Escalated Segmental and Modified Radiation Lobectomy Dosing for Yttrium-90 Radioembolization of Liver-Dominant Metastatic Colorectal Cancer: 10-year Outcomes

Andrew C. Gordon; Saad Abu Zahra; Muhamad Serhal; Sheetal M. Kircher; Aparna Kalyan; Kent Sato; Ahsun Riaz; Elias Hohlastos; Riad Salem; Robert J. Lewandowski

doi:10.1016/j.clcc.2025.02.005

Escalated Segmental and Modified Radiation Lobectomy Dosing for Yttrium-90 Radioembolization of Liver-Dominant Metastatic Colorectal Cancer: 10-year Outcomes

Andrew C. Gordon, Saad Abu Zahra, Muhamad Serhal, Sheetal M. Kircher, Aparna Kalyan, Kent Sato, Ahsun Riaz, Elias Hohlastos, Riad Salem, Robert J. Lewandowski^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Purpose: This study evaluates the safety and efficacy of escalated-dosing Yttrium-90 transarterial radioembolization (TARE) for unresectable, unablatable metastatic colorectal cancer (mCRC) to the liver. Materials and Methods: A retrospective review (September 2009 to March 2020) included 45 patients with liver-dominant mCRC treated with segmental Y90 or modified radiation lobectomy. Patient demographics, treatment details, adverse events, imaging response, and overall survival (OS) were analyzed. OS Prognosticators were examined using log-rank test and Cox proportional hazards regression. Results: 45 patients (median age 61.4 years; 60% male) were included, with 96% ECOG 0-1. Prior treatments included primary site resection (93%), liver resection (65%), chemotherapy (60%), and ablation (27%). Extrahepatic disease was present in 51%. 71% of patients had < 25% liver tumor burden (mean tumor size = 4.8 cm). Treatment was technically successful in all cases, with 4% 30-day mortality. Adverse events were mostly low-grade, including fatigue (58%) and abdominal pain (20%). Mean neutrophil-to-lymphocyte ratio (NLR) increase was 2.9, and 33% of patients showed 50% reduction in CEA. Imaging responses (RECIST) included SD (80%), PR (18%), PD (2%), and CR (0%), with PET/CT showing 39% objective response after 4.2 months. Median OS was 41.9 months (95% CI 15.4-NE). Extrahepatic disease significantly reduced OS (15.7 vs. 44.4 months, P = .0033). Both pre- and post-NLR (HR:1.42, P = .007; HR 1.12, P = .027) were associated with worse OS. In the multivariable analysis, Pre-NLR and extrahepatic disease remained adverse prognosticators. Conclusion: Y90 TARE with escalated dosing demonstrated an acceptable safety profile in heavily pretreated mCRC patients. Extrahepatic disease and pre-NLR were significant adverse prognosticators. Future studies should explore Y90 TARE dosing in mCRC patients.

Original language	English (US)
Pages (from-to)	290-299
Number of pages	10
Journal	Clinical colorectal cancer
Volume	24
Issue number	2
DOIs	https://doi.org/10.1016/j.clcc.2025.02.005
State	Published - Jun 2025

Funding

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. The authors thank Vanessa L. Gates, Karen Grace, Krystina Salzig, and Melissa Williams for their commitment to patient care and dedication to clinical research. No dedicated funding was provided for this study. RJL receives research support from NIH grant R01CA233878-01. The authors thank Vanessa L. Gates, Karen Grace, Krystina Salzig, and Melissa Williams for their commitment to patient care and dedication to clinical research. No dedicated funding was provided for this study. RJL receives research support from NIH grant R01CA233878-01 .

Keywords

Metastatic colorectal cancer
Radioembolization
Survival
Yttrium-90

ASJC Scopus subject areas

Oncology
Gastroenterology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.clcc.2025.02.005

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Gordon, A. C., Zahra, S. A., Serhal, M., Kircher, S. M., Kalyan, A., Sato, K., Riaz, A., Hohlastos, E., Salem, R., & Lewandowski, R. J. (2025). Escalated Segmental and Modified Radiation Lobectomy Dosing for Yttrium-90 Radioembolization of Liver-Dominant Metastatic Colorectal Cancer: 10-year Outcomes. Clinical colorectal cancer, 24(2), 290-299. https://doi.org/10.1016/j.clcc.2025.02.005

