Twelve-year experience of radioembolization for colorectal hepatic metastases in 214 patients: survival by era and chemotherapy

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

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Abstract

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.

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.

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

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

ASJC Scopus subject areas

  • Medicine(all)

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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 F.; Hickey, Ryan; Marshall, Karen; Williams, Melissa; Salzig, Krystina; Gates, Vanessa L.; Atassi, Bassel; Vouche, Michael; Atassi, Rohi; Desai, Kush; Hohlastos, Elias; Sato, Kent; Habib, Ali; Kircher, Sheetal; Newman, Steven B.; Nimeiri, Halla; Benson, Al B.; Salem, Riad.

In: European Journal of Nuclear Medicine and Molecular Imaging, Vol. 41, No. 10, 01.10.2014, p. 1861-1869.

Research output: Contribution to journalArticle

Lewandowski, RJ, Memon, K, Mulcahy, MF, Hickey, R, Marshall, K, Williams, M, Salzig, K, Gates, VL, Atassi, B, Vouche, M, Atassi, R, Desai, K, Hohlastos, E, Sato, K, Habib, A, Kircher, S, Newman, SB, Nimeiri, H, Benson, AB & Salem, R 2014, 'Twelve-year experience of radioembolization for colorectal hepatic metastases in 214 patients: survival by era and chemotherapy', European Journal of Nuclear Medicine and Molecular Imaging, vol. 41, no. 10, pp. 1861-1869. https://doi.org/10.1007/s00259-014-2799-2
Lewandowski, Robert J. ; Memon, Khairuddin ; Mulcahy, Mary F. ; Hickey, Ryan ; Marshall, Karen ; Williams, Melissa ; Salzig, Krystina ; Gates, Vanessa L. ; Atassi, Bassel ; Vouche, Michael ; Atassi, Rohi ; Desai, Kush ; Hohlastos, Elias ; Sato, Kent ; Habib, Ali ; Kircher, Sheetal ; Newman, Steven B. ; Nimeiri, Halla ; Benson, 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 = "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.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.",
author = "Lewandowski, {Robert J.} and Khairuddin Memon and Mulcahy, {Mary F.} and Ryan Hickey and Karen Marshall and Melissa Williams and Krystina Salzig and Gates, {Vanessa L.} and Bassel Atassi and Michael Vouche and Rohi Atassi and Kush Desai and Elias Hohlastos and Kent Sato and Ali Habib and Sheetal Kircher and Newman, {Steven B.} and Halla Nimeiri and Benson, {Al B.} and Riad Salem",
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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 F.

AU - Hickey, Ryan

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

AU - Hohlastos, Elias

AU - Sato, Kent

AU - Habib, Ali

AU - Kircher, Sheetal

AU - Newman, Steven B.

AU - Nimeiri, Halla

AU - Benson, Al B.

AU - Salem, Riad

PY - 2014/10/1

Y1 - 2014/10/1

N2 - 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.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.

AB - 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.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.

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