to predict non-metabolic response and high-metabolic response was tested and two cutoff values (Dmean-under-treated and Dmean-well-treated) were determined using ROC analysis. Patients were dichotomised in the "treated" group (all the lesions received a Dmean > Dmean-under-treated) and in the "under-treated" group (at least one lesion received a Dmean < Dmean-under-treated). Kaplan-Meier product limit method was used to describe OS curves. RESULTS Fifty-seven evaluable mCRC lesions were included. The coefficient of correlation between Dmean and TLG-decrease was 0.82. Two lesion Dmean cutoffs of 39 Gy (sensitivity 80%, specificity 95%, predictive-positive-value 86% and negative-predictive-value 92%) and 60 Gy (sensitivity 70%, specificity 95%, predictive positive-value 96% and negative-predictive-value 63%) were defined to predict non-metabolic response and high-metabolic response respectively. Patients with all lesions Dmean> 39 Gy had a significantly longer OS (13 months) than patients with at least one lesion Dmean < 39 Gy (OS = 5 months) (p = 0.012;hazard-ratio, 2.6 (95% CI 0.98-7.00)). CONCLUSIONS In chemorefractory mCRC patients treated with SIRT, lesion Dmean determined on post-SIRT 90Y-PET/CT correlates with metabolic response and higher lesion Dmean is associated with prolonged OS.
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Affiliation(s)
- Hugo Levillain
- Department of Nuclear Medicine, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet 1, B-1000, Brussels, Belgium.
| | - Ivan Duran Derijckere
- Department of Nuclear Medicine, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet 1, B-1000, Brussels, Belgium
| | - Gwennaëlle Marin
- Department of Medical Physics, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet 1, B-1000, Brussels, Belgium
| | - Thomas Guiot
- Department of Nuclear Medicine, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet 1, B-1000, Brussels, Belgium
| | - Michaël Vouche
- Department of Radiology, Hôpital St-Pierre, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet 1, B-1000, Brussels, Belgium
| | - Nick Reynaert
- Department of Medical Physics, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet 1, B-1000, Brussels, Belgium
| | - Alain Hendlisz
- Department of Digestive Oncology, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet 1, B-1000, Brussels, Belgium
| | - Bruno Vanderlinden
- Department of Medical Physics, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet 1, B-1000, Brussels, Belgium
| | - Patrick Flamen
- Department of Nuclear Medicine, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet 1, B-1000, Brussels, Belgium
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13
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Gill S, Liu DM, Green HM, Sharma RA. Beyond the Knife: The Evolving Nonsurgical Management of Oligometastatic Colorectal Cancer. Am Soc Clin Oncol Educ Book 2018; 38:209-219. [PMID: 30231355 DOI: 10.1200/edbk_200941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In patients with liver-limited oligometastatic disease, the goal of treatment can be curative intent. Historically, this was accomplished in patients presenting with upfront resectable disease. The availability of increasingly efficacious chemotherapy and biologic combinations with encouraging response rates led to the potential to convert unresectable disease to resectability. Beyond the backbone of surgery, we now have a portfolio of locoregional strategies to consider.From an interventional radiology perspective, the use of portal vein embolization can facilitate hypertrophy of the liver in anticipation of resection, thus converting unresectable disease to one amenable to a surgical approach with curative intent. Technological advances in liver-directed ablative therapies have afforded the possibility of eliminate radiographically evident disease with the hope for long-term disease control. Advanced radiotherapy techniques are further increasing the therapeutic options for patients with metastatic colorectal cancer. Improvements in external-beam radiotherapy over the past 2 decades include image-guided radiotherapy, intensity-modulated radiotherapy, stereotactic body radiotherapy, and proton-beam therapy. Finally, selective internal radiation therapy (SIRT) with microspheres labeled with the β-emitter 90Y enable targeted delivery of radiation to hepatic tumors. A coordinated multidisciplinary approach is required to integrate these nonsurgical adjuncts in an evidence-based manner to optimize outcomes for patients with potentially resectable metastatic disease. In this article, we summarize recent developments in systemic therapy, radiotherapy, and interventional liver-directed therapies that have changed the treatment landscape for patients with oligometastatic colorectal cancer.
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Affiliation(s)
- Sharlene Gill
- From the BC Cancer-Vancouver and Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; National Institute for Health Research University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College, London, United Kingdom
| | - David M Liu
- From the BC Cancer-Vancouver and Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; National Institute for Health Research University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College, London, United Kingdom
| | - Harshani M Green
- From the BC Cancer-Vancouver and Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; National Institute for Health Research University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College, London, United Kingdom
| | - Ricky A Sharma
- From the BC Cancer-Vancouver and Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; National Institute for Health Research University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College, London, United Kingdom
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Levi Sandri GB, Ettorre GM, Giannelli V, Colasanti M, Sciuto R, Pizzi G, Cianni R, D'Offizi G, Antonini M, Vennarecci G, Lucatelli P. Trans-arterial radio-embolization: a new chance for patients with hepatocellular cancer to access liver transplantation, a world review. Transl Gastroenterol Hepatol 2017; 2:98. [PMID: 29264436 DOI: 10.21037/tgh.2017.11.11] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 11/22/2017] [Indexed: 01/04/2023] Open
Abstract
Liver transplantation (LT) for hepatocellular carcinoma (HCC) within the Milan criteria (MC) is nowadays a curative procedure. Yttrium-90 microspheres radioembolization (Y90-RE) has shown to be an effective and safe treatment of primary liver tumors. The aim of this work is to offer a view on the publications which report on the use of Y90-RE as bridge or downstaging prior to LT. Twenty articles have been considered for this world review. About 178 LT in patients were treated with Y90-RE prior to LT. Most of patients had a downstaging strategy. In all series alpha-fetoproteins decreased between Y90-RE and LT. Therefore, Y90-RE may have an important role in the bridge and downstaging treatments.
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Affiliation(s)
| | | | | | - Marco Colasanti
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy
| | - Rosa Sciuto
- Division of Nuclear Medicine, IFO Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Pizzi
- Division of Interventional Radiology, IFO Regina Elena National Cancer Institute, Rome, Italy
| | - Roberto Cianni
- Division of Interventional Radiology, S. Camillo Hospital, Rome, Italy
| | - Gianpiero D'Offizi
- Division of Hepatology and Infectious Disease, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy
| | - Mario Antonini
- Anesthesiology and Intensive Care Unit, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy
| | - Giovanni Vennarecci
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy
| | - Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Rome, Italy
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15
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Ettorre GM, Levi Sandri GB, Laurenzi A, Colasanti M, Meniconi RL, Lionetti R, Santoro R, Lepiane P, Sciuto R, Pizzi G, Cianni R, Golfieri R, D'Offizi G, Pellicelli AM, Antonini M, Vennarecci G. Yttrium-90 Radioembolization for Hepatocellular Carcinoma Prior to Liver Transplantation. World J Surg 2017; 41:241-249. [PMID: 27495316 DOI: 10.1007/s00268-016-3682-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Liver transplantation (LT) is a well-established procedure for hepatocellular carcinoma (HCC) within the Milan criteria. Yttrium-90 microspheres radioembolization (Y90-RE) has shown to be an effective and safe treatment of primary liver tumors. We retrospectively evaluate the efficacy of the Y90-RE in patients with HCC prior to LT. METHODS From January 2002 to December 2015, 365 patients were transplanted at the San Camillo Hospital Center. One hundred forty-three patients were transplanted for HCC, and in 22 cases the patients were treated with Y90-RE before LT. RESULTS Three patients were treated with Y90-RE within the Milan criteria, and 19 patients were out of criteria before Y90-RE. Four patients had an increasing MELD score between Y90-RE and LT. On the other hand, alpha-fetoprotein decreases after Y90-RE treatment in all cases. No patient death was observed in Y90-RE procedure or at LT. In 78.9 % of cases, a successful downstaging was observed, and in 100 % of cases bridging was achieved. From Y90-RE treatment overall survival was 43.9 months. From LT, overall mean survival was 30.2 months with a free survival of 29.6 months. The overall survival after LT analysis between the patients treated with Y90-RE and patients without was not significant (p = 0.113). Free survival analysis was not significant (p = 0.897) between the two populations. CONCLUSIONS We successfully performed LT in patients after Y90-RE treatment both as bridging and downstaging for HCC and obtained a similar overall and free survival of LT for HCC within Milan criteria. Y90-RE becomes a real option to provide curative therapy for patients who traditionally are not considered eligible for surgery.
