Cathal O'Leary1, Megan Greally2, John McCaffrey2, Peter Hughes1, Leo L P Lawler1, Martin O'Connell1, Tony Geoghegan1, Cormac Farrelly3. 1. Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland. 2. Oncology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland. 3. Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland. farrellyc@mater.ie.
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.
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.
Authors: Belen Gil-Alzugaray; Ana Chopitea; Mercedes Iñarrairaegui; Jose I Bilbao; Macarena Rodriguez-Fraile; Javier Rodriguez; Alberto Benito; Inés Dominguez; Delia D'Avola; Jose I Herrero; Jorge Quiroga; Jesus Prieto; Bruno Sangro Journal: Hepatology Date: 2013-02-15 Impact factor: 17.425
Authors: Andreas H Mahnken; Carlo Spreafico; Geert Maleux; Thomas Helmberger; Tobias F Jakobs Journal: Cardiovasc Intervent Radiol Date: 2013-03-20 Impact factor: 2.740
Authors: Craig Lance; Gordon McLennan; Nancy Obuchowski; Grace Cheah; Abraham Levitin; Mark Sands; James Spain; Shyam Srinivas; Sankaran Shrikanthan; Federico N Aucejo; Richard Kim; K V Narayanan Menon Journal: J Vasc Interv Radiol Date: 2011-10-08 Impact factor: 3.464
Authors: John B Ammori; Michael I D'Angelica; Yuman Fong; Andrea Cercek; Ronald P Dematteo; Peter J Allen; T Peter Kingham; Philip B Paty; William R Jarnagin; Nancy E Kemeny Journal: J Surg Oncol Date: 2012-07-02 Impact factor: 3.454
Authors: Ricky A Sharma; Guy A Van Hazel; Bruno Morgan; David P Berry; Keith Blanshard; David Price; Geoffrey Bower; Jennifer A Shannon; Peter Gibbs; William P Steward Journal: J Clin Oncol Date: 2007-03-20 Impact factor: 44.544
Authors: D Rohan Jeyarajah; Maria B Majella Doyle; N Joseph Espat; Paul D Hansen; David A Iannitti; Joseph Kim; Thavam Thambi-Pillai; Brendan C Visser Journal: J Gastrointest Oncol Date: 2020-04