1
|
DePietro DM, Li X, Shamimi-Noori SM. Chemoembolization Beyond Hepatocellular Carcinoma: What Tumors Can We Treat and When? Semin Intervent Radiol 2024; 41:27-47. [PMID: 38495263 PMCID: PMC10940046 DOI: 10.1055/s-0043-1777716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Liver metastases are the most common malignancy found in the liver and are 20 to 40 times more common than primary hepatic tumors, including hepatocellular carcinoma. Patients with liver metastases often present with advanced disease and are not eligible for curative-intent surgery or ablative techniques. The unique hepatic arterial blood supply of liver metastases allows interventional radiologists to target these tumors with transarterial therapies. Transarterial chemoembolization (TACE) has been studied in the treatment of liver metastases originating from a variety of primary malignancies and has demonstrated benefits in terms of hepatic progression-free survival, overall survival, and symptomatic relief, among other benefits. Depending on the primary tumor from which they originate, liver metastases may have different indications for TACE, may utilize different TACE regimens and techniques, and may result in different post-procedural outcomes. This review offers an overview of TACE techniques and specific considerations in the treatment of liver metastases, provides an in-depth review of TACE in the treatment of liver metastases originating from colorectal cancer, neuroendocrine tumor, and uveal melanoma, which represent some of the many tumors beyond hepatocellular carcinoma that can be treated by TACE, and summarizes data regarding when one should consider TACE in their treatment algorithms.
Collapse
Affiliation(s)
- Daniel M. DePietro
- Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Xin Li
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan M. Shamimi-Noori
- Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
2
|
Braat MNGJA, Ebbers SC, Alsultan AA, Neek AO, Bruijnen RCG, Smits MLJ, de Bruijne J, Lam MGEH, Braat AJAT. Prophylactic Medication during Radioembolization in Metastatic Liver Disease: Is It Really Necessary? A Retrospective Cohort Study and Systematic Review of the Literature. Diagnostics (Basel) 2023; 13:3652. [PMID: 38132236 PMCID: PMC10742749 DOI: 10.3390/diagnostics13243652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/09/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE Trans-arterial radioembolization is a well-studied tumoricidal treatment for liver malignancies; however, consensus and evidence regarding periprocedural prophylactic medication (PPM) are lacking. METHODS A single-center retrospective analysis from 2014 to 2020 was performed in patients treated with 90Y-glass microspheres for neuroendocrine or colorectal liver metastases. Inclusion criteria were the availability of at least 3 months of clinical, biochemical, and imaging follow-up and post-treatment 90Y-PET/CT imaging for the determination of the whole non-tumorous liver absorbed dose (Dh). Logistic regression models were used to investigate if variables (among which are P/UDCA and Dh) were associated with either clinical toxicity, biochemical toxicity, or hepatotoxicity. Additionally, a structured literature search was performed in November 2022 to identify all publications related to PPM use in radioembolization treatments. RESULTS Fifty-one patients received P/UDCA as post-treatment medication, while 19 did not. No correlation was found between toxicity and P/UDCA use. Dh was associated with biochemical toxicity (p = 0.05). A literature review resulted in eight relevant articles, including a total of 534 patients, in which no consistent advice regarding PPM was provided. CONCLUSION In this single-center, retrospective review, P/UDCA use did not reduce liver toxicity in patients with metastatic liver disease. The whole non-tumorous liver-absorbed dose was the only significant factor for hepatotoxicity. No standardized international guidelines or supporting evidence exist for PPM in radioembolization.
Collapse
Affiliation(s)
- Manon N. G. J. A. Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands (M.G.E.H.L.); (A.J.A.T.B.)
| | - Sander C. Ebbers
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands (M.G.E.H.L.); (A.J.A.T.B.)
| | - Ahmed A. Alsultan
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands (M.G.E.H.L.); (A.J.A.T.B.)
| | - Atal O. Neek
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands (M.G.E.H.L.); (A.J.A.T.B.)
| | - Rutger C. G. Bruijnen
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands (M.G.E.H.L.); (A.J.A.T.B.)
| | - Maarten L. J. Smits
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands (M.G.E.H.L.); (A.J.A.T.B.)
| | - Joep de Bruijne
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Marnix G. E. H. Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands (M.G.E.H.L.); (A.J.A.T.B.)
| | - Arthur J. A. T. Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands (M.G.E.H.L.); (A.J.A.T.B.)
| |
Collapse
|
3
|
Zhao JJ, Tan E, Sultana R, Syn NL, Da Zhuang K, Leong S, Tai DWM, Too CW. Intra-arterial therapy for unresectable colorectal liver metastases: A meta-analysis. J Vasc Interv Radiol 2021; 32:1536-1545.e38. [PMID: 34166803 DOI: 10.1016/j.jvir.2021.05.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 05/09/2021] [Accepted: 05/31/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate the efficacy of hepatic arterial infusion (HAI), conventional trans-arterial chemoembolization (cTACE), drug-eluting embolic trans-arterial chemoembolization (DEE-TACE), trans-arterial radioembolization (TARE) and their combinations with systemic chemotherapy (SCT) for unresectable colorectal liver metastases. METHODS A search was conducted on EMBASE, Scopus, PubMed and Web of Science for prospective non-randomized studies and randomized controlled trials (RCTs) from inception to 20th June 2020. Survival data of patients were recovered from original Kaplan-Meier curves by exploiting a graphical reconstructive algorithm. One-stage meta-analyses were conducted for median overall survival (OS), survival rates (SR), and restricted mean survival time (RMST), while two-stage meta-analyses of proportions were conducted to determine response rates (RR) and conversion-to-resection rates (CRR). RESULTS 71 prospective non-randomized studies and 21 RCTs were identified comprising 6,695 patients. Among patients treated beyond first line, DEE-TACE+SCT (n=152) had the best survival outcomes of median OS of 26.5 (95%-CI: 22.5-29.1) months and 3-year RMST of 23.6 (95%-CI: 21.8-25.5) months. Upon further stratification by publication year, DEE-TACE+SCT appears to consistently have the highest pooled survival rates at 1-year (81.9%) and 2-years (66.1%) in recent publications (2015-2020). DEE-TACE+SCT and HAI+SCT had the highest pooled-RRs of 56.7% (I2=0.90) and 62.6% (I2=0.87) respectively and pooled-CRRs of 35.5% (I2=0.00) and 30.3% (I2=0.80) respectively. CONCLUSION Albeit significant heterogeneity, paucity of high-quality evidence and the non-comparative nature of all analyses, the overall evidence suggests that patients treated with DEE-TACE+SCT may have the best oncological outcomes and greatest potential to be converted for resection.
Collapse
Affiliation(s)
- Joseph J Zhao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Eelin Tan
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences; Radiological Sciences Academic Clinical Program, SingHealth- Duke-National University of Singapore Academic Medical, Singapore General Hospital, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-National University of Singapore Graduate Medical School, Singapore
| | - Nicholas L Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kun Da Zhuang
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences; Radiological Sciences Academic Clinical Program, SingHealth- Duke-National University of Singapore Academic Medical, Singapore General Hospital, Singapore
| | - Sum Leong
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences; Radiological Sciences Academic Clinical Program, SingHealth- Duke-National University of Singapore Academic Medical, Singapore General Hospital, Singapore
| | - David W M Tai
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Chow Wei Too
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences; Radiological Sciences Academic Clinical Program, SingHealth- Duke-National University of Singapore Academic Medical, Singapore General Hospital, Singapore.
| |
Collapse
|
4
|
Serenari M, Neri J, Marasco G, Larotonda C, Cappelli A, Ravaioli M, Mosconi C, Golfieri R, Cescon M. Two-stage hepatectomy with radioembolization for bilateral colorectal liver metastases: A case report. World J Hepatol 2021; 13:261-269. [PMID: 33708354 PMCID: PMC7934009 DOI: 10.4254/wjh.v13.i2.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/20/2021] [Accepted: 02/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Two-stage hepatectomy (TSH) is a well-established surgical technique, used to treat bilateral colorectal liver metastases (CRLM) with a small future liver remnant (FLR). However, in classical TSH, drop-out is reported to be around 25%-40%, due to insufficient FLR increase or progression of disease. Trans-arterial radioembolization (TARE) has been described to control locally tumor growth of liver malignancies such as hepatocellular carcinoma, but it has been also reported to induce a certain degree of contralateral liver hypertrophy, even if at a lower rate compared to portal vein embolization or ligation.
CASE SUMMARY Herein we report the case of a 75-year-old female patient, where TSH and TARE were combined to treat bilateral CRLM. According to computed tomography (CT)-scan, the patient had a hepatic lesion in segment VI-VII and two other confluent lesions in segment II-III. Therefore, one-stage posterior right sectionectomy plus left lateral sectionectomy (LLS) was planned. The liver volumetry estimated a FLR of 38% (segments I-IV-V-VIII). However, due to a more than initially planned, extended right resection, simultaneous LLS was not performed and the patient underwent selective TARE to segments II-III after the first surgery. The CT-scan performed after TARE showed a reduction of the treated lesion and a FLR increase of 55%. Carcinoembryonic antigen and CA 19.9 decreased significantly. Nearly three months later after the first surgery, LLS was performed and the patient was discharged without any postoperative complications.
CONCLUSION According to this specific experience, TARE was used to induce liver hypertrophy and simultaneously control cancer progression in TSH settings for bilateral CRLM.
