Radioembolization in Colorectal Metastases: A Review

Abstract

Radioembolization has gained wide acceptance as a safe and efficient treatment for unresectable liver-dominant metastatic colorectal cancer. In this comprehensive article, we focus on clinical outcomes and dosimetry models in the era of personalized medicine.

Keywords

radioembolization - colorectal - metastasis

Disclosure

None.

• References

• 1 Lien WM, Ackerman NB. The blood supply of experimental liver metastases. II. A microcirculatory study of the normal and tumor vessels of the liver with the use of perfused silicone rubber. Surgery 1970; 68 (02) 334-340
• 2 Fox RA, Klemp PF, Egan G, Mina LL, Burton MA, Gray BN. Dose distribution following selective internal radiation therapy. Int J Radiat Oncol Biol Phys 1991; 21 (02) 463-467
• 3 Kennedy AS, Nutting C, Coldwell D, Gaiser J, Drachenberg C. Pathologic response and microdosimetry of (90)Y microspheres in man: review of four explanted whole livers. Int J Radiat Oncol Biol Phys 2004; 60 (05) 1552-1563
• 4 Dawson LA, Normolle D, Balter JM, McGinn CJ, Lawrence TS, Ten Haken RK. Analysis of radiation-induced liver disease using the Lyman NTCP model. Int J Radiat Oncol Biol Phys 2002; 53 (04) 810-821
• 5 U.S. Nuclear Regulatory Commission. Regulatory Guide. Office of Nuclear Regulatory Research. Regulatory Guide 8.39 (Draft Was Issued as DG-8015). Release of Patients Administered Radioactive Materials (1997). Available at: https://www.nrc.gov/docs/ML0833/ML083300045.pdf . Accessed October 27, 2017
• 6 Gray BN. Colorectal cancer: the natural history of disseminated disease-a review. Aust N Z J Surg 1980; 50 (06) 643-646
• 7 Fong Y, Cohen AM, Fortner JG. , et al. Liver resection for colorectal metastases. J Clin Oncol 1997; 15 (03) 938-946
• 8 Abdalla EK, Vauthey JN, Ellis LM. , et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 2004; 239 (06) 818-825 , discussion 825–827
• 9 Bentrem DJ, Dematteo RP, Blumgart LH. Surgical therapy for metastatic disease to the liver. Annu Rev Med 2005; 56: 139-156
• 10 Adam R, Aloia T, Lévi F. , et al. Hepatic resection after rescue cetuximab treatment for colorectal liver metastases previously refractory to conventional systemic therapy. J Clin Oncol 2007; 25 (29) 4593-4602
• 11 Murthy R, Nunez R, Szklaruk J. , et al. Yttrium-90 microsphere therapy for hepatic malignancy: devices, indications, technical considerations, and potential complications. Radiographics 2005; 25 (Suppl. 01) S41-S55
• 12 Leung TW, Lau WY, Ho SK. , et al. Radiation pneumonitis after selective internal radiation treatment with intraarterial 90 yttrium-microspheres for inoperable hepatic tumors. Int J Radiat Oncol Biol Phys 1995; 33 (04) 919-924
• 13 Murthy R, Brown DB, Salem R. , et al. Gastrointestinal complications associated with hepatic arterial Yttrium-90 microsphere therapy. J Vasc Interv Radiol 2007; 18 (04) 553-561 , quiz 562
• 14 Liu DM, Salem R, Bui JT. , et al. Angiographic considerations in patients undergoing liver-directed therapy. J Vasc Interv Radiol 2005; 16 (07) 911-935
• 15 Cosin O, Bilbao JI, Alvarez S, de Luis E, Alonso A, Martinez-Cuesta A. Right gastric artery embolization prior to treatment with yttrium-90 microspheres. Cardiovasc Intervent Radiol 2007; 30 (01) 98-103
