Intra-Arterial Therapies for Metastatic Colorectal Cancer

 

 Permissions and Reprints

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.

• 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
  CrossrefPubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefGoogle Scholar
• 5 Sasson AR, Sigurdson ER. Surgical treatment of liver metastases. Semin Oncol 2002; 29 (2) 107-118
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefGoogle Scholar
• 7 Köhne CH, Lenz HJ. Chemotherapy with targeted agents for the treatment of metastatic colorectal cancer. Oncologist 2009; 14 (5) 478-488
  CrossrefPubMedGoogle Scholar
• 8 Breedis C, Young G. The blood supply of neoplasms in the liver. Am J Pathol 1954; 30 (5) 969-977
  PubMedGoogle Scholar
• 9 de Baere T, Deschamps F. Arterial therapies of colorectal cancer metastases to the liver. Abdom Imaging 2011; 36 (6) 661-670
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  Google Scholar
• 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)
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 35 Biocompatibles. DEBIRI algorithm—colorectal metastases. Available at: http://www.biocompatibles.com/products/dcbead/technique-guidelines . Accessed August 15, 2012
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 40 Lang EK, Brown Jr CL. Colorectal metastases to the liver: selective chemoembolization. Radiology 1993; 189 (2) 417-422
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 44 Antoine RA. Technical considerations in percutaneous hepatic perfusion—a multi-center experience. J Extra Corpor Technol 2011; 43 (1) 30-33
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 48 Stanford Interventional Radiology. Interventional Oncology–Radioembolization. Available at: http://www.youtube.com/watch?v=3WwSfGPQq9g . Accessed August 15, 2012
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  PubMedGoogle Scholar