Twelve-year experience of radioembolization for colorectal hepatic metastases in 214 patients

survival by era and chemotherapy

Robert J Lewandowski, Khairuddin Memon, Mary Frances Mulcahy, Ryan M Hickey, Karen Marshall, Melissa Williams, Krystina Salzig, Vanessa L. Gates, Bassel Atassi, Michael Vouche, Rohi Atassi, Kush R Desai, Elias Hohlastos, Kent T Sato, Ali Habib, Sheetal Mehta Kircher, Steven B. Newman, Halla S Nimeiri, Al B Benson III, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Methods: A total of 214 patients with CRC metastases were treated with Y90 radioembolization over 12 years. Toxicity was assessed using National Cancer Institute common terminology criteria. Overall survival was analyzed from date of diagnosis of primary cancer, hepatic metastases and from the first Y90. Uni/multivariate analyses were performed. Substratification by era of chemotherapeutics was performed.

Results: Most patients were male (60 %) and <65 years old (61 %). Of them, 98 % had been exposed to chemotherapy. Grade 3 lymphocyte, bilirubin, albumin, ALP and AST toxicities were observed in 39 %, 11 %, 10 %, 8 % and 4 % of patients, respectively. Grade 4 lymphocyte and ALP toxicities were observed in 5 % and 3 % of patients, respectively. Median overall survival was 43.0, 34.6, and 10.6 months from date of diagnosis of primary cancer, hepatic metastases and first Y90, respectively. Survival was significantly longer in patients: (1) who received ≤2 cytotoxic drugs (n = 104) than those who received 3 (n = 110) (15.2 vs. 7.5 months, p = 0.0001); and (2) who received no biologic agents (n = 52) compared with those that did (n = 162) (18.6 vs. 9.4 months, p = 0.0001). Multivariate analyses identified ≤2 cytotoxic agents, no exposure to biologics, ECOG 0, tumor burden <25 %, lack of extrahepatic disease and albumin >3 g/dL as independent predictors of survival.

Conclusion: In this largest metastatic CRC series published to date, Y90 radioembolization was found to be safe; survival varied by prior therapy. Further studies are required to further refine the role of Y90 in metastatic CRC.

Purpose: The aim of this study was to analyze the safety, treatment characteristics and survival outcomes of Yttrium-90 (Y90) radioembolization for unresectable colorectal carcinoma (CRC) liver metastases refractory to standard of care therapy.

Original languageEnglish (US)
Pages (from-to)1861-1869
Number of pages9
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Volume41
Issue number10
DOIs
StatePublished - Jan 1 2014

Fingerprint

Yttrium
Neoplasm Metastasis
Colorectal Neoplasms
Drug Therapy
Survival
Liver
National Cancer Institute (U.S.)
Standard of Care
Liver Neoplasms
Terminology
Therapeutics
Multivariate Analysis
Safety

Keywords

  • Colorectal metastases
  • Radioembolization
  • SIRT
  • Survival
  • Yttrium-90

