Escalated Segmental and Modified Radiation Lobectomy Dosing for Yttrium-90 Radioembolization of Liver-Dominant Metastatic Colorectal Cancer: 10-year Outcomes

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer Pub Date : 2025-02-28 DOI:10.1016/j.clcc.2025.02.005

Andrew C Gordon , Saad Abu Zahra , Muhamad Serhal , Sheetal M Kircher , Aparna Kalyan , Kent Sato , Ahsun Riaz , Elias Hohlastos , Riad Salem , Robert J Lewandowski

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Abstract

Purpose

This study evaluates the safety and efficacy of escalated-dosing Yttrium-90 transarterial radioembolization (TARE) for unresectable, unablatable metastatic colorectal cancer (mCRC) to the liver.

Materials and Methods

A retrospective review (September 2009 to March 2020) included 45 patients with liver-dominant mCRC treated with segmental Y90 or modified radiation lobectomy. Patient demographics, treatment details, adverse events, imaging response, and overall survival (OS) were analyzed. OS Prognosticators were examined using log-rank test and Cox proportional hazards regression.

Results

45 patients (median age 61.4 years; 60% male) were included, with 96% ECOG 0-1. Prior treatments included primary site resection (93%), liver resection (65%), chemotherapy (60%), and ablation (27%). Extrahepatic disease was present in 51%. 71% of patients had < 25% liver tumor burden (mean tumor size = 4.8 cm). Treatment was technically successful in all cases, with 4% 30-day mortality. Adverse events were mostly low-grade, including fatigue (58%) and abdominal pain (20%). Mean neutrophil-to-lymphocyte ratio (NLR) increase was 2.9, and 33% of patients showed 50% reduction in CEA. Imaging responses (RECIST) included SD (80%), PR (18%), PD (2%), and CR (0%), with PET/CT showing 39% objective response after 4.2 months. Median OS was 41.9 months (95% CI 15.4-NE). Extrahepatic disease significantly reduced OS (15.7 vs. 44.4 months, P = .0033). Both pre- and post-NLR (HR:1.42, P = .007; HR 1.12, P = .027) were associated with worse OS. In the multivariable analysis, Pre-NLR and extrahepatic disease remained adverse prognosticators.

Conclusion

Y90 TARE with escalated dosing demonstrated an acceptable safety profile in heavily pretreated mCRC patients. Extrahepatic disease and pre-NLR were significant adverse prognosticators. Future studies should explore Y90 TARE dosing in mCRC patients.

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肝主导型转移性结直肠癌的放射栓塞治疗中，渐进式节段放疗和改良放射肺叶切除术剂量：10年结果。

目的：本研究评估增大剂量钇-90经动脉放射栓塞（TARE）治疗不可切除、不可治愈的肝转移性结直肠癌（mCRC）的安全性和有效性。材料和方法：一项回顾性研究（2009年9月至2020年3月）包括45例肝为主的mCRC患者，他们接受了节段性Y90或改良的放射线肺叶切除术。分析患者人口统计学、治疗细节、不良事件、影像学反应和总生存期（OS）。采用log-rank检验和Cox比例风险回归对OS预后者进行检验。结果：45例患者(中位年龄61.4岁；60%为男性)，96%为ECOG 0-1。既往治疗包括原发部位切除（93%）、肝切除（65%）、化疗（60%）和消融（27%）。肝外疾病占51%。71%的患者肝脏肿瘤负荷< 25%（平均肿瘤大小= 4.8 cm）。所有病例的治疗在技术上都是成功的，30天死亡率为4%。不良事件大多为轻度，包括疲劳（58%）和腹痛（20%）。平均中性粒细胞与淋巴细胞比值（NLR）增加2.9,33%的患者CEA降低50%。影像学反应（RECIST）包括SD（80%）、PR（18%）、PD（2%）和CR(0%)， 4.2个月后PET/CT显示39%的客观反应。中位生存期为41.9个月（95% CI 15.4-NE）。肝外疾病显著降低OS（15.7个月vs. 44.4个月，P = 0.0033）。nlr前后(HR:1.42, P = .007；HR 1.12, P = 0.027)与较差的OS相关。在多变量分析中，前nlr和肝外疾病仍然是不良预后因素。结论：递增剂量的Y90 TARE在重度预处理的mCRC患者中显示出可接受的安全性。肝外疾病和nlr前是显著的不良预后因素。未来的研究应该探索Y90 TARE在mCRC患者中的剂量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical colorectal cancer 医学-肿瘤学

CiteScore

5.50

自引率

2.90%

发文量

审稿时长

27 days

期刊介绍： Clinical Colorectal Cancer is a peer-reviewed, quarterly journal that publishes original articles describing various aspects of clinical and translational research of gastrointestinal cancers. Clinical Colorectal Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of colorectal, pancreatic, liver, and other gastrointestinal cancers. The main emphasis is on recent scientific developments in all areas related to gastrointestinal cancers. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.