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Affiliation(s)
- Giuseppe Maria Ettorre
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy.
| | - Giovanni Battista Levi Sandri
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy.
| | - Andrea Laurenzi
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy
| | - Marco Colasanti
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy
| | - Roberto Luca Meniconi
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy
| | - Raffaella Lionetti
- Division of Hepatology and Infectious Disease, National Institute for Infectious Disease "L. Spallanzani", via Portuense 292, 00152, Rome, Italy
| | - Roberto Santoro
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy
| | - Pasquale Lepiane
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy
| | - Rosa Sciuto
- Division of Nuclear Medicine, IFO Regina Elena National Cancer Institute, via Elio Chianesi 53, 00100, Rome, Italy
| | - Giuseppe Pizzi
- Division of Interventional Radiology, IFO Regina Elena National Cancer Institute, via Elio Chianesi 53, 00100, Rome, Italy
| | - Roberto Cianni
- Division of Interventional Radiology, S.M. Goretti Hospital, via Guido Reni, 04010, Latina, Italy
| | - Rita Golfieri
- Division of Radiology, S. Orsola-Malpighi Hospital, via Pietro Albertoni 15, 40138, Bologna, Italy
| | - Gianpiero D'Offizi
- Division of Hepatology and Infectious Disease, National Institute for Infectious Disease "L. Spallanzani", via Portuense 292, 00152, Rome, Italy
| | - Adriano M Pellicelli
- Liver Unit, San Camillo Forlanini Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy
| | - Mario Antonini
- Anesthesiology and Intensive Care Unit, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy
| | - Giovanni Vennarecci
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy
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Venditti I, Cartoni A, Fontana L, Testa G, Scaramuzzo F, Faccini R, Terracciano CM, Camillocci ES, Morganti S, Giordano A, Scotognella T, Rotili D, Dini V, Marini F, Fratoddi I. Y3+ embedded in polymeric nanoparticles: Morphology, dimension and stability of composite colloidal system. Colloids Surf A Physicochem Eng Asp 2017. [DOI: 10.1016/j.colsurfa.2017.05.082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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17
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Boas FE, Bodei L, Sofocleous CT. Radioembolization of Colorectal Liver Metastases: Indications, Technique, and Outcomes. J Nucl Med 2017; 58:104S-111S. [PMID: 28864605 DOI: 10.2967/jnumed.116.187229] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/08/2017] [Indexed: 12/16/2022] Open
Abstract
Liver metastases are a major cause of death from colorectal cancer. Intraarterial therapy options for colorectal liver metastases include chemoinfusion via a hepatic arterial pump or port, irinotecan-loaded drug-eluting beads, and radioembolization using 90Y microspheres. Intraarterial therapy allows the delivery of a high dose of chemotherapy or radiation into liver tumors while minimizing the impact on liver parenchyma and avoiding systemic effects. Specificity in intraarterial therapy can be achieved both through preferential arterial flow to the tumor and through selective catheter positioning. In this review, we discuss indications, contraindications, preprocedure evaluation, activity prescription, follow-up, outcomes, and complications of radioembolization of colorectal liver metastases. Methods for preventing off-target embolization, increasing the specificity of microsphere delivery, and reducing the lung-shunt fraction are discussed. There are 2 types of 90Y microspheres: resin and glass. Because glass microspheres have a higher activity per particle, they can deliver a particular radiation dose with fewer particles, likely reducing embolic effects. Glass microspheres thus may be more suitable when early stasis or reflux is a concern, in the setting of hepatocellular carcinoma with portal vein invasion, and for radiation segmentectomy. Because resin microspheres have a lower activity per particle, more particles are needed to deliver a particular radiation dose. Resin microspheres thus may be preferable for larger tumors and those with high arterial flow. In addition, resin microspheres have been approved by the U.S. Food and Drug Administration for colorectal liver metastases, whereas institutional review board approval is required before glass microspheres can be used under a compassionate-use or research protocol. Finally, radiation segmentectomy involves delivering a calculated lobar activity of 90Y microspheres selectively to treat a tumor involving 1 or 2 liver segments. This technique administers a very high radiation dose and effectively causes the ablation of tumors that are too large or are in a location considered unsafe for thermal ablation. The selective delivery spares surrounding normal liver, reducing the risk of liver failure.
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Affiliation(s)
- F Edward Boas
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Lisa Bodei
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Constantinos T Sofocleous
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; and
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18
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Wasan HS, Gibbs P, Sharma NK, Taieb J, Heinemann V, Ricke J, Peeters M, Findlay M, Weaver A, Mills J, Wilson C, Adams R, Francis A, Moschandreas J, Virdee PS, Dutton P, Love S, Gebski V, Gray A, van Hazel G, Sharma RA. First-line selective internal radiotherapy plus chemotherapy versus chemotherapy alone in patients with liver metastases from colorectal cancer (FOXFIRE, SIRFLOX, and FOXFIRE-Global): a combined analysis of three multicentre, randomised, phase 3 trials. Lancet Oncol 2017; 18:1159-1171. [PMID: 28781171 PMCID: PMC5593813 DOI: 10.1016/s1470-2045(17)30457-6] [Citation(s) in RCA: 215] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/04/2017] [Accepted: 06/05/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Data suggest selective internal radiotherapy (SIRT) in third-line or subsequent therapy for metastatic colorectal cancer has clinical benefit in patients with colorectal liver metastases with liver-dominant disease after chemotherapy. The FOXFIRE, SIRFLOX, and FOXFIRE-Global randomised studies evaluated the efficacy of combining first-line chemotherapy with SIRT using yttrium-90 resin microspheres in patients with metastatic colorectal cancer with liver metastases. The studies were designed for combined analysis of overall survival. METHODS FOXFIRE, SIRFLOX, and FOXFIRE-Global were randomised, phase 3 trials done in hospitals and specialist liver centres in 14 countries worldwide (Australia, Belgium, France, Germany, Israel, Italy, New Zealand, Portugal, South Korea, Singapore, Spain, Taiwan, the UK, and the USA). Chemotherapy-naive patients with metastatic colorectal cancer (WHO performance status 0 or 1) with liver metastases not suitable for curative resection or ablation were randomly assigned (1:1) to either oxaliplatin-based chemotherapy (FOLFOX: leucovorin, fluorouracil, and oxaliplatin) or FOLFOX plus single treatment SIRT concurrent with cycle 1 or 2 of chemotherapy. In FOXFIRE, FOLFOX chemotherapy was OxMdG (oxaliplatin modified de Gramont chemotherapy; 85 mg/m2 oxaliplatin infusion over 2 h, L-leucovorin 175 mg or D,L-leucovorin 350 mg infusion over 2 h, and 400 mg/m2 bolus fluorouracil followed by a 2400 mg/m2 continuous fluorouracil infusion over 46 h). In SIRFLOX and FOXFIRE-Global, FOLFOX chemotherapy was modified FOLFOX6 (85 mg/m2 oxaliplatin infusion over 2 h, 200 mg leucovorin, and 400 mg/m2 bolus fluorouracil followed by a 2400 mg/m2 continuous fluorouracil infusion over 46 h). Randomisation was done by central minimisation with four factors: presence of extrahepatic metastases, tumour involvement of the liver, planned use of a biological agent, and investigational centre. Participants and investigators were not masked to treatment. The primary endpoint was overall survival, analysed in the intention-to-treat population, using a two-stage meta-analysis of pooled individual patient data. All three trials have completed 2 years of follow-up. FOXFIRE is registered with the ISRCTN registry, number ISRCTN83867919. SIRFLOX and FOXFIRE-Global are registered with ClinicalTrials.gov, numbers NCT00724503 (SIRFLOX) and NCT01721954 (FOXFIRE-Global). FINDINGS Between Oct 11, 2006, and Dec 23, 2014, 549 patients were randomly assigned to FOLFOX alone and 554 patients were assigned FOLFOX plus SIRT. Median follow-up was 43·3 months (IQR 31·6-58·4). There were 411 (75%) deaths in 549 patients in the FOLFOX alone group and 433 (78%) deaths in 554 patients in the FOLFOX plus SIRT group. There was no difference in overall survival (hazard ratio [HR] 1·04, 95% CI 0·90-1·19; p=0·61). The median survival time in the FOLFOX plus SIRT group was 22·6 months (95% CI 21·0-24·5) compared with 23·3 months (21·8-24·7) in the FOLFOX alone group. In the safety population containing patients who received at least one dose of study treatment, as treated, the most common grade 3-4 adverse event was neutropenia (137 [24%] of 571 patients receiving FOLFOX alone vs 186 (37%) of 507 patients receiving FOLFOX plus SIRT). Serious adverse events of any grade occurred in 244 (43%) of 571 patients receiving FOLFOX alone and 274 (54%) of 507 patients receiving FOLFOX plus SIRT. 10 patients in the FOLFOX plus SIRT group and 11 patients in the FOLFOX alone group died due to an adverse event; eight treatment-related deaths occurred in the FOLFOX plus SIRT group and three treatment-related deaths occurred in the FOLFOX alone group. INTERPRETATION Addition of SIRT to first-line FOLFOX chemotherapy for patients with liver-only and liver-dominant metastatic colorectal cancer did not improve overall survival compared with that for FOLFOX alone. Therefore, early use of SIRT in combination with chemotherapy in unselected patients with metastatic colorectal cancer cannot be recommended. To further define the role of SIRT in metastatic colorectal cancer, careful patient selection and studies investigating the role of SIRT as consolidation therapy after chemotherapy are needed. FUNDING Bobby Moore Fund of Cancer Research UK, Sirtex Medical.