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Lewandowski, Robert J ; Memon, Khairuddin ; Mulcahy, Mary Frances ; Hickey, Ryan M ; Marshall, Karen ; Williams, Melissa ; Salzig, Krystina ; Gates, Vanessa L. ; Atassi, Bassel ; Vouche, Michael ; Atassi, Rohi ; Desai, Kush R ; Hohlastos, Elias ; Sato, Kent T ; Habib, Ali ; Kircher, Sheetal Mehta ; Newman, Steven B. ; Nimeiri, Halla S ; Benson III, Al B ; Salem, Riad. / Twelve-year experience of radioembolization for colorectal hepatic metastases in 214 patients : survival by era and chemotherapy. In: European Journal of Nuclear Medicine and Molecular Imaging. 2014 ; Vol. 41, No. 10. pp. 1861-1869.
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abstract = "Methods: A total of 214 patients with CRC metastases were treated with Y90 radioembolization over 12 years. Toxicity was assessed using National Cancer Institute common terminology criteria. Overall survival was analyzed from date of diagnosis of primary cancer, hepatic metastases and from the first Y90. Uni/multivariate analyses were performed. Substratification by era of chemotherapeutics was performed.Results: Most patients were male (60 {\%}) and <65 years old (61 {\%}). Of them, 98 {\%} had been exposed to chemotherapy. Grade 3 lymphocyte, bilirubin, albumin, ALP and AST toxicities were observed in 39 {\%}, 11 {\%}, 10 {\%}, 8 {\%} and 4 {\%} of patients, respectively. Grade 4 lymphocyte and ALP toxicities were observed in 5 {\%} and 3 {\%} of patients, respectively. Median overall survival was 43.0, 34.6, and 10.6 months from date of diagnosis of primary cancer, hepatic metastases and first Y90, respectively. Survival was significantly longer in patients: (1) who received ≤2 cytotoxic drugs (n = 104) than those who received 3 (n = 110) (15.2 vs. 7.5 months, p = 0.0001); and (2) who received no biologic agents (n = 52) compared with those that did (n = 162) (18.6 vs. 9.4 months, p = 0.0001). Multivariate analyses identified ≤2 cytotoxic agents, no exposure to biologics, ECOG 0, tumor burden <25 {\%}, lack of extrahepatic disease and albumin >3 g/dL as independent predictors of survival.Conclusion: In this largest metastatic CRC series published to date, Y90 radioembolization was found to be safe; survival varied by prior therapy. Further studies are required to further refine the role of Y90 in metastatic CRC.Purpose: The aim of this study was to analyze the safety, treatment characteristics and survival outcomes of Yttrium-90 (Y90) radioembolization for unresectable colorectal carcinoma (CRC) liver metastases refractory to standard of care therapy.",
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author = "Lewandowski, {Robert J} and Khairuddin Memon and Mulcahy, {Mary Frances} and Hickey, {Ryan M} and Karen Marshall and Melissa Williams and Krystina Salzig and Gates, {Vanessa L.} and Bassel Atassi and Michael Vouche and Rohi Atassi and Desai, {Kush R} and Elias Hohlastos and Sato, {Kent T} and Ali Habib and Kircher, {Sheetal Mehta} and Newman, {Steven B.} and Nimeiri, {Halla S} and {Benson III}, {Al B} and Riad Salem",
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Twelve-year experience of radioembolization for colorectal hepatic metastases in 214 patients : survival by era and chemotherapy. / Lewandowski, Robert J; Memon, Khairuddin; Mulcahy, Mary Frances; Hickey, Ryan M; Marshall, Karen; Williams, Melissa; Salzig, Krystina; Gates, Vanessa L.; Atassi, Bassel; Vouche, Michael; Atassi, Rohi; Desai, Kush R; Hohlastos, Elias; Sato, Kent T; Habib, Ali; Kircher, Sheetal Mehta; Newman, Steven B.; Nimeiri, Halla S; Benson III, Al B; Salem, Riad.

In: European Journal of Nuclear Medicine and Molecular Imaging, Vol. 41, No. 10, 01.01.2014, p. 1861-1869.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Twelve-year experience of radioembolization for colorectal hepatic metastases in 214 patients

T2 - survival by era and chemotherapy

AU - Lewandowski, Robert J

AU - Memon, Khairuddin

AU - Mulcahy, Mary Frances

AU - Hickey, Ryan M

AU - Marshall, Karen

AU - Williams, Melissa

AU - Salzig, Krystina

AU - Gates, Vanessa L.

AU - Atassi, Bassel

AU - Vouche, Michael

AU - Atassi, Rohi

AU - Desai, Kush R

AU - Hohlastos, Elias

AU - Sato, Kent T

AU - Habib, Ali

AU - Kircher, Sheetal Mehta

AU - Newman, Steven B.

