Liver Resection for Colorectal Hepatic Metastases after Systemic Chemotherapy and Selective Internal Radiation Therapy with Yttrium-90 Microspheres: A Systematic Review

Background: Selective internal radiation therapy (SIRT) using yttrium-90 resin microspheres has been used together with systemic chemotherapy to treat patients with unresectable liver metastases. This study undertook the first systematic pooled assessment of the case profile, treatment and outcome in patients with initially inoperable colorectal hepatic metastases undergoing resection after systemic chemotherapy and SIRT. Methods: A systematic review of the literature was performed using Medline and Embase for publications between January 1998 and August 2017. Keywords and MESH headings “SIRT”, “Yttrium-99 radio embolization” and “liver metastases” were used. Reports on patients undergoing liver resection after SIRT for colorectal liver metastases were included. Case reports, reviews and papers without original data were excluded. The study protocol was registered with PROSPERO, (registration number: CRD42017072374). Results: The study population comprised of 120 patients undergoing liver resection after chemotherapy and SIRT. The conversion rate to hepatectomy in previously unresectable patients was 13.6% (109 of 802). All studies report a single application of SIRT. The interval from SIRT to surgery ranged from 39 days to 9 months. Overall, there were 4 (3.3%) deaths after hepatectomy in patients treated by chemotherapy and SIRT. Conclusions: This large pooled report of patients undergoing hepatectomy for colorectal liver metastases after chemotherapy and SIRT shows that 13.6% of patients with initially inoperable disease undergo resection with low procedure-related mortality.

[1]  V. Gebski,et al.  First-line selective internal radiotherapy plus chemotherapy versus chemotherapy alone in patients with liver metastases from colorectal cancer (FOXFIRE, SIRFLOX, and FOXFIRE-Global): a combined analysis of three multicentre, randomised, phase 3 trials , 2017, The Lancet. Oncology.

[2]  M. Baltatzis,et al.  Superior mesenteric artery (SMA) resection during pancreatectomy for malignant disease of the pancreas: a systematic review. , 2017, HPB : the official journal of the International Hepato Pancreato Biliary Association.

[3]  S. Kopetz,et al.  Right Versus Left Colon Cancer Biology: Integrating the Consensus Molecular Subtypes. , 2017, Journal of the National Comprehensive Cancer Network : JNCCN.

[4]  J. Guinney,et al.  Consensus molecular subtypes and the evolution of precision medicine in colorectal cancer , 2017, Nature Reviews Cancer.

[5]  V. Gebski,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. , 2016, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[6]  K. Haustermans,et al.  Yttrium-90 radioembolization for the treatment of chemorefractory colorectal liver metastases: Technical results, clinical outcome and factors potentially influencing survival , 2016, Acta oncologica.

[7]  J. Burns,et al.  Selective internal radiation therapy for liver malignancies , 2015, The British journal of surgery.

[8]  Jeffrey S. Morris,et al.  The Consensus Molecular Subtypes of Colorectal Cancer , 2015, Nature Medicine.

[9]  K. Tatsch,et al.  Liver resection after selective internal radiotherapy (SIRT): Proof of concept, initial survival, and safety , 2015, Journal of surgical oncology.

[10]  P. Shekelle,et al.  Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement , 2015, Systematic Reviews.

[11]  S. Jegatheeswaran,et al.  Management of colorectal cancer presenting with synchronous liver metastases , 2014, Nature Reviews Clinical Oncology.

[12]  Ricky A. Sharma,et al.  Anatomical basis and histopathological changes resulting from selective internal radiotherapy for liver metastases , 2012, Journal of Clinical Pathology.

[13]  R. Labianca,et al.  ESMO Consensus Guidelines for management of patients with colon and rectal cancer. a personalized approach to clinical decision making. , 2012, Annals of oncology : official journal of the European Society for Medical Oncology.

[14]  J. Sterne,et al.  The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials , 2011, BMJ : British Medical Journal.

[15]  B. Sangro,et al.  Radioembolization for Hepatocellular Carcinoma: Evidence-Based Answers to Frequently Asked Questions , 2011 .

[16]  K. McMasters,et al.  Safety of hepatic resection in metastatic disease to the liver after yttrium-90 therapy. , 2011, The Journal of surgical research.

[17]  E. Van Cutsem,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. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[18]  M. Ducreux,et al.  Patients with initially unresectable colorectal liver metastases: is there a possibility of cure? , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[19]  A. Benson,et al.  Recommendations for radioembolization of hepatic malignancies using yttrium-90 microsphere brachytherapy: a consensus panel report from the radioembolization brachytherapy oncology consortium. , 2007, International journal of radiation oncology, biology, physics.

[20]  P. Gibbs,et al.  Radioembolization of liver metastases from colorectal cancer using yttrium-90 microspheres with concomitant systemic oxaliplatin, fluorouracil, and leucovorin chemotherapy. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[21]  C. Lepage,et al.  Epidemiology and Management of Liver Metastases From Colorectal Cancer , 2006, Annals of surgery.

[22]  G. Launoy,et al.  A population‐based study of the incidence, management and prognosis of hepatic metastases from colorectal cancer , 2006, The British journal of surgery.

[23]  P. Gibbs,et al.  A prospective evaluation of treatment with Selective Internal Radiation Therapy (SIR-spheres) in patients with unresectable liver metastases from colorectal cancer previously treated with 5-FU based chemotherapy , 2005, BMC Cancer.

[24]  Bernard Paule,et al.  Rescue Surgery for Unresectable Colorectal Liver Metastases Downstaged by Chemotherapy: A Model to Predict Long-term Survival , 2004, Annals of surgery.

[25]  W. Ensminger Intrahepatic arterial infusion of chemotherapy: pharmacologic principles. , 2002, Seminars in oncology.

[26]  V. Gebski,et al.  Randomised trial of SIR-Spheres plus chemotherapy vs. chemotherapy alone for treating patients with liver metastases from primary large bowel cancer. , 2001, Annals of oncology : official journal of the European Society for Medical Oncology.

[27]  F. Lévi,et al.  Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy. , 1996, Annals of surgery.