• 16 Hickey R, Mulcahy MF, Lewandowski RJ. , et al. Chemoradiation of hepatic malignancies: prospective, phase 1 study of full-dose capecitabine with escalating doses of yttrium-90 radioembolization. Int J Radiat Oncol Biol Phys 2014; 88 (05) 1025-1031
• 17 Salem R, Thurston KG. Radioembolization with 90Yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 1: Technical and methodologic considerations. J Vasc Interv Radiol 2006; 17 (08) 1251-1278
• 18 Salem R, Thurston KG. Radioembolization with 90yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 2: special topics. J Vasc Interv Radiol 2006; 17 (09) 1425-1439
• 19 Lewandowski RJ, Sato KT, Atassi B. , et al. Radioembolization with 90Y microspheres: angiographic and technical considerations. Cardiovasc Intervent Radiol 2007; 30 (04) 571-592
• 20 Salem R, Lewandowski RJ, Sato KT. , et al. Technical aspects of radioembolization with 90Y microspheres. Tech Vasc Interv Radiol 2007; 10 (01) 12-29
• 21 Petroziello MF, McCann JW, Gonsalves CF. , et al. Side-branch embolization before 90Y radioembolization: rate of recanalization and new collateral development. AJR Am J Roentgenol 2011; 197 (01) W169-W174
• 22 Abdelmaksoud MH, Hwang GL, Louie JD. , et al. Development of new hepaticoenteric collateral pathways after hepatic arterial skeletonization in preparation for yttrium-90 radioembolization. J Vasc Interv Radiol 2010; 21 (09) 1385-1395
• 23 Mahvash A, Zaer N, Shaw C, Chasen B, Avritscher R, Murthy R. Temporary balloon occlusion of the common hepatic artery for administration of yttrium-90 resin microspheres in a patient with patent hepatoenteric collaterals. J Vasc Interv Radiol 2012; 23 (02) 277-280
• 24 Lenoir L, Edeline J, Rolland Y. , et al. Usefulness and pitfalls of MAA SPECT/CT in identifying digestive extrahepatic uptake when planning liver radioembolization. Eur J Nucl Med Mol Imaging 2012; 39 (05) 872-880
• 25 Sirtex Medical Limited. SIR-Spheres® Y-90 resin microspheres (Yttrium-90 microspheres), 2017. Available at: https://www.sirtex.com/media/155126/ssl-us-13.pdf . Accessed October 27, 2017
• 26 Kao YH, Tan EH, Ng CE, Goh SW. Clinical implications of the body surface area method versus partition model dosimetry for yttrium-90 radioembolization using resin microspheres: a technical review. Ann Nucl Med 2011; 25 (07) 455-461
• 27 Van Hazel G, Blackwell A, Anderson J. , et al. Randomised phase 2 trial of SIR-Spheres plus fluorouracil/leucovorin chemotherapy versus fluorouracil/leucovorin chemotherapy alone in advanced colorectal cancer. J Surg Oncol 2004; 88 (02) 78-85
• 28 Grosser OS, Ulrich G, Furth C. , et al. Intrahepatic activity distribution in radioembolization with yttrium-90-labeled resin microspheres using the body surface area method--a less than perfect model. J Vasc Interv Radiol 2015; 26 (11) 1615-1621
• 29 Lam MG, Louie JD, Abdelmaksoud MH, Fisher GA, Cho-Phan CD, Sze DY. Limitations of body surface area-based activity calculation for radioembolization of hepatic metastases in colorectal cancer. J Vasc Interv Radiol 2014; 25 (07) 1085-1093
• 30 Hickey R, Lewandowski RJ, Prudhomme T. , et al. 90Y radioembolization of colorectal hepatic metastases using glass microspheres: safety and survival outcomes from a 531-patient multicenter study. J Nucl Med 2016; 57 (05) 665-671