Collapse
Affiliation(s)
- Matteo Serenari
- General Surgery and Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna 40138, Italy
| | - Jacopo Neri
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
| | - Cristina Larotonda
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
| | - Alberta Cappelli
- Department of Radiology, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna 40138, Italy
| | - Matteo Ravaioli
- General Surgery and Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna 40138, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
| | - Cristina Mosconi
- Department of Radiology, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna 40138, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna 40138, Italy
| | - Matteo Cescon
- General Surgery and Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna 40138, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
| |
Collapse
|
5
|
Yttrium-90 Hepatic Radioembolization for Advanced Chemorefractory Metastatic Colorectal Cancer: Survival Outcomes Based on Right- Versus Left-Sided Primary Tumor Location. AJR Am J Roentgenol 2021; 217:1141-1152. [PMID: 33594907 DOI: 10.2214/ajr.20.25315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND. Primary colon cancer location affects survival of patients with metastatic colorectal cancer (mCRC). Outcomes based on primary tumor location after salvage hepatic radioembolization with 90Y resin microspheres are not well studied. OBJECTIVE. The objectives of this study are to assess the survival outcomes of patients with advanced chemorefractory mCRC treated with 90Y radioembolization, as stratified by primary tumor location, and to explore potential factors that are predictive of survival. METHODS. A total of 99 patients who had progressive mCRC liver metastases while receiving systemic therapy and who were treated with 90Y radioembolization at a single center were retrospectively analyzed. For 89 patients, tumor response on the first imaging follow-up examination (CT or MRI performed at a mean [± SD] of 1.9 ± 0.9 months after 90Y radioembolization) was evaluated using RECIST. Overall survival (OS), OS after 90Y radioembolization, and hepatic progression-free survival (PFS) were calculated using the Kaplan-Meier method. Outcomes and associations of outcomes with tumor response were compared between patients with left- and right-sided tumors. RESULTS. A total of 74 patients had left-sided colon cancer, and 25 patients had right-sided colon cancer. Median OS from the time of mCRC diagnosis was 37.2 months, median OS after 90Y radioembolization was 5.8 months, and median hepatic PFS was 3.3 months. Based on RECIST, progressive disease on first imaging follow-up was observed in 38 patients (43%) after 90Y radioembolization and was associated with shorter OS after 90Y radioembolization compared with observation of disease control on first imaging follow-up (4.0 vs 10.5 months; p < .001). Patients with right-sided primary tumors showed decreased median OS after 90Y radioembolization compared with patients with left-sided primary tumors (5.4 vs 6.2 months; p = .03). Right- and left-sided primary tumors showed no significant difference in RECIST tumor response, hepatic PFS, or extrahepatic disease progression (p > .05). Median survival after 90Y radioembolization was significantly lower among patients with progressive disease than among those with disease control in the group with left-sided primary tumors (4.2 vs 13.9 months; p < .001); however, this finding was not observed in the group with right-sided primary tumors (3.3 vs 7.2 months; p = .05). CONCLUSION. Right-sided primary tumors were independently associated with decreased survival among patients with chemorefractory mCRC after 90Y radioembolization, despite these patients having a similar RECIST tumor response, hepatic PFS, and extrahepatic disease progression compared with patients with left-sided primary tumors. CLINICAL IMPACT. Primary colon cancer location impacts outcomes after salvage 90Y radioembolization and may help guide patient selection.
Collapse
|
6
|
Jeyarajah DR, Doyle MBM, Espat NJ, Hansen PD, Iannitti DA, Kim J, Thambi-Pillai T, Visser BC. Role of yttrium-90 selective internal radiation therapy in the treatment of liver-dominant metastatic colorectal cancer: an evidence-based expert consensus algorithm. J Gastrointest Oncol 2020; 11:443-460. [PMID: 32399284 DOI: 10.21037/jgo.2020.01.09] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Surgical resection of colorectal liver metastases is associated with greater survival compared with non-surgical treatment, and a meaningful possibility of cure. However, the majority of patients are not eligible for resection and may require other non-surgical interventions, such as liver-directed therapies, to be converted to surgical eligibility. Given the number of available therapies, a general framework is needed that outlines the specific roles of chemotherapy, surgery, and locoregional treatments [including selective internal radiation therapy (SIRT) with Y-90 microspheres]. Using a data-driven, modified Delphi process, an expert panel of surgical oncologists, transplant surgeons, and hepatopancreatobiliary (HPB) surgeons convened to create a comprehensive, evidence-based treatment algorithm that includes appropriate treatment options for patients stratified by their eligibility for surgical treatment. The group coined a novel, more inclusive phrase for targeted locoregional tumor treatment (a blanket term for resection, ablation, and other emerging locoregional treatments): local parenchymal tumor destruction therapy. The expert panel proposed new nomenclature for 3 distinct disease categories of liver-dominant metastatic colorectal cancer that is consistent with other tumor types: (I) surgically treatable (resectable); (II) surgically untreatable (borderline resectable); (III) advanced surgically untreatable (unresectable) disease. Patients may present at any point in the algorithm and move between categories depending on their response to therapy. The broad intent of therapy is to transition patients toward individualized treatments where possible, given the survival advantage that resection offers in the context of a comprehensive treatment plan. This article reviews what is known about the role of SIRT with Y-90 as neoadjuvant, definitive, or palliative therapy in these different clinical situations and provides insight into when treatment with SIRT with Y-90 may be appropriate and useful, organized into distinct treatment algorithm steps.
Collapse
Affiliation(s)
| | | | - N Joseph Espat
- Department of Surgery, Roger Williams Medical Center, Boston University School of Medicine, Providence, RI, USA
| | - Paul D Hansen
- HPB Surgery, Providence Portland Center, Portland, OR, USA
| | - David A Iannitti
- HPB Surgery, Atrium Health, Carolinas Medical Center, Charlotte, NC, USA
| | - Joseph Kim
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Thavam Thambi-Pillai
- Department of Surgery, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA
| | - Brendan C Visser
- Department of Surgery, Stanford University Medical Center, CA, USA
| |
Collapse
|
7
|
Incidence of Radioembolization-Induced Liver Disease and Liver Toxicity Following Repeat 90Y-Radioembolization: Outcomes at a Large Tertiary Care Center. Clin Nucl Med 2020; 45:100-104. [PMID: 31876805 DOI: 10.1097/rlu.0000000000002828] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The complication profile following repeat Y-radioembolization (RE) is not well understood, and repeat RE is sometimes avoided because of concerns for RE-induced liver disease (REILD) and liver toxicity. The purpose of this study was to examine the incidence of REILD and liver toxicity following repeat Y-RE and to identify potential risk factors. METHODS A retrospective analysis of patients undergoing repeat RE to the same hepatic lobe between 2013 and 2018 was performed. Baseline factors were evaluated as predictors of liver toxicity, mortality, and REILD, which was defined as the presence symptomatic ascites or jaundice in the absence of biliary obstruction within 8 weeks following RE. Post-RE complications were graded according to the Common Terminology Criteria for Adverse Events version 5. RESULTS A total of 39 patients underwent repeat RE with 14 (35.9%) experiencing Common Terminology Criteria for Adverse Events toxicity of grade 2 or greater, 3 (10.3%) grade 3, and no grade 4 or greater. A Model for End Stage Liver Disease score of 8 or greater was associated with grade 2 toxicity or greater (26.7% vs 75%; P = 0.013). Only 3 patients (7.7%) experienced REILD due to symptomatic ascites without jaundice. Greater than 2 REs were associated with a greater rate of 6-month mortality (12% vs 58.3%, P = 0.003), 12-month mortality (28% vs 75%, P = 0.007), and REILD (0% vs 21.4%, P = 0.016). Age, sex, microsphere type, cirrhosis, Child-Pugh, and Eastern Cooperative Oncology Group status were not significantly associated with complications, REILD, or survival. CONCLUSIONS Repeat Y-RE appears to be well tolerated with a low rate of high-grade adverse events and REILD.
Collapse
|
8
|
Lok SW, De Boer R, Cordwell C, Marx G, Fox P, Hasovits C, Rutovitz J, Harold M, Tran B, Wong HL, Gibbs P. Demonstrating the feasibility of collecting secondary, de-identified data on Australian patients receiving treatment as part of a Medicine Access Programme. Intern Med J 2020; 50:99-104. [PMID: 30816606 DOI: 10.1111/imj.14265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/18/2019] [Accepted: 02/18/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND In Australia, data generated from the carefully selected, treated and monitored patients enrolled in clinical trials largely inform routine care and funding approvals. Medicine Access Programmes (MAP) enable drug access and while potentially a rich source of data, historically have not collected data beyond a participant list. AIMS To explore the feasibility of using MAP to identify patient populations for inclusion in non-interventional studies. METHODS Clinicians affiliated with the Walter and Eliza Hall Institute engaged with Roche to implement PeRSIA, a secondary data use non-interventional study of patients receiving neoadjuvant pertuzumab for non-metastatic HER2+ breast cancer. The study utilised a pre-existing Roche-sponsored MAP to identify clinicians as data contributors. Data security, ownership and reporting issues were addressed utilising the BioGrid platform and standards developed for existing Walter and Eliza Hall Institute registries. Disease experts developed project-specific Case Report Forms documenting treatment, surgical and cancer-specific outcomes, and adverse events. RESULTS To date, 12 of 16 (75%) clinicians approached to participate in PeRSIA are contributing de-identified data. From February through September 2018, data on 41 patients from seven centres were collected. Median patient age is 56 years (range 36-81), 36 (88%) had Stage 2 to 3 disease and 27 (66%) were node positive. The median number of cycles of neoadjuvant pertuzumab planned was 4. CONCLUSIONS This initial report is, to our knowledge, the first description of a secondary data use non-interventional study collecting comprehensive data on patients enrolled, independently, in a MAP. This effort continues and opportunities with other industry partners are being pursued.
Collapse
Affiliation(s)
- Sheau W Lok
- Walter and Eliza Hall Institute, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Richard De Boer
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Gavin Marx
- The University of Sydney and Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Peter Fox
- Orange Health Service, Orange, New South Wales, Australia
| | - Csilla Hasovits
- The University of Sydney and Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Joseph Rutovitz
- Northern Haematology and Oncology Group, Sydney, New South Wales, Australia
| | - Michael Harold
- Walter and Eliza Hall Institute, Melbourne, Victoria, Australia
| | - Ben Tran
- Walter and Eliza Hall Institute, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Hui-Li Wong
- Walter and Eliza Hall Institute, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Peter Gibbs
- Walter and Eliza Hall Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
9
|
Review of Drug-induced Injury in Mucosal Biopsies From the Tubular Gastrointestinal Tract. Adv Anat Pathol 2019; 26:151-170. [PMID: 30870181 DOI: 10.1097/pap.0000000000000230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The use of prescription and over-the-counter medications is on the rise in the US population, especially among those aged 65 and over, with over 46% of the population taking at least 1 prescription medication. Given the frequency of medication use, and that the majority of these medications are taken orally, it has become increasingly relevant for pathologist examining endoscopically obtained gastrointestinal tract mucosal biopsies to consider and recognize patterns of mucosal injury associated with various drugs. Reports on injuries associated with certain classes of drugs can be scattered among different sources, making a comprehensive view of various injury patterns and the drugs known to cause them difficult to obtain. Herein, we provide a comprehensive overview of the drugs known to cause mucosal injuries in the tubular gastrointestinal tract organized by the organ involved and the prominent pattern of injury.
