Single-institution experience with selective internal radiation therapy (SIRT) for the treatment of unresectable colorectal liver metastases

Ir J Med Sci. 2019 Feb;188(1):43-53. doi: 10.1007/s11845-018-1773-6. Epub 2018 Mar 6.

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.

Keywords: Colorectal liver metastases; Cytoreduction; Interventional oncology; Interventional radiology; Intra-arterial brachytherapy; Localized therapy; Molecular genetics; Radioembolization; Radiosensitization; Radiotherapy; Regional therapy; SIRT; Unresectable liver metastases.

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents / therapeutic use
  • Brachytherapy / methods*
  • Chemoradiotherapy / methods
  • Colorectal Neoplasms / pathology*
  • Embolization, Therapeutic
  • Female
  • Humans
  • Liver Neoplasms / drug therapy
  • Liver Neoplasms / radiotherapy*
  • Liver Neoplasms / secondary
  • Male
  • Middle Aged
  • Retrospective Studies
  • Survival Rate
  • Treatment Outcome
  • Yttrium Radioisotopes / therapeutic use*

Substances

  • Antineoplastic Agents
  • Yttrium Radioisotopes