• 31 Ho S, Lau WY, Leung TW. , et al. Partition model for estimating radiation doses from yttrium-90 microspheres in treating hepatic tumours. Eur J Nucl Med 1996; 23 (08) 947-952
• 32 Wondergem M, Smits ML, Elschot M. , et al. 99mTc-macroaggregated albumin poorly predicts the intrahepatic distribution of 90Y resin microspheres in hepatic radioembolization. J Nucl Med 2013; 54 (08) 1294-1301
• 33 Ilhan H, Goritschan A, Paprottka P. , et al. Predictive value of 99mTc-MAA SPECT for 90Y- labeled resin microsphere distribution in radioembolization of primary and secondary hepatic tumors. J Nucl Med 2015; 56 (11) 1654-1660
• 34 Lam MG, Goris ML, Iagaru AH, Mittra ES, Louie JD, Sze DY. Prognostic utility of 90Y radioembolization dosimetry based on fusion 99mTc-macroaggregated albumin-99mTc-sulfur colloid SPECT. J Nucl Med 2013; 54 (12) 2055-2061
• 35 Flamen P, Vanderlinden B, Delatte P. , et al. Multimodality imaging can predict the metabolic response of unresectable colorectal liver metastases to radioembolization therapy with Yttrium-90 labeled resin microspheres. Phys Med Biol 2008; 53 (22) 6591-6603
• 36 Bernardini M, Smadja C, Faraggi M. , et al. Liver selective internal radiation therapy with (90)Y resin microspheres: comparison between pre-treatment activity calculation methods. Phys Med 2014; 30 (07) 752-764
• 37 Cremonesi M, Chiesa C, Strigari L. , et al. Radioembolization of hepatic lesions from a radiobiology and dosimetric perspective. Front Oncol 2014; 4: 210
• 38 Murthy R, Xiong H, Nunez R. , et al. Yttrium 90 resin microspheres for the treatment of unresectable colorectal hepatic metastases after failure of multiple chemotherapy regimens: preliminary results. J Vasc Interv Radiol 2005; 16 (07) 937-945
• 39 Mahnken AH, Spreafico C, Maleux G, Helmberger T, Jakobs TF. Standards of practice in transarterial radioembolization. Cardiovasc Intervent Radiol 2013; 36 (03) 613-622
• 40 Salem R, Lewandowski RJ, Gates VL. , et al; Technology Assessment Committee; Interventional Oncology Task Force of the Society of Interventional Radiology. Research reporting standards for radioembolization of hepatic malignancies. J Vasc Interv Radiol 2011; 22 (03) 265-278
• 41 Giammarile F, Bodei L, Chiesa C. , et al; Therapy, Oncology and Dosimetry Committees. EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds. Eur J Nucl Med Mol Imaging 2011; 38 (07) 1393-1406
• 42 Yip D, Allen R, Ashton C, Jain S. Radiation-induced ulceration of the stomach secondary to hepatic embolization with radioactive yttrium microspheres in the treatment of metastatic colon cancer. J Gastroenterol Hepatol 2004; 19 (03) 347-349
• 43 Wong CY, Salem R, Raman S, Gates VL, Dworkin HJ. Evaluating 90Y-glass microsphere treatment response of unresectable colorectal liver metastases by [18F]FDG PET: a comparison with CT or MRI. Eur J Nucl Med Mol Imaging 2002; 29 (06) 815-820
• 44 Zerizer I, Al-Nahhas A, Towey D. , et al. The role of early ¹⁸F-FDG PET/CT in prediction of progression-free survival after ⁹⁰Y radioembolization: comparison with RECIST and tumour density criteria. Eur J Nucl Med Mol Imaging 2012; 39 (09) 1391-1399
• 45 Salem R, Lewandowski RJ, Atassi B. , et al. Treatment of unresectable hepatocellular carcinoma with use of 90Y microspheres (TheraSphere): safety, tumor response, and survival. J Vasc Interv Radiol 2005; 16 (12) 1627-1639