Collapse
|
10
|
Mitchell D, Puckett Y, Nguyen QN. Literature Review of Current Management of Colorectal Liver Metastasis. Cureus 2019; 11:e3940. [PMID: 30937238 PMCID: PMC6433446 DOI: 10.7759/cureus.3940] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Colorectal cancer is a leading cause of cancer mortality in the United States, and metastasis to the liver is a frequent sequela. Currently, surgical resection is the best option for curative treatment and/or long-term survival after colorectal liver metastasis (CRLM), but unfortunately, not all patients are surgical candidates. Alternative and adjunct therapies commonly used in the treatment of CRLM include chemotherapy, biologic therapy, radio-embolization, and radiofrequency ablation. The aim of this review was to report the various treatment modalities and outcomes currently used in the treatment of CRLM.
Collapse
Affiliation(s)
- Diana Mitchell
- Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Yana Puckett
- Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Quang N Nguyen
- Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| |
Collapse
|
11
|
Levy J, Zuckerman J, Garfinkle R, Acuna SA, Touchette J, Vanounou T, Pelletier JS. Intra-arterial therapies for unresectable and chemorefractory colorectal cancer liver metastases: a systematic review and meta-analysis. HPB (Oxford) 2018; 20:905-915. [PMID: 29887263 DOI: 10.1016/j.hpb.2018.04.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/17/2018] [Accepted: 04/21/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND A large proportion of patients with colorectal cancer liver metastases (CRCLM) not amenable to curative liver resection will progress on systemic therapy. Intra-arterial therapies (IAT) including conventional transarterial chemoembolization (cTACE), drug eluting beads (DEB-TACE) and yttrium-90 radioembolization (Y-90) are indicated to prolong survival and palliate symptoms. The purpose of this systematic review and meta-analysis is to compare the survival benefit and radiologic response of three intra-arterial therapies in patients with chemorefractory and unresectable CRCLM. METHODS A systematic search for eligible references in the Cochrane Library and the EMBASE, MEDLINE and TRIP databases from January 2000 to November 2016 was performed in accordance with PRISMA guidelines. Methodological quality of included studies was assessed using the MINORS scale. One-year overall survival rates and RECIST responder rates were pooled using inverse-variance weighted random-effects models. Overall survival outcomes were collected according to transformed pooled median survivals from first IAT with a subgroup analysis of patients with extrahepatic disease. RESULTS Twenty-three prospective studies were included and analyzed: 5 cTACE (n = 746), 5 DEB-TACE (n = 222) and 13 Y-90 (n = 615). All but five were clinical trials. Eleven of 13 Y-90 studies were industry funded. Pooled RECIST response rates with 95% confidence intervals (CI) were: cTACE 23% (9.7, 36), DEB-TACE 36% (0, 73) and Y-90 23% (11, 34). The pooled 1-year survival rates with CI were: cTACE, 70% (49, 87), DEB-TACE, 80% (74, 86) and Y-90, 41% (28, 54). Transformed pooled median survivals from first IAT and ranges for cTACE, DEB-TACE and Y-90 were 16 months (9.0-23), 16 months (7.3-25) and 12 months (7.0-15), respectively. Significant heterogeneity in inclusion criteria and reporting of confounders, including previous therapy, tumor burden and post-IAT therapy, precluded statistical comparisons between the three therapies. CONCLUSION Methodological and statistical heterogeneity precluded consensus on the optimal treatment strategy. Given the common use and significant cost of radioembolization in this setting, a more robust prospective comparative trial is warranted.
Collapse
Affiliation(s)
- Jordan Levy
- University of Toronto Division of General Surgery, Toronto, ON, Canada; University of Toronto Institute of Health Policy Management and Evaluation, Toronto, ON, Canada.
| | - Jesse Zuckerman
- University of Toronto Division of General Surgery, Toronto, ON, Canada
| | - Richard Garfinkle
- Sir Mortimer B Davis Jewish General Hospital, Hepatobiliary and Pancreatic Surgery, Montreal, QC, Canada
| | - Sergio A Acuna
- University of Toronto Division of General Surgery, Toronto, ON, Canada; University of Toronto Institute of Health Policy Management and Evaluation, Toronto, ON, Canada
| | - Jacynthe Touchette
- Sir Mortimer B Davis Jewish General Hospital Health Sciences Library, Montreal, QC, Canada
| | - Tsafrir Vanounou
- Sir Mortimer B Davis Jewish General Hospital, Hepatobiliary and Pancreatic Surgery, Montreal, QC, Canada
| | - Jean-Sebastien Pelletier
- Sir Mortimer B Davis Jewish General Hospital, Hepatobiliary and Pancreatic Surgery, Montreal, QC, Canada
| |
Collapse
|
12
|
Kurilova I, Beets-Tan RGH, Flynn J, Gönen M, Ulaner G, Petre EN, Edward Boas F, Ziv E, Yarmohammadi H, Klompenhouwer EG, Cercek A, Kemeny NA, Sofocleous CT. Factors Affecting Oncologic Outcomes of 90Y Radioembolization of Heavily Pre-Treated Patients With Colon Cancer Liver Metastases. Clin Colorectal Cancer 2018; 18:8-18. [PMID: 30297264 DOI: 10.1016/j.clcc.2018.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/22/2018] [Accepted: 08/23/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The purpose of this study was to identify predictors of overall (OS) and liver progression-free survival (LPFS) following Yttrium-90 radioembolization (RAE) of heavily pretreated patients with colorectal cancer liver metastases (CLM), as well as to create and validate a predictive nomogram for OS. MATERIALS AND METHODS Metabolic, anatomic, laboratory, pathologic, genetic, primary disease, and procedure-related factors, as well as pre- and post-RAE therapies in 103 patients with CLM treated with RAE from September 15, 2009 to March 21, 2017 were analyzed. LPFS was defined by Response Evaluation Criteria In Solid Tumors 1.1 and European Organization for Research and Treatment of Cancer criteria. Prognosticators of OS and LPFS were selected using univariate Cox regression, adjusted for clustering and competing risk analysis (for LPFS), and subsequently tested in multivariate analysis (MVA). The nomogram was built using R statistical software and internally validated using bootstrap resampling. RESULTS Patients received RAE at a median of 30.9 months (range, 3.4-161.7 months) after detection of CLM. The median OS and LPFS were 11.3 months (95% confidence interval, 7.9-15.1 months) and 4 months (95% confidence interval, 3.3-4.8 months), respectively. Of the 40 parameters tested, 6 were independently associated with OS in MVA. These baseline parameters included number of extrahepatic disease sites (P < .001), carcinoembryonic antigen (P < .001), albumin (P = .005), alanine aminotransferase level (P < .001), tumor differentiation level (P < .001), and the sum of the 2 largest tumor diameters (P < .001). The 1-year OS of patients with total points of < 25 versus > 80 was 90% and 10%, respectively. Bootstrap resampling showed good discrimination (optimism corrected c-index = 0.745) and calibration (mean absolute prediction error = 0.299) of the nomogram. Only baseline maximum standardized uptake value was significant in MVA for LPFS prediction (P < .001; SHR = 1.06). CONCLUSION The developed nomogram included 6 pre-RAE parameters and provided good prediction of survival post-RAE in heavily pretreated patients. Baseline maximum standardized uptake value was the single significant predictor of LPFS.
Collapse
Affiliation(s)
- Ieva Kurilova
- Department of Interventional Oncology/Radiology, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Jessica Flynn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mithat Gönen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gary Ulaner
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elena N Petre
- Department of Interventional Oncology/Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - F Edward Boas
- Department of Interventional Oncology/Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Etay Ziv
- Department of Interventional Oncology/Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hooman Yarmohammadi
- Department of Interventional Oncology/Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Andrea Cercek
- Department of Gastrointestinal Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nancy A Kemeny
- Department of Gastrointestinal Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Constantinos T Sofocleous
- Department of Interventional Oncology/Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
| |
Collapse
|
13
|
O'Leary C, Greally M, McCaffrey J, Hughes P, Lawler LLP, O'Connell M, Geoghegan T, Farrelly C. Single-institution experience with selective internal radiation therapy (SIRT) for the treatment of unresectable colorectal liver metastases. Ir J Med Sci 2018; 188:43-53. [PMID: 29511912 DOI: 10.1007/s11845-018-1773-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/23/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Liver metastases are the commonest cause of death for patients with colorectal cancer. Growing evidence supports the use of selective internal radiation therapy (SIRT) in combination with conventional chemotherapy regimens for liver-only or liver-dominant unresectable metastatic colorectal cancer. AIMS To measure and evaluate outcomes of the first 20 consecutive patients with unresectable colorectal liver metastasis selected for SIRT in addition to their chemotherapy at a single Irish institution. METHODS Retrospective case series was performed. Patient charts and medical records were reviewed. RESULTS All 20 patients (100%) selected for angiographic workup were subsequently successfully treated with radioembolization. All patients were discharged 1 day post-SIRT. At initial imaging evaluation, 12 (60%) had a partial response in their liver, 2 (10%) had stable disease, and 6 (30%) had liver-specific progressive disease. Median follow up was 10 months (range 6-26). At last follow up, 14 (70%) patients were alive and 6 (30%) deceased. Most recent imaging demonstrated 2 (10%) with a complete response, 7 (35%) had a partial response, 2 (10%) had stable disease, and 9 (45%) had progressive disease within their liver. One patient was downstaged to hepatic resection, and one with a complete hepatic response had his primary sigmoid tumor resected 11 months post-SIRT. CONCLUSIONS SIRT is a safe and effective therapy for certain patients with unresectable colorectal liver metastases. This case series supports our opinion that selected patients should be offered SIRT in concert with their medical oncologist, concomitant with their chemotherapy. Larger multi-center studies are required to more clearly define the patient groups that will derive most benefit from SIRT.
