Selective Internal Radiation Therapy in the Multidisciplinary Management of Liver Metastases From Colorectal Carcinoma.

Colorectal cancer (CRC) is the fourth most common cancer in the United States. Most patients diagnosed with CRC will eventually develop metastases. The liver is the most common site of metastases from CRC and liver metastases are the most common cause of death for patients with CRC. Selective internal radiotherapy (SIRT) using yttrium 90 microspheres has emerged as a safe and effective treatment modality for controlling hepatic tumor burden in inoperable patients with liver-only or liver-predominant metastatic CRC. This article serves to review the available data on SIRT in the treatment of liver metastases from CRC in the salvage and first-line setting. Recently published phase III randomized data showing a significant improvement in liver progression-free survival from the addition of SIRT to standard chemotherapy in the first-line setting, while demonstrating no significant improvement in overall survival, will be reviewed. In addition, the present article examines the role of SIRT in the management of CRC liver metastases from right-sided colon cancers in which SIRT has been shown to improve overall survival when combined with chemotherapy in the first-line setting and explores appropriate patient selection for future studies.