• 46 Kennedy AS, Coldwell D, Nutting C. , et al. Resin 90Y-microsphere brachytherapy for unresectable colorectal liver metastases: modern USA experience. Int J Radiat Oncol Biol Phys 2006; 65 (02) 412-425
• 47 Sangro B, Gil-Alzugaray B, Rodriguez J. , et al. Liver disease induced by radioembolization of liver tumors: description and possible risk factors. Cancer 2008; 112 (07) 1538-1546
• 48 Gil-Alzugaray B, Chopitea A, Iñarrairaegui M. , et al. Prognostic factors and prevention of radioembolization-induced liver disease. Hepatology 2013; 57 (03) 1078-1087
• 49 Jakobs TF, Saleem S, Atassi B. , et al. Fibrosis, portal hypertension, and hepatic volume changes induced by intra-arterial radiotherapy with 90yttrium microspheres. Dig Dis Sci 2008; 53 (09) 2556-2563
• 50 Nosher JL, Ohman-Strickland PA, Jabbour S, Narra V, Nosher B. Changes in liver and spleen volumes and liver function after radioembolization with yttrium-90 resin microspheres. J Vasc Interv Radiol 2011; 22 (12) 1706-1713
• 51 Theysohn JM, Ertle J, Müller S. , et al. Hepatic volume changes after lobar selective internal radiation therapy (SIRT) of hepatocellular carcinoma. Clin Radiol 2014; 69 (02) 172-178
• 52 Gaba RC, Lewandowski RJ, Kulik LM. , et al. Radiation lobectomy: preliminary findings of hepatic volumetric response to lobar yttrium-90 radioembolization. Ann Surg Oncol 2009; 16 (06) 1587-1596
• 53 Atassi B, Bangash AK, Lewandowski RJ. , et al. Biliary sequelae following radioembolization with Yttrium-90 microspheres. J Vasc Interv Radiol 2008; 19 (05) 691-697
• 54 Sag AA, Savin MA, Lal NR, Mehta RR. Yttrium-90 radioembolization of malignant tumors of the liver: gallbladder effects. AJR Am J Roentgenol 2014; 202 (05) 1130-1135
• 55 Salem R, Parikh P, Atassi B. , et al. Incidence of radiation pneumonitis after hepatic intra-arterial radiotherapy with yttrium-90 microspheres assuming uniform lung distribution. Am J Clin Oncol 2008; 31 (05) 431-438
• 56 Wright CL, Werner JD, Tran JM. , et al. Radiation pneumonitis following yttrium-90 radioembolization: case report and literature review. J Vasc Interv Radiol 2012; 23 (05) 669-674
• 57 Mallach S, Ramp U, Erhardt A, Schmitt M, Häussinger D. An uncommon cause of gastro-duodenal ulceration. World J Gastroenterol 2008; 14 (16) 2593-2595
• 58 Szyszko T, Al-Nahhas A, Tait P. , et al. Management and prevention of adverse effects related to treatment of liver tumours with 90Y microspheres. Nucl Med Commun 2007; 28 (01) 21-24
• 59 Lam MG, Banerjee S, Louie JD. , et al. Root cause analysis of gastroduodenal ulceration after yttrium-90 radioembolization. Cardiovasc Intervent Radiol 2013; 36 (06) 1536-1547
• 60 Hamami ME, Poeppel TD, Müller S. , et al. SPECT/CT with 99mTc-MAA in radioembolization with 90Y microspheres in patients with hepatocellular cancer. J Nucl Med 2009; 50 (05) 688-692
• 61 Leong QM, Lai HK, Lo RG, Teo TK, Goh A, Chow PK. Radiation dermatitis following radioembolization for hepatocellular carcinoma: a case for prophylactic embolization of a patent falciform artery. J Vasc Interv Radiol 2009; 20 (06) 833-836
