Intra-Arterial Therapies for Metastatic Colorectal Cancer

Abstract

Intra-arterial therapies for unresectable hepatic metastases from colorectal cancer include radioembolization (RE) with yttrium-90 microspheres, transarterial chemoembolization (TACE), hepatic arterial infusion, and percutaneous hepatic perfusion using an organ isolation system. In this article, we discuss our approach toward treatment selection, followed by details of how RE and TACE are performed at our institution.

Keywords

colorectal cancer - liver metastases - radioembolization - drug-eluting beads - irinotecan

• References

• 1 Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011; 61 (2) 69-90
• 2 Surveillance Research Program, National Cancer Institute. SEER stat fact sheets: Colon and rectum. Available at: http://seer.cancer.gov/statfacts/html/colorect.html . Accessed August 20, 2012
• 3 Weiss L, Grundmann E, Torhorst J , et al. Haematogenous metastatic patterns in colonic carcinoma: an analysis of 1541 necropsies. J Pathol 1986; 150 (3) 195-203
• 4 Choti MA. Surgical resection of hepatic metastases. In: Geschwind JF, Soulen MC, , eds. Interventional Oncology: Principles and Practice. New York, NY: Cambridge University Press; 2008: 243-248
• 5 Sasson AR, Sigurdson ER. Surgical treatment of liver metastases. Semin Oncol 2002; 29 (2) 107-118
• 6 Ma WW, Messersmith WA. Medical management of colorectal liver metastasis. In: Geschwind JF, Soulen MC, , eds. Interventional Oncology: Principles and Practice. New York, NY: Cambridge University Press; 2008: 222-242
• 7 Köhne CH, Lenz HJ. Chemotherapy with targeted agents for the treatment of metastatic colorectal cancer. Oncologist 2009; 14 (5) 478-488
• 8 Breedis C, Young G. The blood supply of neoplasms in the liver. Am J Pathol 1954; 30 (5) 969-977
• 9 de Baere T, Deschamps F. Arterial therapies of colorectal cancer metastases to the liver. Abdom Imaging 2011; 36 (6) 661-670
• 10 Wasan H, Kennedy A, Coldwell D, Sangro B, Salem R. Integrating radioembolization with chemotherapy in the treatment paradigm for unresectable colorectal liver metastases. Am J Clin Oncol 2012; 35 (3) 293-301
• 11 Salem R, Thurston KG. Radioembolization with yttrium-90 microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies: part 3: comprehensive literature review and future direction. J Vasc Interv Radiol 2006; 17 (10) 1571-1593
• 12 Nicolay NH, Berry DP, Sharma RA. Liver metastases from colorectal cancer: radioembolization with systemic therapy. Nat Rev Clin Oncol 2009; 6 (12) 687-697
• 13 Deleporte A, Flamen P, Hendlisz A. State of the art: radiolabeled microspheres treatment for liver malignancies. Expert Opin Pharmacother 2010; 11 (4) 579-586
• 14 Vente MA, Wondergem M, van der Tweel I , et al. Yttrium-90 microsphere radioembolization for the treatment of liver malignancies: a structured meta-analysis. Eur Radiol 2009; 19 (4) 951-959
• 15 Gulec SA, Pennington K, Wheeler J , et al. Yttrium-90 microsphere-selective internal radiation therapy with chemotherapy (Chemo-SIRT) for colorectal cancer liver metastases: an in vivo double-arm-controlled phase II trial. Am J Clin Oncol 2012; ; June 14 ( Epub ahead of print)
• 16 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 (9) 1099-1106
• 17 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 (2) 78-85
• 18 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 (6) 780-786
• 19 van Hazel GA, Pavlakis N, Goldstein D , et al. Treatment of fluorouracil-refractory patients with liver metastases from colorectal cancer by using yttrium-90 resin microspheres plus concomitant systemic irinotecan chemotherapy. J Clin Oncol 2009; 27 (25) 4089-4095
• 20 Lim L, Gibbs P, Yip D , 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. BMC Cancer 2005; 5: 132
• 21 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 (3) 324-331
• 22 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 (2) 412-425
• 23 Bester L, Meteling B, Pocock N , et al. Radioembolization versus standard care of hepatic metastases: comparative retrospective cohort study of survival outcomes and adverse events in salvage patients. J Vasc Interv Radiol 2012; 23 (1) 96-105
