Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.
Eur J Nucl Med Mol Imaging. 2014 Oct;41(10):1861-9. doi: 10.1007/s00259-014-2799-2. Epub 2014 Jun 7.
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.
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.
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.
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.
本研究旨在分析钇-90（Y90）放射栓塞治疗标准治疗耐药的不可切除结直肠癌（CRC）肝转移的安全性、治疗特征和生存结果。
在 12 年的时间里，共有 214 例 CRC 转移患者接受了 Y90 放射栓塞治疗。使用国家癌症研究所常见术语标准评估毒性。从原发性癌症、肝转移和第一次 Y90 的诊断日期分析总生存期。进行单变量/多变量分析。按化疗药物时代进行分层。
大多数患者为男性（60%）和<65 岁（61%）。其中，98%的患者接受过化疗。分别有 39%、11%、10%、8%和 4%的患者出现 3 级淋巴细胞、胆红素、白蛋白、碱性磷酸酶和天冬氨酸转氨酶毒性，分别有 5%和 3%的患者出现 4 级淋巴细胞和碱性磷酸酶毒性。从原发性癌症、肝转移和第一次 Y90 的诊断日期起，中位总生存期分别为 43.0、34.6 和 10.6 个月。在接受≤2 种细胞毒性药物（n=104）的患者中，与接受 3 种药物（n=110）的患者相比（15.2 个月比 7.5 个月，p=0.0001），生存时间显著延长；在未接受生物制剂（n=52）的患者中，与接受生物制剂（n=162）的患者相比（18.6 个月比 9.4 个月，p=0.0001），生存时间显著延长。多变量分析确定≤2 种细胞毒性药物、未暴露于生物制剂、ECOG 0、肿瘤负荷<25%、无肝外疾病和白蛋白>3g/dL 是生存的独立预测因素。
在迄今为止发表的最大转移性 CRC 系列中，Y90 放射栓塞被发现是安全的；生存情况因先前的治疗而异。需要进一步的研究来进一步完善 Y90 在转移性 CRC 中的作用。