@article{49be795e2b83427ca6b87c065a1d5afd,

title = "Escalated Segmental and Modified Radiation Lobectomy Dosing for Yttrium-90 Radioembolization of Liver-Dominant Metastatic Colorectal Cancer: 10-year Outcomes",

abstract = "Purpose: This study evaluates the safety and efficacy of escalated-dosing Yttrium-90 transarterial radioembolization (TARE) for unresectable, unablatable metastatic colorectal cancer (mCRC) to the liver. Materials and Methods: A retrospective review (September 2009 to March 2020) included 45 patients with liver-dominant mCRC treated with segmental Y90 or modified radiation lobectomy. Patient demographics, treatment details, adverse events, imaging response, and overall survival (OS) were analyzed. OS Prognosticators were examined using log-rank test and Cox proportional hazards regression. Results: 45 patients (median age 61.4 years; 60\% male) were included, with 96\% ECOG 0-1. Prior treatments included primary site resection (93\%), liver resection (65\%), chemotherapy (60\%), and ablation (27\%). Extrahepatic disease was present in 51\%. 71\% of patients had < 25\% liver tumor burden (mean tumor size = 4.8 cm). Treatment was technically successful in all cases, with 4\% 30-day mortality. Adverse events were mostly low-grade, including fatigue (58\%) and abdominal pain (20\%). Mean neutrophil-to-lymphocyte ratio (NLR) increase was 2.9, and 33\% of patients showed 50\% reduction in CEA. Imaging responses (RECIST) included SD (80\%), PR (18\%), PD (2\%), and CR (0\%), with PET/CT showing 39\% objective response after 4.2 months. Median OS was 41.9 months (95\% CI 15.4-NE). Extrahepatic disease significantly reduced OS (15.7 vs. 44.4 months, P = .0033). Both pre- and post-NLR (HR:1.42, P = .007; HR 1.12, P = .027) were associated with worse OS. In the multivariable analysis, Pre-NLR and extrahepatic disease remained adverse prognosticators. Conclusion: Y90 TARE with escalated dosing demonstrated an acceptable safety profile in heavily pretreated mCRC patients. Extrahepatic disease and pre-NLR were significant adverse prognosticators. Future studies should explore Y90 TARE dosing in mCRC patients.",

keywords = "Metastatic colorectal cancer, Radioembolization, Survival, Yttrium-90",

author = "Gordon, \{Andrew C.\} and Zahra, \{Saad Abu\} and Muhamad Serhal and Kircher, \{Sheetal M.\} and Aparna Kalyan and Kent Sato and Ahsun Riaz and Elias Hohlastos and Riad Salem and Lewandowski, \{Robert J.\}",

note = "Publisher Copyright: {\textcopyright} 2025 Elsevier Inc.",

year = "2025",

month = jun,

doi = "10.1016/j.clcc.2025.02.005",

language = "English (US)",

volume = "24",

pages = "290--299",

journal = "Clinical colorectal cancer",

issn = "1533-0028",

publisher = "Elsevier Inc.",

number = "2",

}

Gordon, AC, Zahra, SA, Serhal, M, Kircher, SM , Kalyan, A , Sato, K , Riaz, A, Hohlastos, E, Salem, R & Lewandowski, RJ 2025, 'Escalated Segmental and Modified Radiation Lobectomy Dosing for Yttrium-90 Radioembolization of Liver-Dominant Metastatic Colorectal Cancer: 10-year Outcomes', Clinical colorectal cancer, vol. 24, no. 2, pp. 290-299. https://doi.org/10.1016/j.clcc.2025.02.005

TY - JOUR

T1 - Escalated Segmental and Modified Radiation Lobectomy Dosing for Yttrium-90 Radioembolization of Liver-Dominant Metastatic Colorectal Cancer

T2 - 10-year Outcomes

AU - Gordon, Andrew C.

AU - Zahra, Saad Abu

AU - Serhal, Muhamad

AU - Kircher, Sheetal M.

AU - Kalyan, Aparna

AU - Sato, Kent

AU - Riaz, Ahsun

AU - Hohlastos, Elias

AU - Salem, Riad

AU - Lewandowski, Robert J.