• 62 Riaz A, Lewandowski RJ, Kulik LM. , et al. Complications following radioembolization with yttrium-90 microspheres: a comprehensive literature review. J Vasc Interv Radiol 2009; 20 (09) 1121-1130 , quiz 1131
• 63 Padia SA, Lewandowski RJ, Johnson GE. , et al; Society of Interventional Radiology Standards of Practice Committee. Radioembolization of hepatic malignancies: background, quality improvement guidelines, and future directions. J Vasc Interv Radiol 2017; 28 (01) 1-15
• 64 Murthy R, Eng C, Krishnan S. , et al. Hepatic yttrium-90 radioembolotherapy in metastatic colorectal cancer treated with cetuximab or bevacizumab. J Vasc Interv Radiol 2007; 18 (12) 1588-1591
• 65 Lin M, Shon IH, Wilson R, D'Amours SK, Schlaphoff G, Lin P. Treatment response in liver metastases following 90Y SIR-spheres: an evaluation with PET. Hepatogastroenterology 2007; 54 (75) 910-912
• 66 Fendler WP, Philippe Tiega DB, Ilhan H. , et al. 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 2013; 54 (08) 1202-1208
• 67 Chapiro J, Duran R, Lin M. , et al. Early survival prediction after intra-arterial therapies: a 3D quantitative MRI assessment of tumour response after TACE or radioembolization of colorectal cancer metastases to the liver. Eur Radiol 2015; 25 (07) 1993-2003
• 68 Sharma RA, Van Hazel GA, Morgan B. , et al. Radioembolization of liver metastases from colorectal cancer using yttrium-90 microspheres with concomitant systemic oxaliplatin, fluorouracil, and leucovorin chemotherapy. J Clin Oncol 2007; 25 (09) 1099-1106
• 69 Mulcahy MF, Lewandowski RJ, Ibrahim SM. , et al. Radioembolization of colorectal hepatic metastases using yttrium-90 microspheres. Cancer 2009; 115 (09) 1849-1858
• 70 Hendlisz A, Van den Eynde M, Peeters M. , et al. Phase III trial comparing protracted intravenous fluorouracil infusion alone or with yttrium-90 resin microspheres radioembolization for liver-limited metastatic colorectal cancer refractory to standard chemotherapy. J Clin Oncol 2010; 28 (23) 3687-3694
• 71 Kalva SP, Rana RS, Liu R. , et al. Yttrium-90 radioembolization as salvage therapy for liver metastases from colorectal cancer. Am J Clin Oncol 2017; 40 (03) 288-293
• 72 Saxena A, Meteling B, Kapoor J, Golani S, Morris DL, Bester L. Is yttrium-90 radioembolization a viable treatment option for unresectable, chemorefractory colorectal cancer liver metastases? A large single-center experience of 302 patients. Ann Surg Oncol 2015; 22 (03) 794-802
• 73 Kennedy AS, Ball D, Cohen SJ. , et al. Multicenter evaluation of the safety and efficacy of radioembolization in patients with unresectable colorectal liver metastases selected as candidates for (90)Y resin microspheres. J Gastrointest Oncol 2015; 6 (02) 134-142
• 74 Häfeli UO, Casillas S, Dietz DW. , et al. Hepatic tumor radioembolization in a rat model using radioactive rhenium (186Re/188Re) glass microspheres. Int J Radiat Oncol Biol Phys 1999; 44 (01) 189-199
• 75 Grady ED, Sale W, Nicolson Jr WP, Rollins LC. Intra-arterial radioisotopes to treat cancer. Am Surg 1960; 26: 678-684
• 76 Ehrhardt GJ, Day DE. Therapeutic use of 90Y microspheres. Int J Rad Appl Instrum B 1987; 14 (03) 233-242
• 77 Kawashita M. , et al. Surface structure and chemical durability of P+-implanted Y2O3-Al2O3-SiO2 glass for radiotherapy of cancer. J Non-Cryst Solids 1999; 255 (2–3): 140-148