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Affiliation(s)
- Harpreet S Wasan
- Imperial College Healthcare NHS Trust and Imperial College, Hammersmith Hospital, London, UK
| | | | - Navesh K Sharma
- Division of Radiation Oncology, Penn State Hershey Cancer Centre, School of Medicine, Hershey, PA, USA
| | - Julien Taieb
- Sorbonne Paris Cité, Université Paris Descartes, Georges Pompidou European Hospital, Department of Hepatogastroenterology and GI Oncology, Paris, France
| | - Volker Heinemann
- Department of Medical Oncology and Comprehensive Cancer Centre, Klinikum Grosshadern, Ludwig-Maximilian, University of Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
| | | | - Michael Findlay
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andrew Weaver
- Oxford University NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Jamie Mills
- Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Charles Wilson
- Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Cambridge, UK
| | | | - Anne Francis
- Oncology Clinical Trials Office, Department of Oncology, University of Oxford, Oxford, UK
| | | | - Pradeep S Virdee
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Peter Dutton
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Sharon Love
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Val Gebski
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Guy van Hazel
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Ricky A Sharma
- Cancer Research UK Medical Research Council (CRUK-MRC) Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK; National Institute for Health Research University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, London, UK.
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Abstract
OBJECTIVE This article reviews recent developments in targeted radionuclide therapy (TRT) approaches directed to malignant liver lesions, bone metastases, neuroendocrine tumors, and castrate-resistant metastatic prostate cancer and discusses challenges and opportunities in this field. CONCLUSION TRT has been employed since the first radioiodine thyroid treatment almost 75 years ago. Progress in the understanding of the complex underlying biology of cancer and advances in radiochemistry science, multimodal imaging techniques including the concept of "see and treat" within the framework of theranostics, and universal traction with the notion of precision medicine have all contributed to a resurgence of TRT.
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de Baere T, Tselikas L, Yevich S, Boige V, Deschamps F, Ducreux M, Goere D, Nguyen F, Malka D. The role of image-guided therapy in the management of colorectal cancer metastatic disease. Eur J Cancer 2017; 75:231-242. [DOI: 10.1016/j.ejca.2017.01.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 11/29/2016] [Accepted: 01/14/2017] [Indexed: 02/07/2023]
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Virdee PS, Moschandreas J, Gebski V, Love SB, Francis EA, Wasan HS, van Hazel G, Gibbs P, Sharma RA. Protocol for Combined Analysis of FOXFIRE, SIRFLOX, and FOXFIRE-Global Randomized Phase III Trials of Chemotherapy +/- Selective Internal Radiation Therapy as First-Line Treatment for Patients With Metastatic Colorectal Cancer. JMIR Res Protoc 2017; 6:e43. [PMID: 28351831 PMCID: PMC5388825 DOI: 10.2196/resprot.7201] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/19/2017] [Accepted: 01/21/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In colorectal cancer (CRC), unresectable liver metastases are associated with a poor prognosis. The FOXFIRE (an open-label randomized phase III trial of 5-fluorouracil, oxaliplatin, and folinic acid +/- interventional radioembolization as first-line treatment for patients with unresectable liver-only or liver-predominant metastatic colorectal cancer), SIRFLOX (randomized comparative study of FOLFOX6m plus SIR-Spheres microspheres versus FOLFOX6m alone as first-line treatment in patients with nonresectable liver metastases from primary colorectal carcinoma), and FOXFIRE-Global (assessment of overall survival of FOLFOX6m plus SIR-Spheres microspheres versus FOLFOX6m alone as first-line treatment in patients with nonresectable liver metastases from primary colorectal carcinoma in a randomized clinical study) clinical trials were designed to evaluate the efficacy and safety of combining first-line chemotherapy with selective internal radiation therapy (SIRT) using yttrium-90 resin microspheres, also called transarterial radioembolization. OBJECTIVE The aim of this analysis is to prospectively combine clinical data from 3 trials to allow adequate power to evaluate the impact of chemotherapy with SIRT on overall survival. METHODS Eligible patients are adults with histologically confirmed CRC and unequivocal evidence of liver metastases which are not treatable by surgical resection or local ablation with curative intent at the time of study entry. Patients may also have limited extrahepatic metastases. Final analysis will take place when all participants have been followed up for a minimum of 2 years. RESULTS Efficacy and safety estimates derived using individual participant data (IPD) from SIRFLOX, FOXFIRE, and FOXFIRE-Global will be pooled using 2-stage prospective meta-analysis. Secondary outcome measures include progression-free survival (PFS), liver-specific PFS, health-related quality of life, response rate, resection rate, and adverse event profile. The large study population will facilitate comparisons of low frequency adverse events and allow for more robust safety analyses. The potential treatment benefit in those patients who present with disease confined to the liver will be investigated using 1-stage IPD meta-analysis. Efficacy will be analyzed on an intention-to-treat basis. CONCLUSIONS This analysis will assess the impact of SIRT combined with chemotherapy on overall survival in the first-line treatment of metastatic CRC. If positive, the results will change the standard of care for this disease. TRIAL REGISTRATION FOXFIRE ISRCTN Registry ISRCTN83867919; http://www.isrctn.com/ISRCTN83867919 (Archived by WebCite at http://www.webcitation.org/6oN7axrvA). SIRFLOX ClinicalTrials.gov NCT00724503; https://clinicaltrials.gov/ ct2/show/NCT00724503 (Archived by WebCite at http://www.webcitation.org/6oN7lEGbD). FOXFIRE-Global ClinicalTrials.gov NCT01721954; https://clinicaltrials.gov/ct2/show/NCT01721954 (Archived by WebCite at http://www.webcitation.org/ 6oN7vvQvG).
