Türk Gamze, Eldem Gonca, Kılıçkap Saadettin, Bozkurt Fani Murat, Salancı Bilge Volkan, Çil Barbaros Erhan, Peynircioğlu Bora, Yalçın Şuayip, Balkancı Ferhun
Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Department of Radiology, Kayseri Training and Research Hospital, Kayseri, Turkey.
J Gastrointest Cancer. 2019 Jun;50(2):236-243. doi: 10.1007/s12029-018-0053-z.
We aimed to evaluate the efficacy and outcomes of radioembolization with Yttrium-90 (Y-90) microspheres in patients with unresectable and chemorefractory colorectal cancer liver metastasis (CRCLM).
This single-center study included 43 patients (34 male, 9 female) who underwent radioembolization with Y-90 for unresectable, chemorefractory CRCLM between September 2008 and July 2014. Overall survival (OS), liver progression-free survival (LPFS), overall response rate (ORR), local disease control rate (LDCR), and relations of these parameters with patient disease characteristics were evaluated. OS and LPFS rates were compared according to microspheres. Survival rates were calculated with Kaplan-Meier method, and potential prognostic variables were evaluated on univariate analyses.
Post-procedural median OS was 12.8 months. LPFS was 5.6 months. ORR was 33%, LDCR was 67% on 3rd month follow-up. Low tumor burden (< 25%) was associated with higher median OS after radioembolization (< 25 vs > 25-50% p < 0.0001 and < 25 vs > 50% p = 0.005). Patients with left colon tumors exhibited significantly longer median OS after metastasis than right colon tumors (p = 0.046). Extrahepatic disease and synchronicity showed poorer survival parameters; however, the difference was not significant (p = 0.1 and p = 0.3, respectively). In subgroup analyses, the distribution of patient number and characteristics showed heterogeneity as number of patients with low tumor burden was higher in resin Y-90 group. Resin Y-90 group exhibited significantly higher median OS and LPFS compared to glass Y-90 group (16.5 vs. 7 months, p = 0.001; 6.73 vs. 3.38 months, p = 0.023, respectively).
Radioembolization is a safe local-regional treatment option in chemorefractory, inoperable CRCLM. Radioembolization at earlier stages may lead to more favorable results especially with lower tumor burden patients.
我们旨在评估钇-90（Y-90）微球放射性栓塞术对不可切除且化疗难治性结直肠癌肝转移（CRCLM）患者的疗效和预后。
这项单中心研究纳入了43例患者（34例男性，9例女性），这些患者在2008年9月至2014年7月期间因不可切除、化疗难治性CRCLM接受了Y-90放射性栓塞术。评估了总生存期（OS）、无肝进展生存期（LPFS）、总缓解率（ORR）、局部疾病控制率（LDCR）以及这些参数与患者疾病特征的关系。根据微球比较OS和LPFS率。采用Kaplan-Meier方法计算生存率，并通过单因素分析评估潜在的预后变量。
术后中位OS为12.8个月。LPFS为5.6个月。在第3个月随访时，ORR为33%，LDCR为67%。低肿瘤负荷（<25%）与放射性栓塞术后较高的中位OS相关（<25% vs >25%-50%，p<0.0001；<25% vs >50%，p=0.005）。左半结肠癌转移患者的中位OS明显长于右半结肠癌转移患者（p=0.046）。肝外疾病和同时性转移显示出生存参数较差；然而，差异不显著（分别为p=0.1和p=0.3）。在亚组分析中，患者数量和特征的分布显示出异质性，因为树脂Y-90组中低肿瘤负荷患者的数量较多。与玻璃Y-90组相比，树脂Y-90组的中位OS和LPFS明显更高（分别为16.5个月对7个月，p=0.001；6.73个月对3.38个月，p=0.023）。
放射性栓塞术是化疗难治性、不可手术切除的CRCLM一种安全的局部区域治疗选择。早期进行放射性栓塞术可能会带来更有利的结果，尤其是对于肿瘤负荷较低的患者。
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