• 24 Cianni R, Urigo C, Notarianni E , et al. Selective internal radiation therapy with SIR-spheres for the treatment of unresectable colorectal hepatic metastases. Cardiovasc Intervent Radiol 2009; 32 (6) 1179-1186
• 25 Jakobs TF, Hoffmann RT, Dehm K , et al. Hepatic yttrium-90 radioembolization of chemotherapy-refractory colorectal cancer liver metastases. J Vasc Interv Radiol 2008; 19 (8) 1187-1195
• 26 Nace GW, Steel JL, Amesur N , et al. Yttrium-90 radioembolization for colorectal cancer liver metastases: a single institution experience. Int J Surg Oncol 2011; 2011: 571261
• 27 Seidensticker R, Denecke T, Kraus P , et al. Matched-pair comparison of radioembolization plus best supportive care versus best supportive care alone for chemotherapy refractory liver-dominant colorectal metastases. Cardiovasc Intervent Radiol 2012; 35 (5) 1066-1073
• 28 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
• 29 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
• 30 Aliberti C, Tilli M, Benea G, Fiorentini G. Trans-arterial chemoembolization (TACE) of liver metastases from colorectal cancer using irinotecan-eluting beads: preliminary results. Anticancer Res 2006; 26 (5B) 3793-3795
• 31 Aliberti C, Fiorentini G, Muzzio PC , et al. Trans-arterial chemoembolization of metastatic colorectal carcinoma to the liver adopting DC Bead^®, drug-eluting bead loaded with irinotecan: results of a phase II clinical study. Anticancer Res 2011; 31 (12) 4581-4587
• 32 Martin RC, Joshi J, Robbins K , et al. Hepatic intra-arterial injection of drug-eluting bead, irinotecan (DEBIRI) in unresectable colorectal liver metastases refractory to systemic chemotherapy: results of multi-institutional study. Ann Surg Oncol 2011; 18 (1) 192-198
• 33 Fiorentini G, Aliberti C, Tilli M , et al. Intra-arterial infusion of irinotecan-loaded drug-eluting beads (DEBIRI) versus intravenous therapy (FOLFIRI) for hepatic metastases from colorectal cancer: final results of a phase III study. Anticancer Res 2012; 32 (4) 1387-1395
• 34 Martin RC, Howard J, Tomalty D , et al. Toxicity of irinotecan-eluting beads in the treatment of hepatic malignancies: results of a multi-institutional registry. Cardiovasc Intervent Radiol 2010; 33 (5) 960-966
• 35 Biocompatibles. DEBIRI algorithm—colorectal metastases. Available at: http://www.biocompatibles.com/products/dcbead/technique-guidelines . Accessed August 15, 2012
• 36 Albert M, Kiefer MV, Sun W , et al. Chemoembolization of colorectal liver metastases with cisplatin, doxorubicin, mitomycin C, Ethiodol, and polyvinyl alcohol. Cancer 2011; 117 (2) 343-352
• 37 Vogl TJ, Gruber T, Balzer JO, Eichler K, Hammerstingl R, Zangos S. Repeated transarterial chemoembolization in the treatment of liver metastases of colorectal cancer: prospective study. Radiology 2009; 250 (1) 281-289
• 38 Tellez C, Benson III AB, Lyster MT , et al. Phase II trial of chemoembolization for the treatment of metastatic colorectal carcinoma to the liver and review of the literature. Cancer 1998; 82 (7) 1250-1259
• 39 Sanz-Altamira PM, Spence LD, Huberman MS , et al. Selective chemoembolization in the management of hepatic metastases in refractory colorectal carcinoma: a phase II trial. Dis Colon Rectum 1997; 40 (7) 770-775
• 40 Lang EK, Brown Jr CL. Colorectal metastases to the liver: selective chemoembolization. Radiology 1993; 189 (2) 417-422
• 41 Kingham TP, D'Angelica M, Kemeny NE. Role of intra-arterial hepatic chemotherapy in the treatment of colorectal cancer metastases. J Surg Oncol 2010; 102 (8) 988-995
• 42 Arai Y, Takeuchi Y, Inaba Y , et al. Percutaneous catheter placement for hepatic arterial infusion chemotherapy. Tech Vasc Interv Radiol 2007; 10 (1) 30-37
• 43 Ganeshan A, Upponi S, Hon LQ, Warakaulle D, Uberoi R. Hepatic arterial infusion of chemotherapy: the role of diagnostic and interventional radiology. Ann Oncol 2008; 19 (5) 847-851
• 44 Antoine RA. Technical considerations in percutaneous hepatic perfusion—a multi-center experience. J Extra Corpor Technol 2011; 43 (1) 30-33
• 45 Miao N, Pingpank JF, Alexander HR, Steinberg SM, Beresneva T, Quezado ZM. Percutaneous hepatic perfusion in patients with metastatic liver cancer: anesthetic, hemodynamic, and metabolic considerations. Ann Surg Oncol 2008; 15 (3) 815-823