Collapse
Affiliation(s)
- Cathal O'Leary
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Megan Greally
- Oncology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - John McCaffrey
- Oncology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Peter Hughes
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Leo L P Lawler
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Martin O'Connell
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Tony Geoghegan
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Cormac Farrelly
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland.
| |
Collapse
|
14
|
Justinger C, Gruden J, Kouladouros K, Stravodimos C, Reimer P, Tannapfel A, Binnenhei M, Bentz M, Tatsch K, Rüdiger T, Schön MR. Histopathological changes resulting from selective internal radiotherapy (SIRT). J Surg Oncol 2018; 117:1084-1091. [DOI: 10.1002/jso.24967] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/10/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Christoph Justinger
- Department of General and Visceral Surgery; Klinikum Karlsruhe; Karlsruhe Germany
| | - Juliana Gruden
- Institute of Pathology; Klinikum Karlsruhe; Karlsruhe Germany
| | | | - Christos Stravodimos
- Department of General and Visceral Surgery; Klinikum Karlsruhe; Karlsruhe Germany
| | - Peter Reimer
- Institute of Diagnostic and Interventional Radiology; Klinikum Karlsruhe; Karlsruhe Germany
| | | | | | - Martin Bentz
- Department of Oncology; Klinikum Karlsruhe; Karlsruhe Germany
| | - Klaus Tatsch
- Department of Nuclear Medicine; Klinikum Karlsruhe; Karlsruhe Germany
| | - Thomas Rüdiger
- Institute of Pathology; Klinikum Karlsruhe; Karlsruhe Germany
| | - Michael R. Schön
- Department of General and Visceral Surgery; Klinikum Karlsruhe; Karlsruhe Germany
| |
Collapse
|
15
|
Kennedy A, Brown DB, Feilchenfeldt J, Marshall J, Wasan H, Fakih M, Gibbs P, Knuth A, Sangro B, Soulen MC, Pittari G, Sharma RA. Safety of selective internal radiation therapy (SIRT) with yttrium-90 microspheres combined with systemic anticancer agents: expert consensus. J Gastrointest Oncol 2017; 8:1079-1099. [PMID: 29299370 PMCID: PMC5750172 DOI: 10.21037/jgo.2017.09.10] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/20/2017] [Indexed: 12/12/2022] Open
Abstract
Selective internal radiation therapy (SIRT) with microspheres labelled with the β-emitter yttrium-90 (Y-90) enables targeted delivery of radiation to hepatic tumors. SIRT is primarily used to treat inoperable primary or metastatic liver tumors. Eligible patients have usually been exposed to a variety of systemic anticancer therapies, including cytotoxic agents, targeted biologics, immunotherapy and peptide receptor radionuclide therapy (PRRT). All these treatments have potential interactions with SIRT; however, robust evidence on the safety of these potential combinations is lacking. This paper provides current clinical experiences and expert consensus guidelines for the use of SIRT in combination with the anticancer treatment agents likely to be encountered in clinical practice. It was agreed by the expert panel that precautions need to be taken with certain drugs, but that, in general, systemic therapies do not necessarily have to be stopped to perform SIRT. The authors recommend stopping vascular endothelial growth factor inhibitors 4-6 weeks before SIRT, and restart after the patient has recovered from the procedure. It may also be prudent to stop potent radiosensitizers such as gemcitabine therapy 4 weeks before SIRT, and restart treatment at least 2‒4 weeks later. Data from phase III studies combining SIRT with fluorouracil (5FU) or folinic acid/5FU/oxaliplatin (FOLFOX) suggest that hematological toxicity is more common from the combination than it is from chemotherapy without SIRT. There is no evidence to suggest that chemotherapy increases SIRT-specific gastro-intestinal or liver toxicities.
Collapse
Affiliation(s)
- Andrew Kennedy
- Radiation Oncology Research, Sarah Cannon Research Institute, Nashville, Tennessee, USA
| | - Daniel B. Brown
- Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - John Marshall
- Hematology and Oncology Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC, USA
| | - Harpreet Wasan
- Imperial College, Division of Cancer, Hammersmith Hospital, London, UK
| | - Marwan Fakih
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, California, USA
| | - Peter Gibbs
- Western Hospital, Footscray, Victoria, Australia
| | - Alexander Knuth
- National Center for Cancer Care and Research, HMC, Doha, Qatar
| | - Bruno Sangro
- Liver Unit, Clinica Universidad de Navarra, IDISNA, CIBEREHD, Pamplona, Navarra, Spain
| | - Michael C. Soulen
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Ricky A. Sharma
- NIHR University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College London, London, UK
| |
Collapse
|
16
|
Yttrium-90 radioembolization treatment for unresectable hepatocellular carcinoma: a single-centre prognostic factors analysis. Med Oncol 2017; 34:174. [DOI: 10.1007/s12032-017-1021-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 03/17/2017] [Indexed: 12/12/2022]
|
17
|
Sangha BS, Nimeiri H, Hickey R, Salem R, Lewandowski RJ. Radioembolization as a Treatment Strategy for Metastatic Colorectal Cancer to the Liver: What Can We Learn from the SIRFLOX Trial? Curr Treat Options Oncol 2017; 17:26. [PMID: 27098532 DOI: 10.1007/s11864-016-0402-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OPINION STATEMENT In the setting of liver metastases from colorectal cancer (CRC), radioembolization with yttrium-90 has been used to treat chemotherapy refractory disease with a growing interest to establish its efficacy in prospective trials combined with first- and second-line chemotherapy. SIRFLOX is an ongoing, multi-center, phase 3 randomized trial comparing first-line chemotherapy alone or in combination with yttrium-90 radioembolization in patients with CRC who have isolated liver metastases or liver-dominant metastases. Preliminary results from SIRFLOX demonstrate that radioembolization combined with first-line chemotherapy is safe and feasible. There was no significant difference in median overall progression-free survival (PFS) between the combined radioembolization-chemotherapy and chemotherapy-only arms (10.7 versus 10.2 months). Although the trial did not meet its primary endpoint of improved median PFS, there was a significant increase in the median hepatic PFS (20.5 versus 12.6 months; p = 0.02) favoring the combination arm. Thus, combining radioembolization with chemotherapy in the first-line setting may be most effective for liver-limited metastatic CRC. Since radioembolization targets liver disease, it is plausible that the trial failed to achieve an improvement in PFS given that 40 % of the SIRFLOX population had extra-hepatic disease. It is also possible that the overall median PFS may be a poor surrogate endpoint, and other endpoints like overall survival still needs to be delineated in this setting. In addition, it is crucial to document improvement or delay in time to deterioration in quality of life symptom endpoints in this population. SIRFLOX is the first of three prospective studies that assess the efficacy of adding radioembolization to first-line chemotherapy, and the combined data from these trials will provide the necessary power for an overall survival analysis. The final results of SIRFLOX will be eagerly awaited to determine if the increased hepatic PFS in preliminary data will translate to increased overall survival benefit.
Collapse
Affiliation(s)
- Bippan Singh Sangha
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Halla Nimeiri
- Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Ryan Hickey
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
- Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
- Division of Hepatology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.
| |
Collapse
|
18
|
Fiorentini G, Sarti D, Aliberti C, Carandina R, Mambrini A, Guadagni S. Multidisciplinary approach of colorectal cancer liver metastases. World J Clin Oncol 2017; 8:190-202. [PMID: 28638789 PMCID: PMC5465009 DOI: 10.5306/wjco.v8.i3.190] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/05/2017] [Accepted: 05/05/2017] [Indexed: 02/06/2023] Open
Abstract
Large bowel cancer is a worldwide public health challenge. More than one third of patients present an advanced stage of disease at diagnosis and the liver is the most common site of metastases. Selection criteria for early diagnosis, chemotherapy and surgery have been recently expanded. The definition of resectability remains unclear. The presence of metastases is the most significant prognostic factor. For this reason the surgical resection of hepatic metastases is the leading treatment. The most appropriate resection approach remains to be defined. The two step and simultaneous resection processes of both primary and metastases have comparable survival long-term outcomes. The advent of targeted biological chemotherapeutic agents and the development of loco-regional therapies (chemoembolization, thermal ablation, arterial infusion chemotherapy) contribute to extend favorable results. Standardized evidence-based protocols are missing, hence optimal management of hepatic metastases should be single patient tailored and decided by a multidisciplinary team. This article reviews the outcomes of resection, systemic and loco-regional therapies of liver metastases originating from large bowel cancer.
Collapse
|
19
|
Yttrium-90 Radioembolization as Salvage Therapy for Liver Metastases From Colorectal Cancer. Am J Clin Oncol 2017; 40:288-293. [DOI: 10.1097/coc.0000000000000151] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
20
|
Bhooshan N, Sharma NK, Badiyan S, Kaiser A, Moeslein FM, Kwok Y, Amin PP, Kudryasheva S, Chuong MD. Pretreatment tumor volume as a prognostic factor in metastatic colorectal cancer treated with selective internal radiation to the liver using yttrium-90 resin microspheres. J Gastrointest Oncol 2016; 7:931-937. [PMID: 28078116 DOI: 10.21037/jgo.2016.06.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Yttrium-90 (90Y)-resin microspheres can prolong intrahepatic disease control and improve overall survival (OS) in patients with metastatic colorectal cancer (CRC). Prognostic factors for improved outcomes in patients undergoing selective internal radiation therapy (SIRT) have been studied, but the relationship between pre-SIRT liver tumor volume and outcomes has not well described. METHODS We retrospectively reviewed the records of patients with metastatic CRC who were treated at our institution with 90Y-resin microspheres. Each patient underwent either MR or CT imaging of the liver with intravenous (IV) contrast before and within ~2-3 months after SIRT. Imaging data were transferred into our treatment planning system. Each metastatic liver lesion was contoured, and the volume of each lesion was summed to determine the total liver tumor volume at a given time point. We evaluated whether pretreatment liver tumor volume was related to OS. We also evaluated the relationship between pre-SIRT tumor volume and radiographic treatment response by either unidimensional Response Evaluation Criteria in Solid Tumors (RECIST) or three-dimensional volumetric criteria. RESULTS We included 60 patients with a median age of 59 years (range, 38-97 years); 60% of patients received sequential lobar treatment. The median number of chemotherapy cycles received prior to SIRT was 2. Median follow-up from first SIRT was 8.9 months. Pre- and post-SIRT tumor volumes were primarily calculated on CT (87%). The median pre-SIRT tumor volume was 77 cc (range, 4.5-2,170.4 cc). The median intervals between the first SIRT and the first, second, and third follow-up scans were 2.2, 4.4, and 7.7 months, respectively. No patient experienced a radiographic complete response. Pretreatment volume was a significant predictor for estimating the odds of a patient having stable disease or partial response using volumetric response criteria at first (P=0.016), second (P=0.023), and third (P=0.015) follow-ups. For each unit increase in log volume, a patient's odds of having a stable or partial response were 0.57, 0.63, and 0.61 times as likely at first, second, and third follow-up, respectively. OS was not significantly associated with pretreatment tumor volume. CONCLUSIONS Patients with metastatic CRC with larger overall pretreatment liver tumor volumes, regardless of number of individual liver lesions, are less likely to have radiographic evidence of stable disease or partial response following SIRT using volumetric response criteria. However, pretreatment volume was not significantly associated with OS, and thus SIRT should be considered for patients with larger pretreatment volumetric tumor burden.
