Kennedy Andrew S, Ball David, Cohen Steven J, Cohn Michael, Coldwell Douglas M, Drooz Alain, Ehrenwald Eduardo, Kanani Samir, Rose Steven C, Nutting Charles W, Moeslein Fred M, Savin Michael A, Schirm Sabine, Putnam Samuel G, Sharma Navesh K, Wang Eric A
1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN 37203, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbott Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 University of California, San Diego Moores Cancer Center, La Jolla, CA, USA ; 10 Radiology Imaging Associates, Englewood, CO, USA ; 11 University of Maryland Medical Center, Baltimore, MD, USA ; 12 Beaumont Hospital, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA.
J Gastrointest Oncol. 2015 Apr;6(2):134-42. doi: 10.3978/j.issn.2078-6891.2014.109.
Metastatic colorectal cancer liver metastases Outcomes after RadioEmbolization (MORE) was an investigator-initiated case-control study to assess the experience of 11 US centers who treated liver-dominant metastases from colorectal cancer (mCRC) using radioembolization [selective internal radiation therapy (SIRT)] with yttrium-90-((90)Y)-labeled resin microspheres.
Data from 606 consecutive patients who received radioembolization between July 2002 and December 2011 were collected by an independent research organization. Adverse events (AEs) and survival were compared across lines of treatment using Fisher's exact test and Kaplan-Meier estimates, respectively.
Patients received a median of 2 (range, 0-6) lines of prior chemotherapy; 35.1% had limited extrahepatic metastases. Median tumor-to-liver ratio and -activity administered at first procedure were 15% and 1.17 GBq, respectively. Hospital stay was <24 hours in 97.8% cases. Common grade ≥3 AEs over 184 days follow-up were: abdominal pain (6.1%), fatigue (5.5%), hyperbilirubinemia (5.4%), ascites (3.6%) and gastrointestinal ulceration (1.7%). There was no statistical difference in AEs across treatment lines (P>0.05). Median survivals [95% confidence interval (CI)] following radioembolization as a 2(nd)-line, 3(rd)-line, or 4(th)-plus line were 13.0 (range, 10.5-14.6), 9.0 (range, 7.8-11.0), and 8.1 (range, 6.4-9.3) months, respectively; and significantly prolonged in patients with ECOG 0 vs. ≥1 (P=0.009). Statistically significant independent variables for survival at radioembolization were: disease stage [extrahepatic metastases, extent of liver involvement (tumor-to-treated-liver ratio)], liver function (uncontrolled ascites, albumin, alkaline phosphatase, aspartate transaminase), leukocytes, and prior chemotherapy.
Radioembolization appears to have a favorable risk/benefit profile, even among mCRC patients who had received ≥3 prior lines of chemotherapy.
放射性栓塞治疗转移性结直肠癌肝转移（MORE）是一项由研究者发起的病例对照研究，旨在评估美国11个中心使用钇-90（90Y）标记的树脂微球进行放射性栓塞[选择性内放射治疗（SIRT）]治疗结直肠癌（mCRC）肝转移为主的转移灶的经验。
2002年7月至2011年12月期间连续接受放射性栓塞治疗的606例患者的数据由一个独立研究机构收集。分别使用Fisher精确检验和Kaplan-Meier估计法比较各治疗线之间的不良事件（AE）和生存率。
患者接受的先前化疗中位数为2（范围0-6）线；35.1%有局限性肝外转移。首次治疗时的肿瘤与肝脏比值中位数和给予的活度分别为15%和1.17GBq。97.8%的病例住院时间<24小时。在184天的随访中，常见的≥3级AE包括：腹痛（6.1%）、疲劳（5.5%）、高胆红素血症（5.4%）、腹水（3.6%）和胃肠道溃疡（1.7%）。各治疗线之间的AE无统计学差异（P>0.05）。放射性栓塞作为二线、三线或四线及以上治疗后的中位生存期[95%置信区间（CI）]分别为13.0（范围10.5-14.6）、9.0（范围7.8-11.0）和8.1（范围6.4-9.3）个月；ECOG 0分与≥1分的患者生存期显著延长（P=0.009）。放射性栓塞时生存的统计学显著独立变量为：疾病分期[肝外转移、肝脏受累程度（肿瘤与治疗肝脏比值）]、肝功能（未控制的腹水、白蛋白、碱性磷酸酶、天冬氨酸转氨酶）、白细胞和先前化疗。
即使在接受过≥3线先前化疗的mCRC患者中，放射性栓塞似乎也具有良好的风险/获益特征。
