Patterns of failure in colorectal patients with liver metastases after yttrium-90 radioembolization.

Abstract

OBJECTIVES:

To assess patterns of failure and factors affecting recurrence patterns in colorectal cancer patients treated with Y-labeled resin microspheres for metastatic liver disease.

METHODS:

We retrospectively reviewed 30 colorectal patients treated with Yttrium-90 radioembolization and assessed follow-up computed tomography scans and positron emission tomography scans to determine disease outcomes. All patients were included in survival analysis. Twenty-six patients with hepatic metastases were assessed for patterns of failure after radioembolization treatment and grouped into 3 patterns: (1) hepatic; (2) extrahepatic; and (3) intrahepatic and extrahepatic.

RESULTS:

The median overall survival and progression-free survival for all colorectal patients treated with radioembolization was 9.4 and 3.2 months, respectively. Overall survival and progression-free survival were not significantly different between patterns of failure (P=0.43 and 0.26, respectively). Logistic regression analysis demonstrated a trend toward the predictive value of tumor volume in determining patterns of failure. Smaller tumor volumes had a higher predictive probability for extrahepatic failure than larger tumor volumes (P=0.057). Tumor volumes <300 mL were predictive for extrahepatic failure patterns compared with hepatic recurrence (P=0.046).

CONCLUSIONS:

Radioembolization with Y-labeled resin microspheres continues to be an effective salvage treatment for colorectal liver metastases. Analysis of patterns of radiologic failure demonstrated that patients treated by radioembolization develop a greater proportion of extrahepatic failure. Tumor volumes >300 mL were predictive for hepatic recurrence, suggesting that increased dosing or retreatment of these lesions may lead to improved hepatic control of disease and better patient outcomes.

• Authors: Caitlin A Schonewolf, Bhavik Patel, Rebekah H Gensure, Venkat Narra, Bruce G Haffty, John L Nosher, Salma K Jabbour
• Journal: American journal of clinical oncology (Am J Clin Oncol) Vol. 37 Issue 3 Pg. 234-40 (Jun 2014) ISSN: 1537-453X [Electronic] United States
• PMID: 23275270 (Publication Type: Journal Article)

Chemical References

• Resins, Synthetic
• Yttrium Radioisotopes

Topics

• Adult
• Aged
• Colorectal Neoplasms (pathology)
• Disease-Free Survival
• Embolization, Therapeutic (methods)
• Female
• Follow-Up Studies
• Humans
• Kaplan-Meier Estimate
• Liver Neoplasms (diagnosis, secondary, therapy)
• Male
• Microspheres
• Middle Aged
• Neoplasm Recurrence, Local
• Positron-Emission Tomography
• Resins, Synthetic (administration & dosage)
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Salvage Therapy (methods)
• Tomography, X-Ray Computed
• Treatment Failure
• Yttrium Radioisotopes (administration & dosage)