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Affiliation(s)
- Pradeep S Virdee
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Joanna Moschandreas
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Sharon B Love
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - E Anne Francis
- Oncology Clinical Trials Office, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Harpreet S Wasan
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | | | - Peter Gibbs
- Western Hospital, Footscray, Victoria, Australia
| | - Ricky A Sharma
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom
- Cancer Research United Kingdom-Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
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Abastabar M, Akbari A, Akhtari J, Hedayati MT, Shokohi T, Mehrad-Majd H, Ghalehnoei H, Ghasemi S. In vitro antitumor activity of patulin on cervical and colorectal cancer cell lines. Curr Med Mycol 2017. [PMID: 29302627 PMCID: PMC5747586 DOI: 10.29252/cmm.3.1.25] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background and Purpose: Patulin is a mycotoxin produced by some molds, especially Aspergillus and Penicilium, and is responsible for mycotoxicosis in animals and humans. There is still not very detailed data about the anti-cancer potency of patulin, but some reports demonstrated that it induces cellular apoptosis and toxicity. Materials and Methods: To determine the efficacy of patulin as a therapeutic strategy for cervical and colorectal cancers, we investigated its effects on HeLa,SW-48, and MRC-5 cell lines. Cell lines were exposed to various concentrations of patulin (i.e., 0.5, 1, 2, and 4 µM), then using methyl thiazolyl tetrazolium (MTT) and bromo-2′-deoxyuridine (BrdU) assays, the rates of apoptosis and cell viability were determined. Results: The obtained results showed a significant reduction in cell viability and apoptosis induction in a dose-dependent manner. Among all the cell lines, the highest growth inhibition rate was obtained at the 4 μM concentration of patulin. Conclusion: Our results suggested that patulin could significantly decrease tumor growth in human cervical and colorectal cancer models.
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Affiliation(s)
- M Abastabar
- Department of Medical Mycology and Parasitology, Invasive Fungi Research Center (IFRC), Mazandaran University of Medical Sciences, Sari, Iran
| | - A Akbari
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - J Akhtari
- Immunogenetics Research Center, Department of Medical Nanotechnology, School of Advanced Technologies in Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - M T Hedayati
- Department of Medical Mycology and Parasitology, Invasive Fungi Research Center (IFRC), Mazandaran University of Medical Sciences, Sari, Iran
| | - T Shokohi
- Department of Medical Mycology and Parasitology, Invasive Fungi Research Center (IFRC), Mazandaran University of Medical Sciences, Sari, Iran
| | - H Mehrad-Majd
- Clinical Research Unit, Mashhad University of Medical Sciences, Mashhad, Iran
| | - H Ghalehnoei
- Immunogenetics Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - S Ghasemi
- Students Research Committee, Department of Parasitology and Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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23
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Abastabar M, Akbari A, Akhtari J, Hedayati MT, Shokohi T, Mehrad-Majd H, Ghalehnoei H, Ghasemi S. In vitro antitumor activity of patulin on cervical and colorectal cancer cell lines. Curr Med Mycol 2017; 3:25-29. [PMID: 29302627 PMCID: PMC5747586 DOI: 10.18869/acadpub.cmm.3.1.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/15/2017] [Accepted: 11/11/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND PURPOSE Patulin is a mycotoxin produced by some molds, especially Aspergillus and Penicilium, and is responsible for mycotoxicosis in animals and humans.There is still not very detailed data about the anti-cancer potency of patulin, but some reports demonstrated that it induces cellular apoptosis and toxicity. MATERIALS AND METHODS To determine the efficacy of patulin as a therapeutic strategy for cervical and colorectal cancers, we investigated its effects on HeLa,SW-48, and MRC-5 cell lines. Cell lines were exposed to various concentrations of patulin (i.e., 0.5, 1, 2, and 4 µM), then using methyl thiazolyl tetrazolium (MTT) and bromo-2'-deoxyuridine (BrdU) assays, the rates of apoptosis and cell viability were determined. RESULTS The obtained results showed a significant reduction in cell viability and apoptosis induction in a dose-dependent manner. Among all the cell lines, the highest growth inhibition rate was obtained at the 4 μM concentration of patulin. CONCLUSION Our results suggested that patulin could significantly decrease tumor growth in human cervical and colorectal cancer models.
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Affiliation(s)
- M Abastabar
- Department of Medical Mycology and Parasitology, Invasive Fungi Research Center (IFRC), Mazandaran University of Medical Sciences, Sari, Iran
| | - A Akbari
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - J Akhtari
- Immunogenetics Research Center, Department of Medical Nanotechnology, School of Advanced Technologies in Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - MT Hedayati
- Department of Medical Mycology and Parasitology, Invasive Fungi Research Center (IFRC), Mazandaran University of Medical Sciences, Sari, Iran
| | - T Shokohi
- Department of Medical Mycology and Parasitology, Invasive Fungi Research Center (IFRC), Mazandaran University of Medical Sciences, Sari, Iran
| | - H Mehrad-Majd
- Clinical Research Unit, Mashhad University of Medical Sciences, Mashhad, Iran
| | - H Ghalehnoei
- Immunogenetics Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - S Ghasemi
- Students Research Committee, Department of Parasitology and Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Kouri BE, Abrams RA, Al-Refaie WB, Azad N, Farrell J, Gaba RC, Gervais DA, Gipson MG, Kolbeck KJ, Marshalleck FE, Pinchot JW, Small W, Ray CE, Hohenwalter EJ. ACR Appropriateness Criteria Radiologic Management of Hepatic Malignancy. J Am Coll Radiol 2016; 13:265-73. [PMID: 26944037 DOI: 10.1016/j.jacr.2015.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 12/04/2015] [Indexed: 12/18/2022]
Abstract
Management of primary and secondary hepatic malignancy is a complex problem. Achieving optimal care for this challenging population often requires the involvement of multiple medical and surgical disciplines. Because of the wide variety of potential therapies, treatment protocols for various malignancies continue to evolve. Consequently, development of appropriate therapeutic algorithms necessitates consideration of medical options, such as systemic chemotherapy; surgical options, such as resection or transplantation; and loco-regional therapies, such as thermal ablation and transarterial embolization techniques. This article provides a review of treatment strategies for the three most common subtypes of hepatic malignancy treated with loco-regional therapies: hepatocellular carcinoma, neuroendocrine metastases, and colorectal metastases. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Affiliation(s)
- Brian E Kouri
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina.
| | | | - Waddah B Al-Refaie
- Georgetown University Hospital, Washington, District of Columbia, American College of Surgeons
| | - Nilofer Azad
- Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, Maryland, American Society of Clinical Oncology
| | - James Farrell
- Interventional Endoscopy and Pancreatic Diseases, New Haven, Connecticut, American Gastroenterological Association
| | - Ron C Gaba
- University of Illinois Hospital, Chicago, Illinois
| | | | - Matthew G Gipson
- University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | | | | | | | - William Small
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Charles E Ray
- University of Illinois Hospital and Health Science System, Chicago, Illinois
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25
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Kunz-Schughart LA, Dubrovska A, Peitzsch C, Ewe A, Aigner A, Schellenburg S, Muders MH, Hampel S, Cirillo G, Iemma F, Tietze R, Alexiou C, Stephan H, Zarschler K, Vittorio O, Kavallaris M, Parak WJ, Mädler L, Pokhrel S. Nanoparticles for radiooncology: Mission, vision, challenges. Biomaterials 2016; 120:155-184. [PMID: 28063356 DOI: 10.1016/j.biomaterials.2016.12.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/08/2016] [Accepted: 12/09/2016] [Indexed: 12/29/2022]
Abstract
Cancer is one of the leading non-communicable diseases with highest mortality rates worldwide. About half of all cancer patients receive radiation treatment in the course of their disease. However, treatment outcome and curative potential of radiotherapy is often impeded by genetically and/or environmentally driven mechanisms of tumor radioresistance and normal tissue radiotoxicity. While nanomedicine-based tools for imaging, dosimetry and treatment are potential keys to the improvement of therapeutic efficacy and reducing side effects, radiotherapy is an established technique to eradicate the tumor cells. In order to progress the introduction of nanoparticles in radiooncology, due to the highly interdisciplinary nature, expertise in chemistry, radiobiology and translational research is needed. In this report recent insights and promising policies to design nanotechnology-based therapeutics for tumor radiosensitization will be discussed. An attempt is made to cover the entire field from preclinical development to clinical studies. Hence, this report illustrates (1) the radio- and tumor-biological rationales for combining nanostructures with radiotherapy, (2) tumor-site targeting strategies and mechanisms of cellular uptake, (3) biological response hypotheses for new nanomaterials of interest, and (4) challenges to translate the research findings into clinical trials.