• 46 SIRTeX Medical. SIR-Spheres Yttrium-90 microspheres package insert, October 2011. Available at: http://www.sirtex.com/files/SSL-US-09.pdf . Accessed August 15, 2012
• 47 Nordion MDS. TheraSphere Yttrium-90 microspheres package insert, US ed. Available at: http://www.nordion.com/therasphere/physicians-package-insert/package-insert-us.pdf . Accessed August 15, 2012
• 48 Stanford Interventional Radiology. Interventional Oncology–Radioembolization. Available at: http://www.youtube.com/watch?v=3WwSfGPQq9g . Accessed August 15, 2012
• 49 Oken MM, Creech RH, Tormey DC , et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982; 5 (6) 649-655
• 50 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 (9) 1425-1439
• 51 Murthy R, Brown DB, Salem R , et al. Gastrointestinal complications associated with hepatic arterial yttrium-90 microsphere therapy. J Vasc Interv Radiol 2007; 18 (4) 553-561; quiz 562
• 52 Abdelmaksoud MH, Louie JD, Kothary N , et al. Consolidation of hepatic arterial inflow by embolization of variant hepatic arteries in preparation for yttrium-90 radioembolization. J Vasc Interv Radiol 2011; 22 (10) 1364-1371, e1
• 53 Abdelmaksoud MH, Louie JD, Kothary N , et al. Embolization of parasitized extrahepatic arteries to reestablish intrahepatic arterial supply to tumors before yttrium-90 radioembolization. J Vasc Interv Radiol 2011; 22 (10) 1355-1362
• 54 Hashimoto M, Heianna J, Tate E, Kurosawa R, Nishii T, Mayama I. The feasibility of retrograde catheterization of the right gastric artery via the left gastric artery. J Vasc Interv Radiol 2001; 12 (9) 1103-1106
• 55 Louie JD, Kothary N, Kuo WT , et al. Incorporating cone-beam CT into the treatment planning for yttrium-90 radioembolization. J Vasc Interv Radiol 2009; 20 (5) 606-613
• 56 Sze DY, Louie JD, Iagaru AH, Abdelmaksoud M, Goris ML. Survival after radioembolization is predicted by dose distribution scintigraphy fusion imaging [abstract]. J Vasc Interv Radiol 2010; 21 (2) S10
• 57 Kennedy A, Nag S, Salem R , et al. Recommendations for radioembolization of hepatic malignancies using yttrium-90 microsphere brachytherapy: a consensus panel report from the radioembolization brachytherapy oncology consortium. Int J Radiat Oncol Biol Phys 2007; 68 (1) 13-23
• 58 Lam MG, Nijsen F, Smits M , et al. Limitations of the BSA-based dose calculation for Yttrium-90 radioembolization [abstract]. J Vasc Interv Radiol 2012; 23 (3) S68
• 59 Leung TW, Lau WY, Ho SK , et al. Radiation pneumonitis after selective internal radiation treatment with intraarterial 90yttrium-microspheres for inoperable hepatic tumors. Int J Radiat Oncol Biol Phys 1995; 33 (4) 919-924
• 60 Abdelmaksoud M, Chang D, Eclov NC , et al. Safety of Y90 radioembolization in patients who have undergone previous external beam radiation therapy [abstract]. J Vasc Interv Radiol 2011; 22 (3) S87
• 61 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 (9) 1385-1395
• 62 Louie JD, Wang EA, Broadwell S , et al. First in man experience with the Surefire infusion system: a dedicated microcatheter system to eliminate reflux during embolotherapy [abstract]. J Vasc Interv Radiol 2012; 23 (3) S80
• 63 Ahmadzadehfar H, Muckle M, Sabet A , et al. The significance of bremsstrahlung SPECT/CT after yttrium-90 radioembolization treatment in the prediction of extrahepatic side effects. Eur J Nucl Med Mol Imaging 2011; 39 (2) 309-315
• 64 Ha BY, Ahmed A, Sze DY , et al. Long-term survival of patients with unresectable hepatocellular carcinoma treated with transcatheter arterial chemoinfusion. Aliment Pharmacol Ther 2007; 26 (6) 839-846
• 65 Tognolini A, Louie JD, Hwang GL, Hofmann LV, Sze DY, Kothary N. Utility of C-arm CT in patients with hepatocellular carcinoma undergoing transhepatic arterial chemoembolization. J Vasc Interv Radiol 2010; 21 (3) 339-347
• 66 Fiorentini G, Aliberti C, Benea G , et al. TACE of liver metastases from colorectal cancer adopting irinotecan-eluting beads: beneficial effect of palliative intra-arterial lidocaine and post-procedure supportive therapy on the control of side effects. Hepatogastroenterology 2008; 55 (88) 2077-2082