Abstract
Radioembolization (RE) is an increasingly used form of brachytherapy which consists of intraarterially injected microspheres loaded with 90Y (a pure beta emitter with a 2.6-day half-life and an average 2.5-mm tissue penetration) as a source for internal radiation purposes. Its aim is to deliver tumoricidal doses of radiation to no matter how many liver tumors at a time while sparing the nontumoral liver from absorbing harmful doses of radiation. Colorectal cancer is one of the leading causes of cancer death worldwide, with the liver being the most common site of metastatic disease. Standard treatment for these patients with unresectable disease involves systemic therapy with either chemotherapy or targeted agents. In recent years, selective internal radiation therapy with embolization of branches of the hepatic artery with biocompatible resin-based 90Y-labeled microspheres has emerged as a valuable tool for patients with this disease. Several phase I/II and randomized trials have proved the ability of SIR-Spheres to produce significant rates of tumor growth control among patients with liver metastases from colorectal cancer. Although the most promising data emerge from combinatorial approaches with systemic therapy, data supporting the use of 90Y-RE as a stand-alone modality, especially in the salvage setting, are provided. Available clinical data with this therapeutic modality are discussed and compared to currently approved standard of care. In addition, this chapter highlights preliminary data regarding the discovery of potential predictive biomarkers of efficacy and efforts made in the field toward a personalized medicine.
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References
Alexander HR, Bartlett DL, Fraker DL, Libutti SK (1996) Regional treatment strategies for unresectable primary or metastatic cancer confined to the liver. Princ Pract Oncol 10:1–19
Bester L, Meteling B, Pocock N et al (2012) Radioembolization versus standard care of hepatic metastases: comparative retrospective cohort study of survival outcomes and adverse events in salvage patients. J Vasc Interv Radiol 23:96–105
Breedis C, Young G (1954) Blood supply of neoplasms of the liver. Am J Pathol 30:969–972
Cianni R, Urigo C, Notarianni E et al (2009) Selective internal radiation therapy with SIR-Spheres for the treatment of unresectable colorectal hepatic metastases. Cardiovasc Interv Radiol 32:1179–1186
Cosimelli M, Golfieri R, Cagol PP et al (2010) Multi-centre phase II clinical trial of yttrium-90 resin microspheres alone in unresectable, chemotherapy refractory colorectal liver metastases. Br J Cancer 103:324–331
Cunningham D, Atkin W, Lenz HJ et al (2010) Colorectal cancer. Lancet 375:1030–1047
de Baere T, Deschamps F (2011) Arterial therapies of colorectal cancer metastases to the liver. Abdom Imaging 36:661–670
Dunfee BL, Riaz A, Lewandowski RJ et al (2010) Yttrium-90 radioembolization for liver malignancies: prognostic factors associated with survival. J Vasc Interv Radiol 21:90–95
Fahmueller YN, Nagel D, Hoffmann RT et al (2012) Predictive and prognostic value of circulating nucleosomes and serum biomarkers in patients with metastasized colorectal cancer undergoing selective internal radiation therapy. BMC Cancer 12:5
Fahmueller YN, Nagel D, Hoffmann RT et al (2013) Immunogenic cell death biomarkers HMGB1, RAGE, and DNAse indicate response to radioembolization therapy and prognosis in colorectal cancer patients. Int J Cancer 132(10):2349–2358
Fendler WP, Philippe Tiega DB, Ilhan H et al (2013) Validation of several SUV-based parameters derived from 18F-FDG PET for prediction of survival after SIRT of hepatic metastases from colorectal cancer. J Nucl Med 54:1202–1208
Grothey A, Van Cutsem E, Sobrero A et al. CORRECT Study Group (2013) Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet 26:303–312
Gulec SA, Mesoloras G, Dezarn WA, McNeillie P, Kennedy AS (2007) Safety and efficacy of Y-90 microsphere treatment in patients with primary and metastatic liver cancer: the tumor selectivity of the treatment as a function of tumor to liver flow ratio. J Transl Med 5:15
Hong K, McBride JD, Georgiades CS et al (2009) Salvage therapy for liver-dominant colorectal metastatic adenocarcinoma: comparison between transcatheter arterial chemoembolization versus yttrium-90 radioembolization. J Vasc Interv Radiol 20:360–367