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Affiliation(s)
- Leoni A Kunz-Schughart
- OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Anna Dubrovska
- OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Claudia Peitzsch
- OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Alexander Ewe
- Rudolf-Boehm-Institute for Pharmacology and Toxicology, Clinical Pharmacology, University of Leipzig, Germany
| | - Achim Aigner
- Rudolf-Boehm-Institute for Pharmacology and Toxicology, Clinical Pharmacology, University of Leipzig, Germany
| | - Samuel Schellenburg
- Institute of Pathology, University Hospital, Carl Gustav Carus, TU Dresden, Germany
| | - Michael H Muders
- Institute of Pathology, University Hospital, Carl Gustav Carus, TU Dresden, Germany
| | - Silke Hampel
- Leibniz Institute of Solid State and Material Research Dresden, 01171 Dresden, Germany
| | - Giuseppe Cirillo
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, CS, Italy
| | - Francesca Iemma
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, CS, Italy
| | - Rainer Tietze
- ENT-Department, Section for Experimental Oncology and Nanomedicine (SEON), Else Kröner-Fresenius Professorship, University Hospital Erlangen, Erlangen, Germany
| | - Christoph Alexiou
- ENT-Department, Section for Experimental Oncology and Nanomedicine (SEON), Else Kröner-Fresenius Professorship, University Hospital Erlangen, Erlangen, Germany
| | - Holger Stephan
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, 01314 Dresden, Germany
| | - Kristof Zarschler
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, 01314 Dresden, Germany
| | - Orazio Vittorio
- Children's Cancer Institute Australia, ARC Centre of Excellence in Convergent Bio-Nano Science and Technology and Australian Centre for NanoMedicine, Sydney, UNSW, Australia
| | - Maria Kavallaris
- Children's Cancer Institute Australia, ARC Centre of Excellence in Convergent Bio-Nano Science and Technology and Australian Centre for NanoMedicine, Sydney, UNSW, Australia
| | - Wolfgang J Parak
- Fachbereich Physik, Philipps Universität Marburg, 35037 Marburg, Germany; CIC Biomagune, 20009 San Sebastian, Spain
| | - Lutz Mädler
- Foundation Institute of Materials Science (IWT), Department of Production Engineering, University of Bremen, 28359 Bremen, Germany
| | - Suman Pokhrel
- Foundation Institute of Materials Science (IWT), Department of Production Engineering, University of Bremen, 28359 Bremen, Germany.
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Fong CW. Platinum based radiochemotherapies: Free radical mechanisms and radiotherapy sensitizers. Free Radic Biol Med 2016; 99:99-109. [PMID: 27417937 DOI: 10.1016/j.freeradbiomed.2016.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/18/2016] [Accepted: 07/08/2016] [Indexed: 12/22/2022]
Abstract
The radiosensitizing ability of Pt drugs can in the first instance be predicted based on the ease that they undergo activation by electron attachment accompanied by structural modification prior to forming Pt-DNA adducts. Unlike cisplatin, carboplatin and nedaplatin, oxaliplatin does not undergo a facile dissociative electron transfer reaction when an electron is attached. However, oxaliplatin undergoes a facile nucleophilic assisted proton coupled electron transfer (NAPCET), which may be key element of the success of FOLFOX radiochemotherapy against certain cancers. Under acidic conditions, oxaliplatin is a superior radiosensitizer to cisplatin or carboplatin, in the presence of nucleophiles such as water, chloride ions or thiols. Oxaliplatin may also be activated as a platinating agent and radiosensitizer by a minor hydrogen radical free radical mechanism as well as the more dominant NAPCET mechanism. The radiosensitizing synergism that is shown when oxaliplatin is combined with 5-fluorouracil can be due to the formation of a π complex between the two drugs, which is more potent under acidic conditions. These factors have a bearing on Pt based chemotherapy clinical regimes as well as clinical radiochemotherapy regimes, and could be a basis for optimizing how such drug schedules are administered.
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Use of Yttrium-90 Radioembolization for Management of Colorectal Liver Metastases. CURRENT COLORECTAL CANCER REPORTS 2016. [DOI: 10.1007/s11888-016-0328-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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28
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Narsinh KH, Van Buskirk M, Kennedy AS, Suhail M, Alsaikhan N, Hoh CK, Thurston K, Minocha J, Ball DS, Cohen SJ, Cohn M, Coldwell DM, Drooz A, Ehrenwald E, Kanani S, Nutting CW, Moeslein FM, Savin MA, Schirm S, Putnam SG, Sharma NK, Wang EA, Rose SC. Hepatopulmonary Shunting: A Prognostic Indicator of Survival in Patients with Metastatic Colorectal Adenocarcinoma Treated with 90Y Radioembolization. Radiology 2016; 282:281-288. [PMID: 27440733 DOI: 10.1148/radiol.2016152100] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose To determine if high lung shunt fraction (LSF) is an independent prognostic indicator of poor survival in patients who undergo yttrium 90 radioembolization for unresectable liver-dominant metastatic colorectal cancer. Materials and Methods Retrospective data were analyzed from 606 patients (62% men; mean age, 62 years) who underwent radioembolization to treat liver metastases from colorectal adenocarcinoma between July 2002 and December 2011 at 11 U.S. centers. Institutional review board exemptions were granted prior to the collection of data at each site. Overall survival was estimated by using Kaplan-Meier survival and univariate Cox proportional hazards models to examine the effect of LSF on survival and to compare this to other potential prognostic indicators. Multivariate analysis was also performed to determine whether LSF is an independent risk factor for poor survival. Results LSF higher than 10% was predictive of significantly decreased survival (median, 6.9 months vs 10.0 months; hazard ratio, 1.60; P < .001) and demonstrated a mild but significant correlation to serum carcinoembryonic antigen levels and tumor-to-liver volume ratio (Pearson correlation coefficients, 0.105 and 0.113, respectively; P < .05). A progressive decrease in survival was observed as LSF increased from less than 5% to more than 20% (P < .05). LSF did not correlate with the presence of extrahepatic metastases or prior administration of bevacizumab. Conclusion Increased LSF is an independent prognostic indicator of worse survival in patients undergoing radioembolization for liver-dominant metastatic colorectal adenocarcinoma. High LSF correlates poorly to other potential markers of tumor size, such as tumor-to-liver volume ratio or serum carcinoembryonic antigen level, and does not correlate to the presence of extrahepatic metastases. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Kazim H Narsinh
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Mark Van Buskirk
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Andrew S Kennedy
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Mohammed Suhail
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Naif Alsaikhan
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Carl K Hoh
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Kenneth Thurston
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Jeet Minocha
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - David S Ball
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Steven J Cohen
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Michael Cohn
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Douglas M Coldwell
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Alain Drooz
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Eduardo Ehrenwald
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Samir Kanani
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Charles W Nutting
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Fred M Moeslein
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Michael A Savin
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Sabine Schirm
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Samuel G Putnam
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Navesh K Sharma
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Eric A Wang
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Steven C Rose
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
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Shiao J, Winter H, Sharma RA. Landmark study raises the bar for interventional oncology. Future Oncol 2016; 12:1747-9. [PMID: 27333807 DOI: 10.2217/fon-2016-0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Jay Shiao
- Oncology Department, Old Research Campus Research Building, University of Oxford, Oxford, OX3 7DQ, UK
| | - Helen Winter
- Oncology Department, Old Research Campus Research Building, University of Oxford, Oxford, OX3 7DQ, UK
| | - Ricky A Sharma
- Oncology Department, Old Research Campus Research Building, University of Oxford, Oxford, OX3 7DQ, UK
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Radiosensitisation of human colorectal cancer cells by ruthenium(II) arene anticancer complexes. Sci Rep 2016; 6:20596. [PMID: 26867983 PMCID: PMC4751532 DOI: 10.1038/srep20596] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/07/2016] [Indexed: 01/14/2023] Open
Abstract
Some of the largest improvements in clinical outcomes for patients with solid cancers observed over the past 3 decades have been from concurrent treatment with chemotherapy and radiotherapy (RT). The lethal effects of RT on cancer cells arise primarily from damage to DNA. Ruthenium (Ru) is a transition metal of the platinum group, with potentially less toxicity than platinum drugs. We postulated that ruthenium-arene complexes are radiosensitisers when used in combination with RT. We screened 14 ruthenium-arene complexes and identified AH54 and AH63 as supra-additive radiosensitisers by clonogenic survival assays and isobologram analyses. Both complexes displayed facial chirality. At clinically relevant doses of RT, radiosensitisation of cancer cells by AH54 and AH63 was p53-dependent. Radiation enhancement ratios for 5–10 micromolar drug concentrations ranged from 1.19 to 1.82. In p53-wildtype cells, both drugs induced significant G2 cell cycle arrest and apoptosis. Colorectal cancer cells deficient in DNA damage repair proteins, EME1 and MUS81, were significantly more sensitive to both agents. Both drugs were active in cancer cell lines displaying acquired resistance to oxaliplatin or cisplatin. Our findings broaden the potential scope for these drugs for use in cancer therapy, including combination with radiotherapy to treat colorectal cancer.