Collapse
Affiliation(s)
- Neha Bhooshan
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Navesh K Sharma
- Penn State Hershey Cancer Institute, Hershey, Pennsylvania, USA
| | | | | | | | | | | | - Svetlana Kudryasheva
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | | |
Collapse
|
21
|
Zampino M, Magni E, Ravenda P, Cella C, Bonomo G, Della Vigna P, Galdy S, Spada F, Varano G, Mauri G, Fazio N, Orsi F. Treatments for colorectal liver metastases: A new focus on a familiar concept. Crit Rev Oncol Hematol 2016; 108:154-163. [DOI: 10.1016/j.critrevonc.2016.11.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 10/09/2016] [Accepted: 11/13/2016] [Indexed: 11/17/2022] Open
|
22
|
Rosenbaum CENM, van den Hoven AF, Braat MNGJA, Koopman M, Lam MGEH, Zonnenberg BA, Verkooijen HM, van den Bosch MAAJ. Yttrium-90 radioembolization for colorectal cancer liver metastases: a prospective cohort study on circulating angiogenic factors and treatment response. EJNMMI Res 2016; 6:92. [PMID: 28004357 PMCID: PMC5177600 DOI: 10.1186/s13550-016-0236-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/04/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Yttrium-90 radioembolization (90Y-RE) as a treatment for liver tumours induces radiation damage and hypoxia in liver tissue, which is also a trigger for systemic release of angiogenic factors, potentially stimulating tumour growth. We examined changes in circulating angiogenic factors following 90Y-RE and investigated the association between response and angiogenic factors. In this prospective study, 42 patients with unresectable, chemorefractory metastatic colorectal cancer (CRCLM) were treated with 90Y-RE. Blood samples were collected pre-treatment and at 0, 1, 3, 7 and 30 days of follow-up. Response was measured with MRI according to RECIST 1.1 at 1 month and subsequently 3-month interval until progressive disease (PD) occurred. Associations between circulating angiogenic factors and response were examined with linear mixed model analysis. RESULTS Following 90Y-RE, three angiogenic factors demonstrated an increase in plasma levels, i.e., vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF) and angiopoietin-2 (Ang-2). Non-responders (= PD at 1-month follow-up, n = 10) had a significant increase of Ang-2 and HGF at 3 and 7 days post treatment compared to responders (= stable disease or better, n = 32), who showed little to no changes in plasma levels (respectively p = 0.01 and p = 0.007). Median overall survival was 9.2 months (95% confidence interval 6.1-12.4). CONCLUSIONS Significant increases in plasma levels of Ang-2 and HGF in the first week after treatment were associated with rapid progressive disease of liver lesions at 1 month after 90Y-RE. Combination of 90Y-RE with anti-angiogenic therapy may reduce these effects and result in better response.
Collapse
Affiliation(s)
- C E N M Rosenbaum
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - A F van den Hoven
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - M N G J A Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - M Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - B A Zonnenberg
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - H M Verkooijen
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - M A A J van den Bosch
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| |
Collapse
|
23
|
Damm R, Seidensticker R, Ulrich G, Breier L, Steffen IG, Seidensticker M, Garlipp B, Mohnike K, Pech M, Amthauer H, Ricke J. Y90 Radioembolization in chemo-refractory metastastic, liver dominant colorectal cancer patients: outcome assessment applying a predictive scoring system. BMC Cancer 2016; 16:509. [PMID: 27439702 PMCID: PMC4955133 DOI: 10.1186/s12885-016-2549-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 07/11/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In treatment-refractory liver dominant metastatic colorectal cancer, the role of liver directed therapies still is unclear. We sought to determine a prognostic score for Y90 radioembolization in these patients. METHODS We analyzed 106 patients with refractory liver dominant mCRC who had undergone a total of 178 Y90 radioembolizations with resin microspheres was collected. Potential factors influencing survival were analyzed using a Cox regression. The Log rank test served to establish prognostic factors and to form a clinical score for outcome prediction after Y90 radioembolization. RESULTS Median survival of all patients was 6.7 months. Neither age nor prior surgical or systemic therapy nor metastatic spread had an effect on survival. In contrast, hepatic tumor load, Karnofsky index as well as CEA and CA19-9 serums level had a significant influence (p < 0.001, p = 0.037, p = 0.023 and p < 0.001, respectively). These three factors formed a score with 1 point each for tumor load >20 %, CEA >130 ng/ml or CA19-9 > 200U/ml and Karnofsky index <80 %. Patients with a score of 0 and 1 displayed a median OS of 10.4 months. Patients with a score of 2 and 3 demonstrated a median OS of 5.1 months only (p < 0.001). CONCLUSION Overaggressive patient selection for Y90 radioembolization of liver dominant chemorefractory mCRC is of questionable benefit. A scoring system comprising hepatic tumor load, CEA and CA19-9 serum levels and Karnofsky index (TuCK-score) may support an improved patient selection. In our cohort of liver only versus liver dominant disease, extrahepatic lung or lymphatic metastases did not significantly alter the prognosis.
Collapse
Affiliation(s)
- Robert Damm
- />Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Ricarda Seidensticker
- />Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
- />Deutsche Akademie für Mikrotherapie e.V., Magdeburg, Germany
| | - Gerhard Ulrich
- />Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Leonie Breier
- />Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Ingo G. Steffen
- />Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Max Seidensticker
- />Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
- />Deutsche Akademie für Mikrotherapie e.V., Magdeburg, Germany
| | - Benjamin Garlipp
- />Department of General and Visceral Surgery, University of Magdeburg, Magdeburg, Germany
| | - Konrad Mohnike
- />Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
- />Deutsche Akademie für Mikrotherapie e.V., Magdeburg, Germany
| | - Maciej Pech
- />Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
- />Deutsche Akademie für Mikrotherapie e.V., Magdeburg, Germany
| | - Holger Amthauer
- />Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
- />Deutsche Akademie für Mikrotherapie e.V., Magdeburg, Germany
| | - Jens Ricke
- />Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
- />Deutsche Akademie für Mikrotherapie e.V., Magdeburg, Germany
| |
Collapse
|
24
|
Cho M, Gong J, Fakih M. The state of regional therapy in the management of metastatic colorectal cancer to the liver. Expert Rev Anticancer Ther 2016; 16:229-45. [PMID: 26652741 DOI: 10.1586/14737140.2016.1129277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Colorectal cancer (CRC) is one of the leading causes of cancer-related mortality in the United States. Most colorectal cancer patients die from advanced disease, and two-thirds of CRC deaths are due to liver metastases. Liver resection provides the best curative option for patients with colorectal liver metastases (CRLM), yet only 20% of those patients are eligible for liver metastases resection for curative intent. Loco-regional treatment of CRLM may provide additional benefits in terms of down-staging for resection and prolonged hepatic disease control. This review focusses on hepatic arterial infusion, radioembolization and chemoembolization.
Collapse
Affiliation(s)
- May Cho
- a Department of Medical Oncology , City of Hope National Medical Center , Duarte , CA , USA
| | - Jun Gong
- a Department of Medical Oncology , City of Hope National Medical Center , Duarte , CA , USA
| | - Marwan Fakih
- a Department of Medical Oncology , City of Hope National Medical Center , Duarte , CA , USA
| |
Collapse
|
25
|
Gabrielson A, Miller A, Banovac F, Kim A, He AR, Unger K. Outcomes and Predictors of Toxicity after Selective Internal Radiation Therapy Using Yttrium-90 Resin Microspheres for Unresectable Hepatocellular Carcinoma. Front Oncol 2015; 5:292. [PMID: 26779437 PMCID: PMC4688348 DOI: 10.3389/fonc.2015.00292] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 12/07/2015] [Indexed: 02/01/2023] Open
Abstract
Purpose We sought to report outcomes and toxicity in patients with hepatocellular carcinoma (HCC) who received resin yttrium-90 selective internal radiation therapy (90Y-SIRT) and to identify factors associated with declining liver function. Methods Patients treated with 90Y-SIRT were retrospectively evaluated. Radiographic response was assessed using RECIST 1.1. Median liver progression-free survival (LPFS) and overall survival (OS) were calculated using the Kaplan–Meier method. Bivariate analysis was used to examine associations between change in Child-Pugh (CP) score/class and patient characteristics and treatment parameters. Results Twenty-seven patients with unresectable HCC underwent SIRT, 52% were CP Class A, 48% were Class B, 11% were BCLC stage B, and 89% were stage C. Forty-four percent of patients had portal vein thrombus at baseline. One-third of patients received bilobar treatment. Median activity was 32.1 mCi (range 9.18–43.25) and median-absorbed dose to the liver was 39.6 Gy (range 13.54–67.70). Median LPFS and OS were 2.5 and 11.7 months, respectively. Three-month disease control rate was 63 and 52% in the target lesions and whole liver, respectively. New onset or worsened from baseline clinical toxicities were confined to Grade 1–2 events. However, new or worsened Grade 3–4 laboratory toxicities occurred in 38% of patients at 3 months and 43% of patients at 6 months following SIRT (six had lymphocytopenia, three had hypoalbuminemia, and two had transaminasemia). After 3 months, six patients had worsened in CP score and five had worsened in class from baseline. After 6 months, four patients had worsened in CP score and one had worsened in class from baseline. Pretreatment bilirubinemia was associated with a 2+ increase in CP score within 3 months (P = 0.001) and 6 months (P = 0.039) of 90Y-SIRT. Pretreatment transaminasemia and bilirubinemia were associated with increased CP class within 3 months of SIRT (P = 0.021 and 0.009, respectively). Conclusion 90Y-SIRT was well-tolerated in patients with unresectable HCC, with no Grade 3–4 clinical toxicities. However, Grade 3–4 laboratory toxicities and worsened CP scores were more frequent. HCC patients with pretreatment bilirubinemia or transaminasemia may be at higher risk of experiencing a decline in liver function following 90Y-SIRT.