PY - 2025/6

Y1 - 2025/6

N2 - Purpose: This study evaluates the safety and efficacy of escalated-dosing Yttrium-90 transarterial radioembolization (TARE) for unresectable, unablatable metastatic colorectal cancer (mCRC) to the liver. Materials and Methods: A retrospective review (September 2009 to March 2020) included 45 patients with liver-dominant mCRC treated with segmental Y90 or modified radiation lobectomy. Patient demographics, treatment details, adverse events, imaging response, and overall survival (OS) were analyzed. OS Prognosticators were examined using log-rank test and Cox proportional hazards regression. Results: 45 patients (median age 61.4 years; 60% male) were included, with 96% ECOG 0-1. Prior treatments included primary site resection (93%), liver resection (65%), chemotherapy (60%), and ablation (27%). Extrahepatic disease was present in 51%. 71% of patients had < 25% liver tumor burden (mean tumor size = 4.8 cm). Treatment was technically successful in all cases, with 4% 30-day mortality. Adverse events were mostly low-grade, including fatigue (58%) and abdominal pain (20%). Mean neutrophil-to-lymphocyte ratio (NLR) increase was 2.9, and 33% of patients showed 50% reduction in CEA. Imaging responses (RECIST) included SD (80%), PR (18%), PD (2%), and CR (0%), with PET/CT showing 39% objective response after 4.2 months. Median OS was 41.9 months (95% CI 15.4-NE). Extrahepatic disease significantly reduced OS (15.7 vs. 44.4 months, P = .0033). Both pre- and post-NLR (HR:1.42, P = .007; HR 1.12, P = .027) were associated with worse OS. In the multivariable analysis, Pre-NLR and extrahepatic disease remained adverse prognosticators. Conclusion: Y90 TARE with escalated dosing demonstrated an acceptable safety profile in heavily pretreated mCRC patients. Extrahepatic disease and pre-NLR were significant adverse prognosticators. Future studies should explore Y90 TARE dosing in mCRC patients.

AB - Purpose: This study evaluates the safety and efficacy of escalated-dosing Yttrium-90 transarterial radioembolization (TARE) for unresectable, unablatable metastatic colorectal cancer (mCRC) to the liver. Materials and Methods: A retrospective review (September 2009 to March 2020) included 45 patients with liver-dominant mCRC treated with segmental Y90 or modified radiation lobectomy. Patient demographics, treatment details, adverse events, imaging response, and overall survival (OS) were analyzed. OS Prognosticators were examined using log-rank test and Cox proportional hazards regression. Results: 45 patients (median age 61.4 years; 60% male) were included, with 96% ECOG 0-1. Prior treatments included primary site resection (93%), liver resection (65%), chemotherapy (60%), and ablation (27%). Extrahepatic disease was present in 51%. 71% of patients had < 25% liver tumor burden (mean tumor size = 4.8 cm). Treatment was technically successful in all cases, with 4% 30-day mortality. Adverse events were mostly low-grade, including fatigue (58%) and abdominal pain (20%). Mean neutrophil-to-lymphocyte ratio (NLR) increase was 2.9, and 33% of patients showed 50% reduction in CEA. Imaging responses (RECIST) included SD (80%), PR (18%), PD (2%), and CR (0%), with PET/CT showing 39% objective response after 4.2 months. Median OS was 41.9 months (95% CI 15.4-NE). Extrahepatic disease significantly reduced OS (15.7 vs. 44.4 months, P = .0033). Both pre- and post-NLR (HR:1.42, P = .007; HR 1.12, P = .027) were associated with worse OS. In the multivariable analysis, Pre-NLR and extrahepatic disease remained adverse prognosticators. Conclusion: Y90 TARE with escalated dosing demonstrated an acceptable safety profile in heavily pretreated mCRC patients. Extrahepatic disease and pre-NLR were significant adverse prognosticators. Future studies should explore Y90 TARE dosing in mCRC patients.

KW - Metastatic colorectal cancer

KW - Radioembolization

KW - Survival

KW - Yttrium-90

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U2 - 10.1016/j.clcc.2025.02.005

DO - 10.1016/j.clcc.2025.02.005

M3 - Article

C2 - 40133187

AN - SCOPUS:105000887556

SN - 1533-0028

VL - 24

SP - 290

EP - 299

JO - Clinical colorectal cancer

JF - Clinical colorectal cancer

IS - 2

ER -

Escalated Segmental and Modified Radiation Lobectomy Dosing for Yttrium-90 Radioembolization of Liver-Dominant Metastatic Colorectal Cancer: 10-year Outcomes

Abstract

Funding

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UN SDGs

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