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Local Therapy Options for Oligometastatic Disease in the Liver. CURRENT COLORECTAL CANCER REPORTS 2015. [DOI: 10.1007/s11888-015-0279-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Justinger C, Kouladouros K, Gärtner D, Tatsch K, Reimer P, Rüdiger T, Binnenhei M, Bentz M, Schön MR. Liver resection after selective internal radiotherapy (SIRT): Proof of concept, initial survival, and safety. J Surg Oncol 2015; 112:436-42. [PMID: 26256832 DOI: 10.1002/jso.24000] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 07/21/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Extent of liver resections are restricted by the volume of the future liver remnant. Different strategies have been developed to increase the frequency of curative resections. Selective internal radiation therapy (SIRT) has emerged as an effective therapy for patients with primary non-resectable malignancies of the liver. Here, we report the first clinical series of patients with curative liver resection following SIRT. METHODS Starting 2010, patients with marginally resectable liver metastases treated by SIRT followed by liver resection were identified and prospectively documented in a database for subsequent retrospective analysis. RESULTS Thirteen patients (five female, eight male; age 70 years [32-77 years]) with marginally resectable liver metastases were selected for liver resection after SIRT. After performing SIRT, 12 patients had potentially curative hepatic resection. In two patients, liver resection after SIRT could not be performed due to the appearance of new extrahepatic metastases. Analyzing the effect of SIRT, we observed a decrease in tumor size with central scaring. None of the patients developed liver necrosis after SIRT. Liver resection was performed safely in all patients. CONCLUSIONS The combination of SIRT with state-of-the-art liver surgery opens up new therapeutic options in patients with liver metastases.
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Affiliation(s)
- Christoph Justinger
- Department of General and Visceral Surgery, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | | | - Daniel Gärtner
- Department of General and Visceral Surgery, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Klaus Tatsch
- Department of Nuclear Medicine, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Peter Reimer
- Department of Diagnostic and Interventional Radiology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Thomas Rüdiger
- Department of Pathology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Martin Binnenhei
- Department of Oncology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Martin Bentz
- Department of Oncology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Michael R Schön
- Department of General and Visceral Surgery, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
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Ablative and catheter-directed therapies for colorectal liver and lung metastases. Hematol Oncol Clin North Am 2015; 29:117-33. [PMID: 25475575 DOI: 10.1016/j.hoc.2014.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Increasing data on treatment of liver metastases with locoregional therapies have solidified the expanding role of interventional radiologists (IRs) in the treatment of liver metastases from colorectal cancer. Ablative approaches such as radiofrequency ablation and microwave ablation have shown durable eradication of tumors. Catheter-directed therapies such as transarterial chemoembolization, drug-eluting beads, yttrium-90 radioembolization, and intra-arterial chemotherapy ports represent potential techniques for managing patients with unresectable liver metastases. Understanding the timing and role of these techniques in multidisciplinary care of patients is crucial. Implementation of IRs for consultation enables better integration of these therapies into patients' overall care.
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de Baere T, Tselikas L, Pearson E, Yevitch S, Boige V, Malka D, Ducreux M, Goere D, Elias D, Nguyen F, Deschamps F. Interventional oncology for liver and lung metastases from colorectal cancer: The current state of the art. Diagn Interv Imaging 2015; 96:647-54. [DOI: 10.1016/j.diii.2015.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 04/08/2015] [Indexed: 02/07/2023]
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Sharma RA, Peeters M, Taïeb J. Case histories in unresectable liver-dominant metastatic colorectal cancer. Future Oncol 2014; 10:41-7. [PMID: 25478766 DOI: 10.2217/fon.14.222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ricky A Sharma
- CRUK-MRC Oxford Institute for Radiation Oncology, Department of Oncology, Old Road Campus Research Building, University of Oxford, Oxford, OX3 7DQ, UK
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Selective Internal Radiotherapy of the Liver: At the Crossroads of Interventional Oncology Research and National Health Service Commissioning. Clin Oncol (R Coll Radiol) 2014; 26:733-5. [DOI: 10.1016/j.clon.2014.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 09/10/2014] [Indexed: 11/21/2022]
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Abstract
[(18)F]Fluorodeoxyglucose (FDG) PET is a functional imaging tool that provides metabolic information, which has the potential to detect a lesion before it becomes anatomically apparent. This ability constitutes a strong argument for using FDG-PET/computed tomography (CT) in the management of oncology patients. Many studies have investigated the accuracy of FDG-PET or FDG-PET/CT for these purposes, but with small sample sizes based on retrospective cohorts. This article provides an overview of the role of FDG-PET or FDG-PET/CT in patients with liver malignancies treated by means of surgical resection, ablative therapy, chemoembolization, radioembolization, and brachytherapy, all being liver-directed oncologic interventions.
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Gibbs P, Tie J, Bester L. Radioembolization for colorectal cancer liver metastases: current role and future opportunities – the medical oncologist’s perspective. COLORECTAL CANCER 2014. [DOI: 10.2217/crc.14.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
SUMMARY The liver is the most common and often the only site of metastatic disease in patients with metastatic colorectal cancer. For patients who do not have resectable disease, a number of liver-directed therapies are increasingly being used in routine clinical practice, including yttrium-90 radioembolization. The challenge for the medical oncologist is how best to integrate this promising new option into routine practice in the setting of ever-evolving standard systemic therapy options. Here we review the most recent data on the efficacy and safety of yttrium-90, considerations when selecting patients for treatment and we examine the potential impact of current clinical trials.
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Affiliation(s)
- Peter Gibbs
- Department of Medical Oncology, Royal Melbourne Hospital, Parkville, Melbourne, Australia
| | - Jeanne Tie
- Systems Biology Division, Walter and Eliza Hall Institute, Parkville, Melbourne, Australia
| | - Lourens Bester
- Interventional Radiology, Department of Medical Imaging, St Vincent’s Hospital, Sydney, Australia
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Dutton SJ, Kenealy N, Love SB, Wasan HS, Sharma RA. FOXFIRE protocol: an open-label, randomised, phase III trial of 5-fluorouracil, oxaliplatin and folinic acid (OxMdG) with or without interventional Selective Internal Radiation Therapy (SIRT) as first-line treatment for patients with unresectable liver-only or liver-dominant metastatic colorectal cancer. BMC Cancer 2014; 14:497. [PMID: 25011439 PMCID: PMC4107961 DOI: 10.1186/1471-2407-14-497] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/30/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the second most common malignancy in Europe and a leading cause of cancer-related death. Almost 50% of patients with CRC develop liver metastases, which heralds a poor prognosis unless metastases can be downsized to surgical resection or ablation. The FOXFIRE trial examines the hypothesis that combining radiosensitising chemotherapy (OxMdG: oxaliplatin, 5-fluorouracil and folic acid) with Selective Internal Radiation Therapy (SIRT or radioembolisation) using yttrium-90 resin microspheres (SIR-Spheres®; Sirtex Medical Limited, North Sydney, Australia) as a first-line treatment for liver-dominant metastatic CRC will improve clinical outcomes when compared to OxMdG chemotherapy alone. METHODS/DESIGN FOXFIRE is an open-label, multicentre, randomised controlled trial of OxMdG with or without the addition of SIRT (1:1 randomisation). Eligible adult patients have histologically confirmed colorectal adenocarcinoma, liver metastases measurable on computed tomography scan and untreatable by either surgical resection or local ablation, and they may have limited extra-hepatic disease, defined as ≤5 nodules in the lung and/or one other metastatic site which is amenable to future definitive treatment. Eligible patients may have received adjuvant chemotherapy following resection of the primary tumour, but are not permitted to have previously received chemotherapy for metastatic disease, and must have a life expectancy of ≥3 months and a WHO performance status of 0-1. The primary outcome is overall survival. Secondary outcomes include progression free survival (PFS), liver-specific PFS, patient-reported outcomes, safety, response rate, resection rate and cost-effectiveness. FOXFIRE shares a combined statistical analysis plan with an international sister trial called SIRFLOX. DISCUSSION This trial is establishing a network of SIRT centres and 'feeder' chemotherapy-only centres to standardise the delivery of SIRT across the whole of the UK and to provide greater equity of access to this highly specialised liver-directed therapy. The FOXFIRE trial will establish the potential role of adding SIRT to first-line chemotherapy for unresectable liver metastatic colorectal cancer, and the impact on current treatment paradigms for metastatic CRC. TRIAL REGISTRATION ISRCTN83867919.
