Radioembolisation in the treatment of colorectal liver metastases:
An emerging synergy with systemic chemotherapy
Dr. med. Tobias F. Jakobs
Department of Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany
Address for correspondence:
Dr. med. Tobias F. Jakobs
Section Chief, Angiography and Interventional Radiology
Ludwig-Maximilians-University of Munich
Department of Radiology - Campus Grosshadern
Marchioninistrasse 15
81377 Munich, Germany
Tel: +49 89 7095 3620 Fax: +49 89 7095 8832
Email: tobias.jakobs@med.lmu.de
Table 1A. Studies of radioembolisation (RE) with 90Y resin microspheres in mCRC. First- and second-line treatment combined with chemotherapy.
Table 1B. Studies of radioembolisation (RE) with 90Y resin microspheres in mCRC. Salvage therapy for treatment chemo-refractory.
* Retrospective analysis.
FUDR = floxuridine; HAC = Hepatic Artery Chemotherapy; n.r. = not reported; ORR = overall response rate; PFS = progression free survival; SD = stable disease; TTP = time to progression.
Abstract
Although chemotherapy regimens combined with biological agents have improved the control of colorectal cancer (CRC) liver metastases and rendered an increasing number of patients suitable to undergo resection, the recurrent nature of liver metastases continues to present a life-limiting prognosis for most patients with advanced CRC. Intra-arterial radiotherapy with yttrium-90 microspheres (radioembolisation) is a therapeutic procedure, exclusively applied to the liver that allows the direct delivery of high-dose radiation to liver tumours by means of endovascular catheters selectively placed within the tumour vasculature. For patients with unresectable liver-dominant disease, early evidence indicates that combining radioembolisation with modern polychemotherapy regimens substantially improves the stabilisation of liver disease, thereby prolonging time to disease progression and overall survival compared with chemotherapy alone. Phase III prospective trials of radioembolisation in combination with first-line or subsequent lines of chemotherapy in metastatic liver-dominant CRC are ongoing.
Dr. med. Tobias F. Jakobs is an interventional radiologist and is Section Chief of Angiography and Interventional Radiology at the Ludwig-Maximilians-University of Munich, Department of Radiology at the Grosshadern campus. Dr Jakobs received his postgraduate training in interventional radiology from the University Hospitals of the Ludwig-Maximilians-University of Munich and also from the University of Texas, MD Anderson Cancer Center, Houston, Texas, in the United States. His main topics of research are local ablative therapies (e.g. RFA) in primary and secondary liver tumours as well as transarterial radioembolisation of liver tumours, and vertebroplasty in osteoporotic vertebral fractures and tumorous osteolyses.
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