Nuclear medicine improves survival from colorectal cancer metastasis to the liver

For patients who fail to respond to current first-line and second-line treatments for colorectal cancer liver metastases (also known as salvage patients), radioembolization with Y-90 microspheres could extend survival, according to new research. A systematic review showed that approximately 50% of salvage patients have an overall survival of more than 12 months after this nuclear medicine therapy.

Colorectal cancer is the third most commonly diagnosed type of cancer worldwide in men and the second in women, and it is also the third most common cause of death. In approximately 50% of patients, metastases to the liver are present at diagnosis or during follow-up, which account for a large portion of morbidity and mortality in patients.

A structured review was performed by researchers to gather all available evidence on radioembolization for the specific group of patients with colorectal cancer liver metastases. "Although quite some reviews are printed on the subject of radioembolization, we felt that a structured and comprehensive review on survival and response data for these patients was lacking," said lead author Charlotte E.N.M. Rosenbaum, PhD, of University Medical Center Urecht in The Netherlands. The study was published in the November issue of The Journal of Nuclear Medicine (2013; doi:10.2967/jnumed.113.119545).

The research team reviewed a total of 13 articles on Y-90 radioembolization as a monotherapy and 13 articles on Y-90 radioembolization as a combined with chemotherapy. Among the studies, disease control rates (ie, complete response, partial response, and stable disease) ranged from 29% to 90% in the monotherapy studies, which involved 901 patients. In the studies in which Y-90 radioembolization was combined with chemotherapy, involving 472 patients, disease control rates ranged from 59% to 100%.

"From the studies included in this systematic review, survival proportions of approximately 50% were found. Therefore, in this group of salvage colorectal cancer liver metastases patients who otherwise have no regular treatment options and a life expectancy of less than 6 months, Y-90 radioembolization seems to be a hopeful treatment option," noted Rosenbaum.

"Our paper shows all published data on this subject from the first randomized trial onwards. Furthermore, we have determined 12-month survival proportions for all included articles to provide a better overview and to better allow for comparisons. Finally, this overview of the literature shows which topics have not been the focus of much research and may thus be interesting for further work."

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