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Affiliation(s)
- Susan J Dutton
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nicola Kenealy
- Oncology Clinical Trials Office, Department of Oncology, University of Oxford, Oxford, UK
| | - Sharon B Love
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Harpreet S Wasan
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Ricky A Sharma
- CRUK-MRC Oxford Institute for Radiation Oncology, NIHR Biomedical Research Centre Oxford, Department of Oncology, University of Oxford, Old Road Campus Research Building, Oxford, UK
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41
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Hosein PJ, Echenique A, Loaiza-Bonilla A, Froud T, Barbery K, Rocha Lima CM, Yrizarry JM, Narayanan G. Percutaneous irreversible electroporation for the treatment of colorectal cancer liver metastases with a proposal for a new response evaluation system. J Vasc Interv Radiol 2014; 25:1233-1239.e2. [PMID: 24861662 DOI: 10.1016/j.jvir.2014.04.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 04/11/2014] [Accepted: 04/11/2014] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To describe an initial experience with irreversible electroporation (IRE) in patients with colorectal liver metastasis (CLM). MATERIALS AND METHODS A retrospective analysis of patients undergoing IRE for the management of CLM was performed. Procedures were done percutaneously under general anesthesia. Patients were then followed for adverse events, tumor response, and survival. RESULTS Between March 2010 and February 2013, 29 patients underwent percutaneous ablation of 58 tumors in 36 IRE sessions. Most patients (89%) had an absolute or relative contraindication to thermal ablation. The median age was 62 years, and the median time from diagnosis to IRE was 28 months. The median number of lesions treated per patient was two, and the median tumor size was 2.7 cm. Patients had received previous chemotherapy regimens (range, 1-5 per patient). A new Metabolic Imaging And Marker Integration response evaluation criteria was used for response assessment, and was a predictor of progression-free and overall survival. The 2-year progression-free survival rate was 18% (95% confidence interval, 0%-35%), and the 2-year overall survival rate was 62% (95% confidence interval, 37%-87%). Complications included arrhythmias (n = 1) and postprocedure pain (n = 1). Both patients recovered without sequelae. CONCLUSIONS Percutaneous IRE of CLM is feasible and safe. A new response evaluation system for colorectal cancer appears to be prognostic.
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Affiliation(s)
- Peter J Hosein
- Department of Medicine and Division of Hematology/Oncology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave., Suite 3400, Miami, FL 33136.
| | - Ana Echenique
- Department of Radiology and Division of Vascular/Interventional Radiology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave., Suite 3400, Miami, FL 33136
| | - Arturo Loaiza-Bonilla
- Department of Medicine and Division of Hematology/Oncology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave., Suite 3400, Miami, FL 33136
| | - Tatiana Froud
- Department of Radiology and Division of Vascular/Interventional Radiology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave., Suite 3400, Miami, FL 33136
| | - Katuzka Barbery
- Department of Radiology and Division of Vascular/Interventional Radiology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave., Suite 3400, Miami, FL 33136
| | - Caio M Rocha Lima
- Department of Radiology and Division of Vascular/Interventional Radiology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave., Suite 3400, Miami, FL 33136
| | - Jose M Yrizarry
- Department of Radiology and Division of Vascular/Interventional Radiology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave., Suite 3400, Miami, FL 33136
| | - Govindarajan Narayanan
- Department of Radiology and Division of Vascular/Interventional Radiology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave., Suite 3400, Miami, FL 33136
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42
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Xing M, Kooby DA, El-Rayes BF, Kokabi N, Camacho JC, Kim HS. Locoregional therapies for metastatic colorectal carcinoma to the liver--an evidence-based review. J Surg Oncol 2014; 110:182-96. [PMID: 24760444 DOI: 10.1002/jso.23619] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/18/2014] [Indexed: 12/17/2022]
Abstract
The liver is the most common visceral site of colorectal cancer metastasis and recurrence. Given that only 25% of patients with colorectal liver metastases are amenable to curative surgical resection at initial diagnosis, locoregional intra-arterial therapies including hepatic arterial infusion chemotherapy, conventional transarterial chemoembolization, drug-eluting-bead transarterial chemoembolization, and radioembolization have increasingly developed as viable treatment options. The rationale, efficacy, safety, and toxicity of each of these therapies are reviewed and stratified based on current evidence.
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Affiliation(s)
- Minzhi Xing
- Division of Interventional Radiology, Department of Radiology, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA; Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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43
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Safety of redo hepatectomy for colorectal liver metastases after selective interarterial radiation therapy: a case report. Case Rep Surg 2014; 2014:712572. [PMID: 24716079 PMCID: PMC3971541 DOI: 10.1155/2014/712572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 01/19/2014] [Indexed: 11/30/2022] Open
Abstract
Surgical resection is the only potentially curative strategy in the treatment of patients with colorectal liver metastases (CLM). Unfortunately, only about 10%–15% of patients are candidates for resection. Preoperative chemotherapy aims to increase the number of patients that may be eligible for liver resection by downsizing liver metastases. For patients with unresectable, chemotherapy refractory CLM the available treatment options are limited. Selective interarterial radiation therapy (SIRT) is one of the most promising treatment options for this group of patients. Although only a small number of these patients have been reported as becoming candidates for potentially curative hepatic resection following sufficient reduction in the volume of liver metastases, the question arises regarding the safety of liver resection in these patients. We report a case of a patient who presented unresectable liver relapse of CLM after previous right hepatectomy. He underwent SIRT which resulted in downsizing of the liver metastases making the patient candidate for left lateral sectionectomy. He underwent the redo hepatectomy without any complications. To the best of our knowledge, this is the first reported case of redo hepatectomy after SIRT for CLM.
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44
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Bester L, Meteling B, Boshell D, Saxena A, Morris DL. Current role of transarterial chemoembolization and radioembolization in the treatment of metastatic colorectal cancer. Hepat Oncol 2014; 1:215-228. [PMID: 30190956 DOI: 10.2217/hep.13.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
In this article, we review two liver-directed therapies that are currently used for the palliative treatment of primary and secondary hepatic malignancies, transcatheter arterial chemoembolization (TACE), including a new type of TACE with drug-eluting beads, and radioembolization. Important developments and administration techniques for all therapies are discussed, as well as their integration into the current routine clinical care for management of metastatic colorectal cancer. According to published data from clinical trials, as presented in this review, both radioembolization and TACE/TACE with drug-eluting beads have been proven to be safe and effective in selected patients with chemorefractory liver metastases from colorectal cancer. For patients with unresectable liver-only or liver-dominant disease who have failed standard chemotherapy options or for whom chemotherapy is contraindicated, new modalities, such as those discussed, are particularly valid and promising if clinical guidelines for patient selection and treatment administration are followed.