• 78 Wunderlich G, Pinkert J, Andreeff M. , et al. Preparation and biodistribution of rhenium-188 labeled albumin microspheres B 20: a promising new agent for radiotherapy. Appl Radiat Isot 2000; 52 (01) 63-68
• 79 Cosimelli M, Golfieri R, Cagol PP. , et al; Italian Society of Locoregional Therapies in Oncology (SITILO). Multi-centre phase II clinical trial of yttrium-90 resin microspheres alone in unresectable, chemotherapy refractory colorectal liver metastases. Br J Cancer 2010; 103 (03) 324-331
• 80 Gray B, Van Hazel G, Hope M. , et al. Randomised trial of SIR-Spheres plus chemotherapy vs. chemotherapy alone for treating patients with liver metastases from primary large bowel cancer. Ann Oncol 2001; 12 (12) 1711-1720
• 81 van Hazel GA, Heinemann V, Sharma NK. , et al. SIRFLOX: randomized phase III trial comparing first-line mFOLFOX6 (plus or minus bevacizumab) versus mFOLFOX6 (plus or minus bevacizumab) plus selective internal radiation therapy in patients with metastatic colorectal cancer. J Clin Oncol 2016; 34 (15) 1723-1731
• 82 van Hazel G, Heinemann V, Sharma N. , et al. Overall survival analysis of the FOXFIRE-SIRFLOX-FOXFIRE global prospective randomized studies of first-line selective internal radiotherapy (SIRT) in patients with liver metastases from colorectal cancer. Ann Oncol 2017; 28 (suppl_3): iii137-iii149
• 83 Kosmider S, Tan TH, Yip D, Dowling R, Lichtenstein M, Gibbs P. Radioembolization in combination with systemic chemotherapy as first-line therapy for liver metastases from colorectal cancer. J Vasc Interv Radiol 2011; 22 (06) 780-786
• 84 Lewandowski RJ, Thurston KG, Goin JE. , et al. 90Y microsphere (TheraSphere) treatment for unresectable colorectal cancer metastases of the liver: response to treatment at targeted doses of 135-150 Gy as measured by [18F]fluorodeoxyglucose positron emission tomography and computed tomographic imaging. J Vasc Interv Radiol 2005; 16 (12) 1641-1651
• 85 Benson III AB, Geschwind JF, Mulcahy MF. , et al. Radioembolisation for liver metastases: results from a prospective 151 patient multi-institutional phase II study. Eur J Cancer 2013; 49 (15) 3122-3130
• 86 Fidelman N, Kerlan Jr RK, Hawkins RA. , et al. 90Y glass microspheres for the treatment of unresectable metastatic liver disease from chemotherapy-refractory gastrointestinal cancers: a pilot study. J Gastrointest Cancer 2014; 45 (02) 168-180
• 87 Fidelman N, Kerlan Jr RK, Hawkins RA. , et al. Radioembolization with (90)Y glass microspheres for the treatment of unresectable metastatic liver disease from chemotherapy-refractory gastrointestinal cancers: final report of a prospective pilot study. J Gastrointest Oncol 2016; 7 (06) 860-874
• 88 Sato KT, Lewandowski RJ, Mulcahy MF. , et al. Unresectable chemorefractory liver metastases: radioembolization with 90Y microspheres--safety, efficacy, and survival. Radiology 2008; 247 (02) 507-515
• 89 Abbott AM, Kim R, Hoffe SE. , et al. Outcomes of Therasphere radioembolization for colorectal metastases. Clin Colorectal Cancer 2015; 14 (03) 146-153
• 90 Lewandowski RJ, Memon K, Mulcahy MF. , et al. Twelve-year experience of radioembolization for colorectal hepatic metastases in 214 patients: survival by era and chemotherapy. Eur J Nucl Med Mol Imaging 2014; 41 (10) 1861-1869