Clinical Study
Transarterial Chemoembolization with Irinotecan Beads in the Treatment of Colorectal Liver Metastases: Systematic Review

https://doi.org/10.1016/j.jvir.2013.05.055Get rights and content

Abstract

Purpose

For patients with unresectable colorectal liver metastasis (CRLM), transarterial embolization with the use of drug-eluting beads with irinotecan (DEBIRI) represents a novel alternative to systemic chemotherapy or local treatments alone. The present systematic review evaluates available data on the efficacy and safety of DEBIRI embolization.

Materials and Methods

A comprehensive search of medical literature identified studies describing the use of DEBIRI in the treatment of CRLM. Data describing adverse events, pharmacokinetics, tumor response, and overall survival were collected.

Results

Five observational studies and one randomized controlled trial (RCT) were reviewed. A total of 235 patients were included in the descriptive analysis of observational studies. Postembolization syndrome was the most common adverse event. Peak plasma levels of irinotecan were observed at 1–2 hours after administration. Wide variations in tumor response were observed. The median survival time ranged from 15.2 months to 25 months. In the RCT, treatment with DEBIRI was superior to systemic chemotherapy with 5-fluorouracil/leucovorin/irinotecan in terms of quality of life and progression-free survival.

Conclusions

For patients with unresectable CRLM, particularly after failure to respond to first-line regimens, DEBIRI represents a novel alternative to systemic chemotherapy alone, transarterial embolization with other agents, or other local treatments (eg, microwave or radiofrequency ablation). In these reports, DEBIRI was safe and effective in the in the treatment of unresectable CRLM. Further RCTs comparing DEBIRI with alternative management strategies are required to define the optimal role for this treatment.

Section snippets

Literature Search Strategy

A systematic review was conducted by two authors (A.J.R. and V.L.). The following electronic databases were searched: Medline (1950–2012), Embase (1974–2012), the Cochrane controlled trials register, and the science citation index. Combinations of Medical Subject Headings as well as key words including the following were searched: “liver metastases,” “colorectal cancer,” “chemoembolization,” “drug-eluting beads,” “DEBIRI,” and “irinotecan.” The literature search was not restricted by language

Results

The search strategy is depicted in the Figure. The publication by Morise et al (11) had only four patients with incomplete follow-up data and was therefore excluded from analysis. After exclusion of dual publications (10, 12, 13, 14, 15, 16, 17), there were six studies included in the review (Table 1) (14, 15, 17, 18, 19, 20). The inclusion and exclusion criteria for treatment, along with the use of previous systemic chemotherapy, are noted in Table 1. With the exception of one study (18), all

Discussion

Surgical resection of CRLM remains the most efficacious treatment, with 5-year survival rates ranging from 29% to 70% (22, 23). However, surgical resection is possible in only approximately 25% of patients. Even in patients who have undergone resection, the recurrence rate can be as high as 75% (24). Therefore, there remains a need for palliative treatments and therapies that can downstage disease to the extent of resectability.

The results of the present systematic review suggest that DEBIRI

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