Collapse
Affiliation(s)
- Andrew Gabrielson
- Division of Hematology and Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital , Washington, DC , USA
| | - Akemi Miller
- Department of Interventional Radiology, Georgetown University Hospital , Washington, DC , USA
| | - Filip Banovac
- Department of Interventional Radiology, Georgetown University Hospital , Washington, DC , USA
| | - Alexander Kim
- Department of Interventional Radiology, Georgetown University Hospital , Washington, DC , USA
| | - Aiwu Ruth He
- Division of Hematology and Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital , Washington, DC , USA
| | - Keith Unger
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| |
Collapse
|
26
|
Kennedy AS, Ball DS, Cohen SJ, Cohn M, Coldwell DM, Drooz A, Ehrenwald E, Kanani S, Nutting CW, Moeslein FM, Putnam SG, Rose SC, Savin MA, Schirm S, Sharma NK, Wang EA. Hepatic imaging response to radioembolization with yttrium-90-labeled resin microspheres for tumor progression during systemic chemotherapy in patients with colorectal liver metastases. J Gastrointest Oncol 2015; 6:594-604. [PMID: 26697190 DOI: 10.3978/j.issn.2078-6891.2015.082] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To assess response and the impact of imaging artifacts following radioembolization with yttrium-90-labeled resin microspheres ((90)Y-RE) based on the findings from a central independent review of patients with liver-dominant metastatic colorectal cancer (mCRC). METHODS Patients with mCRC who received (90)Y-RE (SIR-Spheres(®); Sirtex Medical, Sydney, Australia) at nine US institutions between July 2002 and December 2011 were included in the analysis. Tumor response was assessed at baseline and 3 months using either the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0 or 1.1. For each lesion, known artifacts affecting the interpretation of response (peri-tumoral edema and necrosis) were documented. Survivals (Kaplan-Meier analyses) were compared in responders [partial response (PR)] and non-responders [stable (SD) or progressive disease (PD)]. RESULTS Overall, 195 patients (mean age 62 years) received (90)Y-RE after a median of 2 (range, 1-6) lines of prior chemotherapy. Using RECIST 1.0 and RECIST 1.1, 7.6% and 6.9% of patients were partial responders, 47.3% and 48.1% had SD, and 55.0% and 55.0% PD, respectively. RECIST 1.0 and RECIST 1.1 showed excellent agreement {Kappa =0.915 [95% confidence interval (CI): 0.856-0.975]}. Peri-tumoral edema was documented in 32.8%, necrosis in 48.1% and both in 57.3% of cases (using RECIST 1.0). Although baseline characteristics were similar in responders and non-responders (P>0.05), responders survived significantly longer in an analysis according to RECIST 1.0: PR median (95% CI) 25.2 (range, 9.2-49.4) months vs. SD 15.8 (range, 9.3-21.1) months vs. PD 7.1 (range, 6.0-9.5) months (P<0.0001). CONCLUSIONS RECIST 1.0 and RECIST 1.1 imaging responses provide equivalent interpretations in the assessment of hepatic tumors following (90)Y-RE. Radiologic lesion responses at 3 months must be interpreted with caution due to the significant proportion of patients with peri-tumoral edema and necrosis, which may lead to an under-estimation of PR/SD. Nevertheless, 3-month radiologic responses were predictive of prolonged survival.
Collapse
Affiliation(s)
- Andrew S Kennedy
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - David S Ball
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Steven J Cohen
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Michael Cohn
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Douglas M Coldwell
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Alain Drooz
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Eduardo Ehrenwald
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Samir Kanani
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Charles W Nutting
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Fred M Moeslein
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Samuel G Putnam
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Steven C Rose
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Michael A Savin
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Sabine Schirm
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Navesh K Sharma
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Eric A Wang
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| |
Collapse
|
27
|
Lee VHF, Leung DK, Luk MY, Tong CC, Law MW, Ng SC, Wong KK, Poon RT, Kwong DL, Leung TW. Yttrium-90 radioembolization for advanced inoperable hepatocellular carcinoma. Onco Targets Ther 2015; 8:3457-64. [PMID: 26640386 PMCID: PMC4662370 DOI: 10.2147/ott.s92473] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Advanced inoperable hepatocellular carcinoma (HCC) conferring a grave prognosis may benefit from yttrium-90 ((90)Y) radioembolization. METHODS Thirty patients with advanced inoperable HCC including those with any lesion >8 cm in maximal diameter or multiple bi-lobar lesions (totally more than five lesions), or portal vein thrombosis treated with radioembolization were reviewed. Treatment efficacy and safety were evaluated. Univariate and multivariate analyses were performed for identifying potential prognostic factors. RESULTS After a median follow-up of 18.3 months, the response rate was 30.0%, and the disease control rate was 50.0%. Median overall progression-free survival (PFS) and overall survival (OS) were 3.3 months and 13.2 months, respectively. Longer median PFS was noted in those who had transarterial chemoembolization before radioembolization (7.3 months vs 3.1 months; P=0.021) and duration of alfafeto protein (AFP) response ≥6 months (11.8 months vs 3.0 months; P<0.001). Longer median OS was also revealed in those without portal vein thrombosis (17.1 months vs 4.4 months; P=0.015) and those whose duration of AFP response was ≥6 months (21.2 months vs 8.6 months; P=0.001). Seventeen patients (56.7%) developed treatment-related complications including five (16.7%) grade 3 events. Multivariate analysis revealed that treatment responders (P=0.001) and duration of AFP response ≥6 months (P=0.006) were prognostic of PFS, whereas the absence of portal vein invasion (P=0.025), treatment responders (P=0.010), and duration of AFP response ≥6 months (P=0.001) were prognostic of OS. CONCLUSION (90)Y radioembolization is an alternative treatment with a promising outcome for poor-risk advanced inoperable HCC.
Collapse
Affiliation(s)
- Victor Ho-Fun Lee
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Dennis Kc Leung
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Mai-Yee Luk
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Chi-Chung Tong
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Martin Wm Law
- Department of Nuclear Medicine, The University of Hong Kong, Hong Kong
| | - Sherry Cy Ng
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Ka-Kin Wong
- Department of Radiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Ronnie Tp Poon
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Dora Lw Kwong
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - To-Wai Leung
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| |
Collapse
|
28
|
Abbott AM, Kim R, Hoffe SE, Arslan B, Biebel B, Choi J, El-Haddad G, Kis B, Sweeney J, Meredith KL, Almhanna K, Strosberg J, Shibata D, Fulp WJ, Shridhar R. Outcomes of Therasphere Radioembolization for Colorectal Metastases. Clin Colorectal Cancer 2015; 14:146-53. [DOI: 10.1016/j.clcc.2015.02.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/21/2015] [Accepted: 02/06/2015] [Indexed: 01/05/2023]
|
29
|
Rodríguez-Fraile M, Iñarrairaegui M. Radioembolization with 90Y-microspheres for liver tumors. Rev Esp Med Nucl Imagen Mol 2015. [DOI: 10.1016/j.remnie.2015.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
30
|
Rodríguez-Fraile M, Iñarrairaegui M. [Radioembolization with (90)Y-microspheres for liver tumors]. Rev Esp Med Nucl Imagen Mol 2015; 34:244-57. [PMID: 25911062 DOI: 10.1016/j.remn.2015.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 03/12/2015] [Accepted: 03/13/2015] [Indexed: 12/16/2022]
Affiliation(s)
- M Rodríguez-Fraile
- Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, Navarra; Área de Oncología Hepatobiliopancreática, Clínica Universidad de Navarra, Pamplona, Navarra, España; Instituto de Investigaciones Sanitarias de Navarra (IDISNA), España.
| | - M Iñarrairaegui
- Unidad de Hepatología, Clínica Universidad de Navarra, Pamplona, Navarra, España; Área de Oncología Hepatobiliopancreática, Clínica Universidad de Navarra, Pamplona, Navarra, España; Instituto de Investigaciones Sanitarias de Navarra (IDISNA), España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Pamplona, España
| |
Collapse
|
31
|
Kennedy AS, Ball D, Cohen SJ, Cohn M, Coldwell DM, Drooz A, Ehrenwald E, Kanani S, Rose SC, Nutting CW, Moeslein FM, Savin MA, Schirm S, Putnam SG, Sharma NK, Wang EA. Multicenter evaluation of the safety and efficacy of radioembolization in patients with unresectable colorectal liver metastases selected as candidates for (90)Y resin microspheres. J Gastrointest Oncol 2015; 6:134-42. [PMID: 25830033 DOI: 10.3978/j.issn.2078-6891.2014.109] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 12/08/2014] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Metastatic colorectal cancer liver metastases Outcomes after RadioEmbolization (MORE) was an investigator-initiated case-control study to assess the experience of 11 US centers who treated liver-dominant metastases from colorectal cancer (mCRC) using radioembolization [selective internal radiation therapy (SIRT)] with yttrium-90-((90)Y)-labeled resin microspheres. METHODS Data from 606 consecutive patients who received radioembolization between July 2002 and December 2011 were collected by an independent research organization. Adverse events (AEs) and survival were compared across lines of treatment using Fisher's exact test and Kaplan-Meier estimates, respectively. RESULTS Patients received a median of 2 (range, 0-6) lines of prior chemotherapy; 35.1% had limited extrahepatic metastases. Median tumor-to-liver ratio and -activity administered at first procedure were 15% and 1.17 GBq, respectively. Hospital stay was <24 hours in 97.8% cases. Common grade ≥3 AEs over 184 days follow-up were: abdominal pain (6.1%), fatigue (5.5%), hyperbilirubinemia (5.4%), ascites (3.6%) and gastrointestinal ulceration (1.7%). There was no statistical difference in AEs across treatment lines (P>0.05). Median survivals [95% confidence interval (CI)] following radioembolization as a 2(nd)-line, 3(rd)-line, or 4(th)-plus line were 13.0 (range, 10.5-14.6), 9.0 (range, 7.8-11.0), and 8.1 (range, 6.4-9.3) months, respectively; and significantly prolonged in patients with ECOG 0 vs. ≥1 (P=0.009). Statistically significant independent variables for survival at radioembolization were: disease stage [extrahepatic metastases, extent of liver involvement (tumor-to-treated-liver ratio)], liver function (uncontrolled ascites, albumin, alkaline phosphatase, aspartate transaminase), leukocytes, and prior chemotherapy. CONCLUSIONS Radioembolization appears to have a favorable risk/benefit profile, even among mCRC patients who had received ≥3 prior lines of chemotherapy.
