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Y-90 radioembolization in the treatment of colorectal cancer that is metastatic to the liver. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
593 Background: Y-90 radioembolization has shown promise in the treatment of unresectable metastatic colorectal cancer (mCRC) and primary hepatocellular carcinoma (HCC). The goal of our study was to assess the efficacy in patients with refractory mCRC who underwent Y-90 radioembolization. Methods: Patients with unresectable mCRC to the liver underwent treatment at the Ohio State University with resin microspheres. Response to treatment or progression of disease was assessed by CT imaging per RECIST criteria. Overall survival (OS) and progression free survival (PFS) were estimated by Kaplan-Meier method. Log-rank test was used to compare the survival curves between the groups. The Cox-regression model was used to explore any association between time to treatment and PFS (or OS). Results: 24 patients with a mean age of 63 years old were included. 54% of patients had extrahepatic disease, 67% had hepatic bilobar involvement, and more than 80% of our patients had more than two chemotherapy regimens prior to initiation of Y-90 radioembolization. There were no objective responses radiographically. 5 patients had a CEA response. The estimated median PFS and OS were 3.9 months (CI 95%: 2.4,4.8) and 8.9 months (CI 95%: 4.2,16.7), respectively. Patients with any CEA response to treatment tended to have a significantly longer PFS (4.8 months vs. 2.7 months, p=0.088), but no significant association with OS (p=0.64). The presence of extrahepatic disease prior to initiation of treatment resulted in a significantly lower PFS (2.9 vs. 5.1 months, p=0.076) but no significant difference in OS (p=0.86). Patients older than 65 appeared to have an improvement in PFS compared to younger patients (4.6 vs. 2.4 months, p=0.052). There was no significant association between the time to initiation of treatment and PFS (p=0.63) or OS (p=1). Conclusions: Y-90 radioembolization appears to have promising activity in patients with refractory unresectable liver metastasis from mCRC. Factors such as older age and absence of extrahepatic disease may be associated with improved outcomes. CEA response may be a surrogate marker for benefit. Large randomized studies need to confirm our findings. No significant financial relationships to disclose.
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