Details

Autor(en) / Beteiligte

• Sharma, Ricky A
• Nicolay, Nils H
• Berry, David P

Titel

Liver metastases from colorectal cancer: radioembolization with systemic therapy

Ist Teil von

• Nature reviews. Clinical oncology, 2009-12, Vol.6 (12), p.687-697

Ort / Verlag

London: Nature Publishing Group UK

Erscheinungsjahr

2009

Quelle

MEDLINE

Beschreibungen/Notizen

• Most patients with advanced colorectal cancer die from hepatic metastases. Radioembolization is a technique for administering radiotherapy internally to unresectable primary or secondary hepatic malignancies in a single procedure to improve local control of disease. This technique enables significant downsizing of liver metastases after surgical resection, and the rationale for this approach combined with cytotoxic and molecularly targeted agents is outlined. The majority of patients with advanced colorectal cancer die from hepatic metastases caused by disease progression; therefore, several novel technologies are in clinical development to potentially improve local control of liver disease. Radioembolization is a technique for administering radiotherapy internally to unresectable primary or secondary hepatic malignancies in a single procedure. This technique involves the injection of resin or glass microspheres that contain 90 Y into the arterial supply of the liver. Clinical trials of radioembolization used with concomitant radiosensitizing chemotherapy have shown promising results in patients with metastatic colorectal cancer. Several reports suggest that radioembolization is associated with significant downsizing of liver metastases to permit subsequent surgical resection. In this article, the rationale for combining radioembolization with the cytotoxic and molecularly targeted agents licensed for the systemic treatment of colorectal cancer is outlined. Clinical data from trials of radioembolization with concomitant systemic treatment are reviewed, with an emphasis on the appropriateness of primary end points in large-scale trials and the practical aspects of surgical resection in patients whose tumors are successfully downsized by this chemoradiation approach. Key Points Radioembolization is a means of administering internal radiotherapy to unresectable hepatic malignancies by the injection of radioactive resin or glass microspheres into the arterial supply of the liver Unlike local ablation techniques such as surgical resection or external-beam radiotherapy, radioembolization is not limited by the number and distribution of liver metastases The safe administration and appropriate use of radioembolization depends on the experience of a multidisciplinary team, including an interventional vascular radiologist, radiation oncologist and nuclear medicine physician Potential radiosensitizing effects of systemic agents used to treat metastatic colorectal cancer include cell-cycle arrest, apoptosis and direct and indirect effects on DNA bases, repair proteins and tumor vasculature More than 10 prospective clinical trials of radioembolization are underway; these trials will determine whether it should be included in first-line treatment or subsequent lines of treatment Hepatic artery embolization, fibrotic changes in the future liver remnant and portal hypertension raise questions as to the safety and radicality of resection following radioembolization