Role of yttrium-90 selective internal radiation therapy in the treatment of liver-dominant metastatic colorectal cancer: an evidence-based expert consensus algorithm
- PMID: 32399284
- PMCID: PMC7212103
- DOI: 10.21037/jgo.2020.01.09
Role of yttrium-90 selective internal radiation therapy in the treatment of liver-dominant metastatic colorectal cancer: an evidence-based expert consensus algorithm
Abstract
Surgical resection of colorectal liver metastases is associated with greater survival compared with non-surgical treatment, and a meaningful possibility of cure. However, the majority of patients are not eligible for resection and may require other non-surgical interventions, such as liver-directed therapies, to be converted to surgical eligibility. Given the number of available therapies, a general framework is needed that outlines the specific roles of chemotherapy, surgery, and locoregional treatments [including selective internal radiation therapy (SIRT) with Y-90 microspheres]. Using a data-driven, modified Delphi process, an expert panel of surgical oncologists, transplant surgeons, and hepatopancreatobiliary (HPB) surgeons convened to create a comprehensive, evidence-based treatment algorithm that includes appropriate treatment options for patients stratified by their eligibility for surgical treatment. The group coined a novel, more inclusive phrase for targeted locoregional tumor treatment (a blanket term for resection, ablation, and other emerging locoregional treatments): local parenchymal tumor destruction therapy. The expert panel proposed new nomenclature for 3 distinct disease categories of liver-dominant metastatic colorectal cancer that is consistent with other tumor types: (I) surgically treatable (resectable); (II) surgically untreatable (borderline resectable); (III) advanced surgically untreatable (unresectable) disease. Patients may present at any point in the algorithm and move between categories depending on their response to therapy. The broad intent of therapy is to transition patients toward individualized treatments where possible, given the survival advantage that resection offers in the context of a comprehensive treatment plan. This article reviews what is known about the role of SIRT with Y-90 as neoadjuvant, definitive, or palliative therapy in these different clinical situations and provides insight into when treatment with SIRT with Y-90 may be appropriate and useful, organized into distinct treatment algorithm steps.
Keywords: Metastatic colorectal cancer; local parenchymal tumor destruction therapy; selective internal radiation therapy (SIRT); transarterial radioembolization; yttrium-90.
2020 Journal of Gastrointestinal Oncology. All rights reserved.
Conflict of interest statement
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jgo.2020.01.09). Authors received an honorarium for Advisory Board attendance that served as the basis for the modified Delphi consensus exercise. No payment was provided for the time spent authoring this manuscript. DR Jeyarajah, NJ Espat, BC Visser, DA Iannitti, Doyle MBM, J Kim, and T Thambi-Pillai are or have been consultants to Sirtex Medical, Inc. NJ Espat has served as a speaker on behalf of Sirtex. DR Jeyarajah has served as a consultant to Ethicon.
Figures
Similar articles
-
Treatment options for unresectable HCC with a focus on SIRT with Yttrium-90 resin microspheres.Int J Clin Pract. 2017 Nov;71(11). doi: 10.1111/ijcp.12972. Epub 2017 Jul 30. Int J Clin Pract. 2017. PMID: 28758319 Review.
-
Effects of Yttrium-90 selective internal radiation therapy on non-conventional liver tumors.World J Gastroenterol. 2015 Jul 21;21(27):8271-83. doi: 10.3748/wjg.v21.i27.8271. World J Gastroenterol. 2015. PMID: 26217079 Free PMC article. Review.
-
Selective Internal Radiation Therapy (SIRT) with yttrium-90 resin microspheres plus standard systemic chemotherapy regimen of FOLFOX versus FOLFOX alone as first-line treatment of non-resectable liver metastases from colorectal cancer: the SIRFLOX study.BMC Cancer. 2014 Dec 1;14:897. doi: 10.1186/1471-2407-14-897. BMC Cancer. 2014. PMID: 25487708 Free PMC article. Clinical Trial.
-
Selective internal radiation therapy with 90yttrium microspheres for extensive colorectal liver metastases.J Gastrointest Surg. 2001 May-Jun;5(3):294-302. doi: 10.1016/s1091-255x(01)80051-2. J Gastrointest Surg. 2001. PMID: 11360053
-
Yttrium-90 radioembolization of hepatic metastases from colorectal cancer.Front Oncol. 2014 Jul 25;4:120. doi: 10.3389/fonc.2014.00120. eCollection 2014. Front Oncol. 2014. PMID: 25120951 Free PMC article. Review.
Cited by
-
The Influence of Additional Treatments on the Survival of Patients Undergoing Transarterial Radioembolization (TARE).Curr Oncol. 2024 Mar 13;31(3):1504-1514. doi: 10.3390/curroncol31030114. Curr Oncol. 2024. PMID: 38534947 Free PMC article.
-
Applications of Yttrium-90 (90Y) in Hepatocellular Carcinoma.Onco Targets Ther. 2024 Feb 23;17:149-157. doi: 10.2147/OTT.S445898. eCollection 2024. Onco Targets Ther. 2024. PMID: 38414759 Free PMC article. Review.
-
Selective Internal Radiation Therapy Using Y-90 Resin Microspheres for Metastatic Colorectal Cancer: An Updated Systematic Review and Network Meta-Analysis.Adv Ther. 2024 Apr;41(4):1606-1620. doi: 10.1007/s12325-024-02800-5. Epub 2024 Feb 26. Adv Ther. 2024. PMID: 38407790 Free PMC article.
-
The efficacy and safety of anti-EGFR target agents in patients with potentially resectable metastatic colorectal cancer: a meta-analysis of randomized controlled trials.World J Surg Oncol. 2023 Oct 26;21(1):340. doi: 10.1186/s12957-023-03222-3. World J Surg Oncol. 2023. PMID: 37880688 Free PMC article.
-
Defining a New Classification System for the Surgical Management of Neuroendocrine Tumor Liver Metastases.J Clin Med. 2023 Mar 23;12(7):2456. doi: 10.3390/jcm12072456. J Clin Med. 2023. PMID: 37048539 Free PMC article. Review.
References
-
- Network NCC. Clinical practice guidelines in oncology. Colon cancer. Version 4. 2018.
Publication types
LinkOut - more resources
Full Text Sources