Factors affecting oncologic outcomes of 90Y radioembolization of heavily pre-treated patients with colon cancer liver metastases Journal Article


Authors: Kurilova, I.; Beets-Tan, R. G. H.; Flynn, J.; Gönen, M.; Ulaner, G.; Petre, E. N.; Boas, F. E.; Ziv, E.; Yarmohammadi, H.; Klompenhouwer, E. G.; Cercek, A.; Kemeny, N. A.; Sofocleous, C. T.
Article Title: Factors affecting oncologic outcomes of 90Y radioembolization of heavily pre-treated patients with colon cancer liver metastases
Abstract: Introduction: The purpose of this study was to identify predictors of overall (OS) and liver progression-free survival (LPFS) following Yttrium-90 radioembolization (RAE) of heavily pretreated patients with colorectal cancer liver metastases (CLM), as well as to create and validate a predictive nomogram for OS. Materials and Methods: Metabolic, anatomic, laboratory, pathologic, genetic, primary disease, and procedure-related factors, as well as pre- and post-RAE therapies in 103 patients with CLM treated with RAE from September 15, 2009 to March 21, 2017 were analyzed. LPFS was defined by Response Evaluation Criteria In Solid Tumors 1.1 and European Organization for Research and Treatment of Cancer criteria. Prognosticators of OS and LPFS were selected using univariate Cox regression, adjusted for clustering and competing risk analysis (for LPFS), and subsequently tested in multivariate analysis (MVA). The nomogram was built using R statistical software and internally validated using bootstrap resampling. Results: Patients received RAE at a median of 30.9 months (range, 3.4-161.7 months) after detection of CLM. The median OS and LPFS were 11.3 months (95% confidence interval, 7.9-15.1 months) and 4 months (95% confidence interval, 3.3-4.8 months), respectively. Of the 40 parameters tested, 6 were independently associated with OS in MVA. These baseline parameters included number of extrahepatic disease sites (P <.001), carcinoembryonic antigen (P <.001), albumin (P =.005), alanine aminotransferase level (P <.001), tumor differentiation level (P <.001), and the sum of the 2 largest tumor diameters (P <.001). The 1-year OS of patients with total points of < 25 versus > 80 was 90% and 10%, respectively. Bootstrap resampling showed good discrimination (optimism corrected c-index = 0.745) and calibration (mean absolute prediction error = 0.299) of the nomogram. Only baseline maximum standardized uptake value was significant in MVA for LPFS prediction (P <.001; SHR = 1.06). Conclusion: The developed nomogram included 6 pre-RAE parameters and provided good prediction of survival post-RAE in heavily pretreated patients. Baseline maximum standardized uptake value was the single significant predictor of LPFS. © 2018 One-year overall survival prediction nomogram included 6 easy-to-obtain pre Yttrium-90 radioembolization parameters and provided good prediction of overall survival post Yttrium-90 radioembolization. This can be useful for pretreatment patient stratification and counseling of heavily pretreated patients with colorectal cancer liver metastases. Baseline maximum standardized uptake value predicted liver progression-free survival. © 2018
Keywords: liver tumors; arterially directed therapies; selective internal radiation therapy; colon cancer liver metastases; yttium-90 radioembolization
Journal Title: Clinical Colorectal Cancer
Volume: 18
Issue: 1
ISSN: 1533-0028
Publisher: Elsevier Inc.  
Date Published: 2019-03-01
Start Page: 8
End Page: 18
Language: English
DOI: 10.1016/j.clcc.2018.08.004
PROVIDER: scopus
PUBMED: 30297264
DOI/URL:
Notes: Article -- Export Date: 1 April 2019 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Gary Ulaner
    89 Ulaner
  2. Mithat Gonen
    716 Gonen
  3. Elena Nadia Petre
    50 Petre
  4. Nancy Kemeny
    358 Kemeny
  5. Franz Edward Boas
    37 Boas
  6. Etay   Ziv
    28 Ziv
  7. Jessica Flynn
    10 Flynn