Division of Hematology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH, USA.
Clin Colorectal Cancer. 2012 Sep;11(3):195-9. doi: 10.1016/j.clcc.2011.12.002. Epub 2012 Jan 24.
Few patients with metastatic colorectal cancer (mCRC) are candidates for resection of their hepatic disease. Yttrium-90 ((90)Y) radioembolization has promise in the treatment of unresectable mCRC. We conducted a retrospective study to assess the efficacy in patients with refractory mCRC who underwent (90)Y radioembolization.
Patients with unresectable mCRC with liver metastases treated at The Ohio State University were included in this analysis. Demographic data, carcinoembryonic antigen (CEA) values, observed toxicities, and information on prior therapies were collected. Response was assessed by RECIST (Response Evaluation Criteria in Solid Tumors) 1.1 criteria. Overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan-Meier method.
Twenty-four patients (median age, 63 years) were included. Of the patients, 54% had extrahepatic disease; 67% had bilobar involvement. The patients had received a median of 3 prior therapies. No objective responses were observed. Five patients had a CEA response. Median PFS and OS were 3.9 months (95% CI, 2.4-4.8 months) and 8.9 months (95% CI, 4.2-16.7 months), respectively. Patients older than 65 years had improved PFS (4.6 vs. 2.4 months) and OS (14 vs. 5.5 months) vs. younger patients, likely due to receipt of (90)Y treatment earlier in their disease course. The presence of extrahepatic disease and the absence of CEA response appeared negatively predictive of efficacy. Toxicities were expected and manageable.
(90)Y radioembolization is active in select patients with refractory mCRC and with liver metastases, and is safe and well tolerated in the elderly. In patients with extensive extrahepatic disease, (90)Y should be used in combination with chemotherapy. CEA may be a predictor of efficacy.
转移性结直肠癌（mCRC）患者中只有少数适合切除肝部疾病。钇-90（90Y）放射性栓塞治疗在不可切除的 mCRC 治疗中有一定的效果。我们进行了一项回顾性研究，以评估在接受 90Y 放射性栓塞治疗的难治性 mCRC 患者中的疗效。
这项分析纳入了在俄亥俄州立大学接受治疗的不可切除 mCRC 伴肝转移患者。收集了人口统计学数据、癌胚抗原（CEA）值、观察到的毒性以及既往治疗信息。采用 RECIST（实体瘤反应评估标准）1.1 标准评估反应。通过 Kaplan-Meier 法估计总生存期（OS）和无进展生存期（PFS）。
共纳入 24 例患者（中位年龄 63 岁）。其中 54%的患者有肝外疾病；67%的患者有双侧肝累及。患者接受了中位数为 3 种的既往治疗。未观察到客观反应。5 例患者的 CEA 有反应。中位 PFS 和 OS 分别为 3.9 个月（95%CI，2.4-4.8 个月）和 8.9 个月（95%CI，4.2-16.7 个月）。年龄大于 65 岁的患者 PFS（4.6 个月比 2.4 个月）和 OS（14 个月比 5.5 个月）均有改善，这可能是由于他们在疾病进程中更早地接受了 90Y 治疗。肝外疾病的存在和 CEA 无反应似乎是疗效的负预测因素。毒性是可预期的且可管理的。
90Y 放射性栓塞在有肝转移的难治性 mCRC 患者中是有效的，在老年人中是安全且耐受良好的。对于广泛肝外疾病的患者，90Y 应与化疗联合使用。CEA 可能是疗效的预测因素。