Collapse
Affiliation(s)
- Andrew S Kennedy
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN 37203, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbott Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 University of California, San Diego Moores Cancer Center, La Jolla, CA, USA ; 10 Radiology Imaging Associates, Englewood, CO, USA ; 11 University of Maryland Medical Center, Baltimore, MD, USA ; 12 Beaumont Hospital, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - David Ball
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN 37203, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbott Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 University of California, San Diego Moores Cancer Center, La Jolla, CA, USA ; 10 Radiology Imaging Associates, Englewood, CO, USA ; 11 University of Maryland Medical Center, Baltimore, MD, USA ; 12 Beaumont Hospital, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Steven J Cohen
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN 37203, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbott Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 University of California, San Diego Moores Cancer Center, La Jolla, CA, USA ; 10 Radiology Imaging Associates, Englewood, CO, USA ; 11 University of Maryland Medical Center, Baltimore, MD, USA ; 12 Beaumont Hospital, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Michael Cohn
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN 37203, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbott Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 University of California, San Diego Moores Cancer Center, La Jolla, CA, USA ; 10 Radiology Imaging Associates, Englewood, CO, USA ; 11 University of Maryland Medical Center, Baltimore, MD, USA ; 12 Beaumont Hospital, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Douglas M Coldwell
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN 37203, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbott Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 University of California, San Diego Moores Cancer Center, La Jolla, CA, USA ; 10 Radiology Imaging Associates, Englewood, CO, USA ; 11 University of Maryland Medical Center, Baltimore, MD, USA ; 12 Beaumont Hospital, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Alain Drooz
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN 37203, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbott Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 University of California, San Diego Moores Cancer Center, La Jolla, CA, USA ; 10 Radiology Imaging Associates, Englewood, CO, USA ; 11 University of Maryland Medical Center, Baltimore, MD, USA ; 12 Beaumont Hospital, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Eduardo Ehrenwald
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN 37203, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbott Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 University of California, San Diego Moores Cancer Center, La Jolla, CA, USA ; 10 Radiology Imaging Associates, Englewood, CO, USA ; 11 University of Maryland Medical Center, Baltimore, MD, USA ; 12 Beaumont Hospital, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Samir Kanani
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN 37203, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbott Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 University of California, San Diego Moores Cancer Center, La Jolla, CA, USA ; 10 Radiology Imaging Associates, Englewood, CO, USA ; 11 University of Maryland Medical Center, Baltimore, MD, USA ; 12 Beaumont Hospital, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Steven C Rose
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN 37203, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbott Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 University of California, San Diego Moores Cancer Center, La Jolla, CA, USA ; 10 Radiology Imaging Associates, Englewood, CO, USA ; 11 University of Maryland Medical Center, Baltimore, MD, USA ; 12 Beaumont Hospital, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Charles W Nutting
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN 37203, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbott Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 University of California, San Diego Moores Cancer Center, La Jolla, CA, USA ; 10 Radiology Imaging Associates, Englewood, CO, USA ; 11 University of Maryland Medical Center, Baltimore, MD, USA ; 12 Beaumont Hospital, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Fred M Moeslein
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN 37203, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbott Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 University of California, San Diego Moores Cancer Center, La Jolla, CA, USA ; 10 Radiology Imaging Associates, Englewood, CO, USA ; 11 University of Maryland Medical Center, Baltimore, MD, USA ; 12 Beaumont Hospital, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Michael A Savin
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN 37203, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbott Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 University of California, San Diego Moores Cancer Center, La Jolla, CA, USA ; 10 Radiology Imaging Associates, Englewood, CO, USA ; 11 University of Maryland Medical Center, Baltimore, MD, USA ; 12 Beaumont Hospital, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Sabine Schirm
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN 37203, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbott Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 University of California, San Diego Moores Cancer Center, La Jolla, CA, USA ; 10 Radiology Imaging Associates, Englewood, CO, USA ; 11 University of Maryland Medical Center, Baltimore, MD, USA ; 12 Beaumont Hospital, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Samuel G Putnam
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN 37203, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbott Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 University of California, San Diego Moores Cancer Center, La Jolla, CA, USA ; 10 Radiology Imaging Associates, Englewood, CO, USA ; 11 University of Maryland Medical Center, Baltimore, MD, USA ; 12 Beaumont Hospital, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Navesh K Sharma
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN 37203, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbott Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 University of California, San Diego Moores Cancer Center, La Jolla, CA, USA ; 10 Radiology Imaging Associates, Englewood, CO, USA ; 11 University of Maryland Medical Center, Baltimore, MD, USA ; 12 Beaumont Hospital, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Eric A Wang
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN 37203, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbott Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 University of California, San Diego Moores Cancer Center, La Jolla, CA, USA ; 10 Radiology Imaging Associates, Englewood, CO, USA ; 11 University of Maryland Medical Center, Baltimore, MD, USA ; 12 Beaumont Hospital, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| |
Collapse
|
32
|
Garlipp B, Bruns CJ. The evidence for resection post-selective internal radiation therapy. Future Oncol 2014; 10:49-52. [PMID: 25478767 DOI: 10.2217/fon.14.223] [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: 01/03/2023] Open
Affiliation(s)
- Benjamin Garlipp
- Department of Surgery, University Hospital Magdeburg, Otto von Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | | |
Collapse
|
33
|
Chimiothérapie intra-artérielle hépatique, chimioembolisation et radioembolisation : un apport important pour le traitement des métastases hépatiques des cancers colorectaux. ONCOLOGIE 2014. [DOI: 10.1007/s10269-014-2468-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
34
|
Golfieri R. SIR-Spheres yttrium-90 radioembolization for the treatment of unresectable liver cancers. Hepat Oncol 2014; 1:265-283. [PMID: 30190962 DOI: 10.2217/hep.14.6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Transarterial radioembolization with yttrium-90 resin microspheres (SIR-Spheres; Sirtex Medical Limited, Sydney, Australia) is a liver-directed therapy that is gaining recognition as a treatment option for liver-dominant primary and metastatic cancers. The incidence of complications is low and can be further reduced by patient selection and rigorous pretreatment assessment. Ideal candidates for radioembolization have preserved liver function without ascites or encephalopathy, Child-Pugh score <7 and limited lung shunting. Phase III randomized controlled trials (RCTs) against other liver-directed therapies are lacking for intermediate-stage hepatocellular carcinoma. However, preliminary data from a recent RCT has suggested that radioembolization has a similar time-to-progression and comparable toxicity to selective chemoembolization. Phase II/III RCTs are now ongoing to evaluate the combination of radioembolization with systemic therapies in advanced-stage hepatocellular carcinoma and metastatic liver-dominant colorectal cancer in order to expand the treatment opportunities for patients with cancers in the liver.
Collapse
Affiliation(s)
- Rita Golfieri
- Radiology Unit, Department of Digestive Diseases & Internal Medicine, Azienda Ospedaliero-Universitaria, Policlinico S. Orsola-Malpighi, Via Massarenti 9, Bologna, Italy
| |
Collapse
|
35
|
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.
Collapse
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
| |
Collapse
|
36
|
Raval M, Bande D, Pillai AK, Blaszkowsky LS, Ganguli S, Beg MS, Kalva SP. Yttrium-90 radioembolization of hepatic metastases from colorectal cancer. Front Oncol 2014; 4:120. [PMID: 25120951 PMCID: PMC4110696 DOI: 10.3389/fonc.2014.00120] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 05/09/2014] [Indexed: 12/29/2022] Open
Abstract
Liver metastases from colorectal cancer (CRC) result in substantial morbidity and mortality. The primary treatment is systemic chemotherapy, and in selected patients, surgical resection; however, for patients who are not surgical candidates and/or fail systemic chemotherapy, liver-directed therapies are increasingly being utilized. Yttrium-90 (Y-90) microsphere therapy, also known as selective internal radiation therapy (SIRT) or radioembolization, has proven to be effective in terms of extending time to progression of disease and also providing survival benefit. This review focuses on the use of Y-90 microsphere therapy in the treatment of liver metastases from CRC, including a comprehensive review of published clinical trials and prospective studies conducted thus far. We review the methodology, outcomes, and side effects of Y-90 microsphere therapy for metastatic CRC.