AU - Nimeiri, Halla S

AU - Benson III, Al B

AU - Salem, Riad

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Methods: A total of 214 patients with CRC metastases were treated with Y90 radioembolization over 12 years. Toxicity was assessed using National Cancer Institute common terminology criteria. Overall survival was analyzed from date of diagnosis of primary cancer, hepatic metastases and from the first Y90. Uni/multivariate analyses were performed. Substratification by era of chemotherapeutics was performed.Results: Most patients were male (60 %) and <65 years old (61 %). Of them, 98 % had been exposed to chemotherapy. Grade 3 lymphocyte, bilirubin, albumin, ALP and AST toxicities were observed in 39 %, 11 %, 10 %, 8 % and 4 % of patients, respectively. Grade 4 lymphocyte and ALP toxicities were observed in 5 % and 3 % of patients, respectively. Median overall survival was 43.0, 34.6, and 10.6 months from date of diagnosis of primary cancer, hepatic metastases and first Y90, respectively. Survival was significantly longer in patients: (1) who received ≤2 cytotoxic drugs (n = 104) than those who received 3 (n = 110) (15.2 vs. 7.5 months, p = 0.0001); and (2) who received no biologic agents (n = 52) compared with those that did (n = 162) (18.6 vs. 9.4 months, p = 0.0001). Multivariate analyses identified ≤2 cytotoxic agents, no exposure to biologics, ECOG 0, tumor burden <25 %, lack of extrahepatic disease and albumin >3 g/dL as independent predictors of survival.Conclusion: In this largest metastatic CRC series published to date, Y90 radioembolization was found to be safe; survival varied by prior therapy. Further studies are required to further refine the role of Y90 in metastatic CRC.Purpose: The aim of this study was to analyze the safety, treatment characteristics and survival outcomes of Yttrium-90 (Y90) radioembolization for unresectable colorectal carcinoma (CRC) liver metastases refractory to standard of care therapy.

AB - Methods: A total of 214 patients with CRC metastases were treated with Y90 radioembolization over 12 years. Toxicity was assessed using National Cancer Institute common terminology criteria. Overall survival was analyzed from date of diagnosis of primary cancer, hepatic metastases and from the first Y90. Uni/multivariate analyses were performed. Substratification by era of chemotherapeutics was performed.Results: Most patients were male (60 %) and <65 years old (61 %). Of them, 98 % had been exposed to chemotherapy. Grade 3 lymphocyte, bilirubin, albumin, ALP and AST toxicities were observed in 39 %, 11 %, 10 %, 8 % and 4 % of patients, respectively. Grade 4 lymphocyte and ALP toxicities were observed in 5 % and 3 % of patients, respectively. Median overall survival was 43.0, 34.6, and 10.6 months from date of diagnosis of primary cancer, hepatic metastases and first Y90, respectively. Survival was significantly longer in patients: (1) who received ≤2 cytotoxic drugs (n = 104) than those who received 3 (n = 110) (15.2 vs. 7.5 months, p = 0.0001); and (2) who received no biologic agents (n = 52) compared with those that did (n = 162) (18.6 vs. 9.4 months, p = 0.0001). Multivariate analyses identified ≤2 cytotoxic agents, no exposure to biologics, ECOG 0, tumor burden <25 %, lack of extrahepatic disease and albumin >3 g/dL as independent predictors of survival.Conclusion: In this largest metastatic CRC series published to date, Y90 radioembolization was found to be safe; survival varied by prior therapy. Further studies are required to further refine the role of Y90 in metastatic CRC.Purpose: The aim of this study was to analyze the safety, treatment characteristics and survival outcomes of Yttrium-90 (Y90) radioembolization for unresectable colorectal carcinoma (CRC) liver metastases refractory to standard of care therapy.

KW - Colorectal metastases

KW - Radioembolization

KW - SIRT

KW - Survival

KW - Yttrium-90

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