Jakobs TF, Hoffmann R-T, Dehm K et al (2008) Hepatic yttrium-90 radioembolization of chemotherapy-refractory colorectal cancer liver metastases. J Vasc Interv Radiol 19:1187–1195
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61:69–90
Jonker DJ, O’Callaghan CJ, Karapetis CS et al (2007) Cetuximab for the treatment of colorectal cancer. N Engl J Med 357:2040–2048
Kennedy AS, Coldwell D, Nutting C et al (2006) Resin 90Y-microsphere brachytherapy for unresectable colorectal liver metastases: modern USA experience. Int J Radiat Oncol Biol Phys 65:412–425
Lin L, Zhong K, Sun Z, Wu G, Ding G (2012) Receptor for advanced glycation end products (RAGE) partially mediates HMGB1-ERKs activation in clear cell renal cell carcinoma. J Cancer Res Clin Oncol 138:11–22
Martin LK, Cucci A, Wei L et al (2012) Yttrium-90 radioembolization as salvage therapy for colorectal cancer with liver metastases. Clin Colorectal Cancer 11:195–199
Melucci E, Cosimelli M, Carpanese L et al. Italian Society of Locoregional Therapies in Oncology (S.I.T.I.L.O.) (2013) Decrease of survivin, p53 and Bcl-2 expression in chemorefractory colorectal liver metastases may be predictive of radiosensivity after radioembolization with yttrium-90 resin microspheres. J Exp Clin Cancer Res 32:13
Mulcahy MF, Lewandowski RJ, Ibrahim SM et al (2009) Radioembolization of colorectal hepatic metastases using yttrium-90 microspheres. Cancer 115:1849–1858
Nace GW, Steel JL, Amesur N et al (2011) Yttrium-90 radioembolization for colorectal cancer liver metastases: a single institution experience. Int J Surg Oncol 2011:571261
Robertson JM, Lawrence TS, Walker S et al (1995) The treatment of colorectal liver metastases with conformal radiation therapy and regional chemotherapy. Int J Radiat Oncol Biol Phys 32:445–450
Robertson JM, McGinn CJ, Walker S et al (1997) A phase I trial of hepatic arterial bromodeoxyuridine and conformal radiation therapy for patients with primary hepatobiliary cancers or colorectal liver metastases. Int J Radiat Oncol Biol Phys 39:1087–1092
Rosenbaum CE, Verkooijen HM, Lam MG et al (2013) Radioembolization for treatment of salvage patients with colorectal cancer liver metastases: a systematic review. J Nucl Med. [Epub ahead of print] PubMed PMID: 24071510
Sato KT, Lewandowski RJ, Mulcahy MF et al (2008) Unresectable chemorefractory liver metastases: radioembolization with 90Y microspheres—safety, efficacy, and survival. Radiology 247:507–515
Seidensticker R, Denecke T, Kraus P et al (2012) Matched-pair comparison of radioembolization plus best supportive care versus best supportive care alone for chemotherapy refractory liver-dominant colorectal metastases. Cardiovasc Interv Radiol 35:1066–1073
Sigurdson ER, Ridge JA, Kemeny N et al (1987) Tumor and liver drug uptake following hepatic artery and portal vein infusion. J Clin Oncol 5:1836
Smits ML, van den Hoven AF, Rosenbaum CE et al (2013) Clinical and laboratory toxicity after intra-arterial radioembolization with (90)y-microspheres for unresectable liver metastases. PLoS One 8(7):e69448
Stoetzer OJ, Wittwer C, Lehner J et al (2012) Circulating nucleosomes and biomarkers of immunogenic cell death as predictive and prognostic markers in cancer patients undergoing cytotoxic therapy. Expert Opin Biol Ther 12(Suppl 1):S217–S224
Townsend A, Price T, Karapetis C (2009) Selective internal radiation therapy for liver metastases from colorectal cancer. Cochrane Database Syst Rev 4:CD007045
Van Beijnum JR, Nowak-Sliwinska P, van den Boezem E et al (2013) Tumor angiogenesis is enforced by autocrine regulation of high-mobility group box 1. Oncogene 32:363–374
Van Cutsem E, Peeters M, Siena S et al (2007) Open-label phase III trial of panitumumab plus best supportive care compared with best supportive care alone in patients with chemotherapy-refractory metastatic colorectal cancer. J Clin Oncol 25:1658–1664
Yao X, Zhao G, Yang H, Hong X, Bie L, Liu G (2010) Overexpression of high-mobility group box 1 correlates with tumor progression and poor prognosis in human colorectal carcinoma. J Cancer Res Clin Oncol 136:677–684
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Rodríguez, J., Chopitea, A., Sangro, B., Bilbao, J.I. (2013). Results in Liver Metastatic Colorectal Cancer. In: Bilbao, J., Reiser, M. (eds) Liver Radioembolization with 90Y Microspheres. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2013_942
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DOI: https://doi.org/10.1007/174_2013_942
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