Collapse
Affiliation(s)
- Mihir Raval
- Department of Hospital Medicine, Essentia Health , Fargo, ND , USA
| | - Dinesh Bande
- Department of Hospital Medicine, Sanford Health , Fargo, ND , USA ; Roger Maris Cancer Center , Fargo, ND , USA ; Department of Internal Medicine, University of North Dakota , Fargo, ND , USA
| | - Anil K Pillai
- Harold Simmons Cancer Center, University of Texas Southwestern Medical Center , Dallas, TX , USA ; Interventional Radiology, University of Texas Southwestern Medical Center , Dallas, TX , USA
| | - Lawrence S Blaszkowsky
- Massachusetts General Hospital Cancer Center , Boston, MA , USA ; Department of Hematology and Oncology, Massachusetts General Hospital , Boston, MA , USA ; Department of Medicine, Harvard Medical School , Boston, MA , USA
| | - Suvranu Ganguli
- Massachusetts General Hospital Cancer Center , Boston, MA , USA ; Section of Interventional Radiology, Department of Imaging, Massachusetts General Hospital , Boston, MA , USA ; Department of Radiology, Harvard Medical School , Boston, MA , USA
| | - Muhammad S Beg
- Harold Simmons Cancer Center, University of Texas Southwestern Medical Center , Dallas, TX , USA ; Division of Hematology and Oncology, Department of Medicine, University of Texas Southwestern Medical Center , Dallas, TX , USA
| | - Sanjeeva P Kalva
- Harold Simmons Cancer Center, University of Texas Southwestern Medical Center , Dallas, TX , USA ; Interventional Radiology, University of Texas Southwestern Medical Center , Dallas, TX , USA
| |
Collapse
|
37
|
A low-interaction automatic 3D liver segmentation method using computed tomography for selective internal radiation therapy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:198015. [PMID: 25105118 PMCID: PMC4106113 DOI: 10.1155/2014/198015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 05/31/2014] [Accepted: 06/10/2014] [Indexed: 12/23/2022]
Abstract
This study introduces a novel liver segmentation approach for estimating anatomic liver volumes towards selective internal radiation treatment (SIRT). The algorithm requires minimal human interaction since the initialization process to segment the entire liver in 3D relied on a single computed tomography (CT) slice. The algorithm integrates a localized contouring algorithm with a modified k-means method. The modified k-means segments each slice into five distinct regions belonging to different structures. The liver region is further segmented using localized contouring. The novelty of the algorithm is in the design of the initialization masks for region contouring to minimize human intervention. Intensity based region growing together with novel volume of interest (VOI) based corrections is used to accomplish the single slice initialization. The performance of the algorithm is evaluated using 34 liver CT scans. Statistical experiments were performed to determine consistency of segmentation and to assess user dependency on the initialization process. Volume estimations are compared to the manual gold standard. Results show an average accuracy of 97.22% for volumetric calculation with an average Dice coefficient of 0.92. Statistical tests show that the algorithm is highly consistent (P = 0.55) and independent of user initialization (P = 0.20 and Fleiss' Kappa = 0.77 ± 0.06).
Collapse
|
38
|
Abstract
Unresectable primary and metastatic liver tumors are a leading cause of cancer mortality and morbidity. This remains a challenging and key task for every oncologist despite significant advances that have been made with selective targeted systemic agents and in technology advances with radiotherapy delivery. Radioembolization (RE) is a technique of permanently implanting microspheres containing Yttrium-90 ((90)Y), a beta-emitting isotope with a treatment range of 2 mm, into hepatic tumors. This form of brachytherapy utilizes the unique dual vascular anatomy of the liver to preferentially deliver radioactive particles via the hepatic artery to tumor, sparing normal liver parenchyma. The main treatment inclusion criteria are patients with solid tumors, compensated liver functions, life expectancy of at least three months, and ECOG performance status 0-2. Benefit of RE has been proven in patients that have low-to-moderate extrahepatic disease burden, prior liver radiotherapy, heavy prior chemotherapy and biologic agent exposure, and history of hepatic surgery or ablation. Most of the clinical evidence is reported in metastatic colorectal, and neuroendocrine tumors (NET), and primary hepatocellular cancer. A growing body of data supports the use of RE in hepatic metastatic breast cancer, intrahepatic cholangiocarinoma, and many other metastatic tumor types. Side effects are typically mild constitutional and GI issues limited to the first 7-14 days post treatment, with only 6% grade 3 toxicity reported in large series. Potentially serious or fatal radiation induced liver disease is extremely rare, reported in only 1% or fewer in major series of both metastatic and primary tumors treated with RE. Currently, high priority prospective clinical trials are testing RE combined with chemotherapy in first line therapy for colorectal hepatic metastases, and combined with sorafenib for hepatocellular carcinomas (HCCs). Fortunately, this beneficial and now widely available therapy is being increasingly incorporated into the standard therapy algorithms of multidisciplinary GI cancer teams worldwide. This form of radiotherapy differs significantly from daily external beam radiotherapy in many ways, particularly in dose rate, dosimetric coverage and duration of radiation delivery, side effects, and patient selection factors. A wealth of experience using RE in solid tumors exists and ongoing major prospective clinical trials will soon clarify the role of RE in the management of metastatic colorectal liver metastases.
Collapse
Affiliation(s)
- Andrew Kennedy
- Radiation Oncology Research, Sarah Cannon Research Institute, 3322 West End Ave., Suite 800 Nashville, TN 37203, USA
| |
Collapse
|
39
|
Butte JM, Ball CG, Dixon E. Treatment of Unresectable Liver-Only Disease: Systemic Therapy versus Locoregional Therapy. CURRENT SURGERY REPORTS 2014. [DOI: 10.1007/s40137-014-0050-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
40
|
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.
Collapse
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
| |
Collapse
|
41
|
Seminerio J, McGrath K, Arnold CA, Voltaggio L, Singhi AD. Medication-associated lesions of the GI tract. Gastrointest Endosc 2014; 79:140-50. [PMID: 24119504 DOI: 10.1016/j.gie.2013.08.027] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 08/22/2013] [Indexed: 02/08/2023]
Affiliation(s)
- Jennifer Seminerio
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kevin McGrath
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Christina A Arnold
- Department of Pathology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Lysandra Voltaggio
- Department of Pathology, George Washington University, Washington, District of Columbia
| | - Aatur D Singhi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| |
Collapse
|
42
|
Saxena A, Bester L, Shan L, Perera M, Gibbs P, Meteling B, Morris DL. A systematic review on the safety and efficacy of yttrium-90 radioembolization for unresectable, chemorefractory colorectal cancer liver metastases. J Cancer Res Clin Oncol 2013; 140:537-47. [PMID: 24318568 DOI: 10.1007/s00432-013-1564-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 11/28/2013] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The management of unresectable, chemorefractory colorectal cancer liver metastases (CRCLM) is a clinical dilemma. Yttrium-90 (Y90) radioembolization is a potentially safe and effective treatment for patients with CRCLM who have failed conventional chemotherapy regimens. METHODS A systematic review of clinical studies before November 2012 was performed to examine the radiological response, overall survival and progression-free survival of patients who underwent Y90 radioembolization of unresectable CRCLM refractory to systemic therapy. The secondary objectives were to evaluate the safety profile of this treatment and identify prognostic factors for overall survival. RESULTS Twenty studies comprising 979 patients were examined. Patients had failed a median of 3 lines of chemotherapy (range 2-5). After treatment, the average reported value of patients with complete radiological response, partial response and stable disease was 0% (range 0-6%), 31% (range 0-73%) and 40.5% (range 17-76%), respectively. The median time to intra-hepatic progression was 9 months (range 6-16). The median overall survival was 12 months (range 8.3-36). The overall acute toxicity rate ranged from 11 to 100% (median 40.5 %). Most cases of acute toxicity were mild (Grade I or II) (median 39%; range 7-100%) which resolved without intervention. The number of previous lines of chemotherapy (≥ 3), poor radiological response to treatment, extra-hepatic disease and extensive liver disease (≥ 25%) were the factors most commonly associated with poorer overall survival. CONCLUSION Y90 radioembolization is a safe and effective treatment of CRCLM in the salvage setting and should be more widely utilized.
Collapse
Affiliation(s)
- Akshat Saxena
- UNSW Department of Surgery, St George Hospital, Kogarah, NSW, 2217, Australia,
| | | | | | | | | | | | | |
Collapse
|
43
|
Importance of Response to Neoadjuvant Therapy in Patients With Liver-Limited mCRC When the Intent Is Resection and/or Ablation. Clin Colorectal Cancer 2013; 12:223-32. [DOI: 10.1016/j.clcc.2013.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 05/30/2013] [Accepted: 06/17/2013] [Indexed: 01/04/2023]
|
44
|
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
|
45
|
|
46
|
GREGORY SM, MUNNEKE GJ. Interventional radiology in liver cancer. IMAGING 2013. [DOI: 10.1259/imaging.20120010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
47
|
Mahnken AH, Pereira PL, de Baère T. Interventional oncologic approaches to liver metastases. Radiology 2013; 266:407-30. [PMID: 23362094 DOI: 10.1148/radiol.12112544] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Metastatic liver disease is the most common cause of death in cancer patients. Complete surgical resection is currently considered the only curative treatment, with only about 25% of patients being amenable to surgery. Therefore, a variety of interventional oncologic techniques have been developed for treating secondary liver malignancies. The aim of these therapies is either to allow patients with unresectable tumors to become surgical candidates, provide curative treatment options in nonsurgical candidates, or improve survival in a palliative or even curative approach. Among these interventional therapies are transcatheter therapies such as portal vein embolization, hepatic artery infusion chemotherapy, transarterial chemoembolization, and radioembolization, as well as interstitial techniques, particularly radiofrequency ablation as the most commonly applied technique. The rationale, application and clinical results of each of these techniques are reviewed on the basis of the current literature. Future prospects such as gene therapy and immunotherapy are introduced.
Collapse
Affiliation(s)
- Andreas H Mahnken
- Department of Diagnostic and Interventional Radiology, University Hospital, RWTH Aachen University, Aachen, Germany
| | | | | |
Collapse
|
48
|
Luo DL, Chan JKC. Basophilic Round Bodies in Gastric Biopsies Little Known by Pathologists. Int J Surg Pathol 2013; 21:535-7. [PMID: 23564705 DOI: 10.1177/1066896913481057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Selective internal radiation therapy is a relatively new technique that irradiates primary and metastatic liver cancer using yttrium 90 microspheres. Increasing reports have shown this to be a useful treatment for unresectable primary hepatocellular carcinoma and others metastases from colon, lung, breast, sarcoma, and ocular melanoma. On the other hand, more and more therapy-related complications have been described. Since the morphologic description of injured organs are relatively uncommon, we report 2 cases of selective internal radiation therapy–related gastric injury, which represent basophilic round bodies in gastric biopsies little known by pathologists. The appearances in esophagogastroduodenoscopy include gastrointestinal ulcer, edema, and bleeding. Histological findings are mucosal atrophy, mild to moderate cytologic atypia, edema of the stroma, and inflammatory infiltration. The most characteristic feature is the presence of round blue and dark microspheres in the stromal blood vessels.
Collapse
Affiliation(s)
- Dong-Lan Luo
- Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China
| | | |
Collapse
|
49
|
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.
Collapse
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
| |
Collapse
|
50
|
Seront E, Van den Eynde M. Liver-Directed Therapies: Does It Make Sense in the Current Therapeutic Strategy for Patients With Confined Liver Colorectal Metastases? Clin Colorectal Cancer 2012; 11:177-84. [DOI: 10.1016/j.clcc.2011.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 10/21/2011] [Accepted: 12/01/2011] [Indexed: 12/22/2022]
|