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Affiliation(s)
- Lourens Bester
- Department of Interventional Radiology, University of New South Wales, St. Vincent's Hospital, Darlinghurst, New South Wales 2010, Australia.,Department of Interventional Radiology, University of New South Wales, St. Vincent's Hospital, Darlinghurst, New South Wales 2010, Australia
| | - Baerbel Meteling
- Department of Interventional Radiology, University of New South Wales, St. Vincent's Hospital, Darlinghurst, New South Wales 2010, Australia.,Department of Interventional Radiology, University of New South Wales, St. Vincent's Hospital, Darlinghurst, New South Wales 2010, Australia
| | - David Boshell
- Department of Interventional Radiology, University of New South Wales, St. Vincent's Hospital, Darlinghurst, New South Wales 2010, Australia.,Department of Interventional Radiology, University of New South Wales, St. Vincent's Hospital, Darlinghurst, New South Wales 2010, Australia
| | - Akshat Saxena
- Department of Surgery, University of New South Wales, St. George Hospital, Kogarah, New South Wales 2217, Australia.,Department of Surgery, University of New South Wales, St. George Hospital, Kogarah, New South Wales 2217, Australia
| | - David L Morris
- Department of Surgery, University of New South Wales, St. George Hospital, Kogarah, New South Wales 2217, Australia.,Department of Surgery, University of New South Wales, St. George Hospital, Kogarah, New South Wales 2217, Australia
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Fernández-Ros N, Silva N, Bilbao JI, Iñarrairaegui M, Benito A, D'Avola D, Rodriguez M, Rotellar F, Pardo F, Sangro B. Partial liver volume radioembolization induces hypertrophy in the spared hemiliver and no major signs of portal hypertension. HPB (Oxford) 2014; 16:243-9. [PMID: 23530966 PMCID: PMC3945850 DOI: 10.1111/hpb.12095] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 02/07/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Post-treatment contralateral hemiliver hypertrophy has created an interest in lobar liver radioembolization (RE) as a pre-surgery tool. METHODS Liver and spleen volumes and function were studied in 83 patients submitted to partial liver volume RE at 4-8 weeks (T1), 10-26 weeks (T2), and >26 weeks (T3) after RE. RESULTS More than half of the patients had cirrhosis with hepatocellular carcinoma. The main finding was a progressive increase in the volume of the spared hemiliver (mean absolute increase at T3: 230 ml). The percentage of patients in whom the baseline ratio of spared volume to total liver volume was <40% dropped from 56.6% at baseline to 29.4% at T2 (P < 0.001). A significant and progressive increase in spleen volume but not in portal vein diameter was also observed. A small percentage of patients developed hypersplenism, mostly those without cirrhosis (16.0% at T2). Six patients (five with portal vein thrombosis, cirrhosis or both) developed signs of portal hypertension by T2. CONCLUSIONS The present results warrant further studies to better elucidate the mechanism underlying this phenomenon of spared hemiliver hypertrophy and to investigate its role as an alternative to portal vein embolization in the management of patients with potentially resectable liver tumours.
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Affiliation(s)
- Nerea Fernández-Ros
- Liver Unit, Department of Internal Medicine, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain
| | - Nuno Silva
- Department of Radiology, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain
| | - Jose Ignacio Bilbao
- Department of Radiology, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain,HPB Oncology Area, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain
| | - Mercedes Iñarrairaegui
- Liver Unit, Department of Internal Medicine, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain,HPB Oncology Area, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd; Network Centre for Biomedical Research into Hepatic and Digestive Diseases)Pamplona, Spain
| | - Alberto Benito
- Department of Radiology, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain,HPB Oncology Area, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain
| | - Delia D'Avola
- Liver Unit, Department of Internal Medicine, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd; Network Centre for Biomedical Research into Hepatic and Digestive Diseases)Pamplona, Spain
| | - Macarena Rodriguez
- Department of Nuclear Medicine, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain,HPB Oncology Area, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain
| | - Fernando Rotellar
- Department of Hepatopancreatobiliary (HPB) Surgery, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain,HPB Oncology Area, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain
| | - Fernando Pardo
- Department of Hepatopancreatobiliary (HPB) Surgery, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain,HPB Oncology Area, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain
| | - Bruno Sangro
- Liver Unit, Department of Internal Medicine, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain,HPB Oncology Area, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd; Network Centre for Biomedical Research into Hepatic and Digestive Diseases)Pamplona, Spain,Correspondence Bruno Sangro, Liver Unit, Department of Internal Medicine, Clinica Universidad de Navarra, Avenida Pio XII 36, 31008 Pamplona, Spain. Tel: + 34 948 296 637. Fax: + 34 948 296 500. E-mail:
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46
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Vente MAD, Zonnenberg BA, Nijsen JFW. Microspheres for radioembolization of liver malignancies. Expert Rev Med Devices 2014; 7:581-3. [DOI: 10.1586/erd.10.48] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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47
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Rosenbaum CE, Verkooijen HM, Lam MG, Smits ML, Koopman M, van Seeters T, Vermoolen MA, van den Bosch MA. Radioembolization for Treatment of Salvage Patients with Colorectal Cancer Liver Metastases: A Systematic Review. J Nucl Med 2013; 54:1890-5. [DOI: 10.2967/jnumed.113.119545] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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48
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Fendler WP, Philippe Tiega DB, Ilhan H, Paprottka PM, Heinemann V, Jakobs TF, Bartenstein P, Hacker M, Haug AR. Validation of Several SUV-Based Parameters Derived from 18F-FDG PET for Prediction of Survival After SIRT of Hepatic Metastases from Colorectal Cancer. J Nucl Med 2013; 54:1202-8. [DOI: 10.2967/jnumed.112.116426] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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49
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Wang DS, Louie JD, Sze DY. Intra-arterial therapies for metastatic colorectal cancer. Semin Intervent Radiol 2013; 30:12-20. [PMID: 24436513 PMCID: PMC3700785 DOI: 10.1055/s-0033-1333649] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Intra-arterial therapies for unresectable hepatic metastases from colorectal cancer include radioembolization (RE) with yttrium-90 microspheres, transarterial chemoembolization (TACE), hepatic arterial infusion, and percutaneous hepatic perfusion using an organ isolation system. In this article, we discuss our approach toward treatment selection, followed by details of how RE and TACE are performed at our institution.
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Affiliation(s)
- David S. Wang
- Division of Interventional Radiology, Department of Radiology, Stanford University Medical Center, Stanford, California
| | - John D. Louie
- Division of Interventional Radiology, Department of Radiology, Stanford University Medical Center, Stanford, California
| | - Daniel Y. Sze
- Division of Interventional Radiology, Department of Radiology, Stanford University Medical Center, Stanford, California
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50
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Wang LM, Jani AR, Hill EJ, Sharma RA. Anatomical basis and histopathological changes resulting from selective internal radiotherapy for liver metastases. J Clin Pathol 2012; 66:205-11. [PMID: 23162108 PMCID: PMC3595145 DOI: 10.1136/jclinpath-2012-201231] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Knowledge that liver tumours preferentially take their blood supply from the arterial blood supply rather than the portal venous system can be used for local delivery of treatment or for embolisation to cut off the blood supply to tumours. AIMS To present histological evaluation of malignant and non-malignant hepatic tissue of one such therapy, selective internal radiation therapy (SIRT) with yttrium-90 microspheres, to decipher its principal mechanism of action. METHODS The H&E stained sections of hepatic resection specimens from three patients with liver metastases from colorectal (CRC) cancer, who underwent hepatic surgery 4-9 months following SIRT, were examined and the pathological changes documented. RESULTS Resin microspheres were identified in the vascular tumour bed and vessels within the portal tracts of the background liver parenchyma. Microspheres were usually associated with giant cell reaction or histiocytes. In the tumour bed, tumour necrosis, mucinous alteration, collections of foamy histiocytes, ectatic vessels, calcification and fibrosis were observed. There was minimal cellular inflammatory response observed, suggestive of direct radiation injury as a non-immune mediated process. CONCLUSIONS We describe in detail the spectrum of histopathological changes in malignant tissue and liver parenchyma in patients with metastatic CRC treated with SIRT. Our findings are consistent with the hypothesis that the principal mechanism of action of SIRT appears to be via arterially directed delivery of highly radioactive microspheres in and around the vascular tumour bed rather than by micro-arterial embolisation.
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Affiliation(s)
- Lai Mun Wang
- Department of Cellular Pathology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK
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