SIR 2024
Interventional Oncology
Andrew C. Gordon, MD, PhD (he/him/his)
Integrated Interventional Radiology Resident
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
Muhamad Serhal, MD
Postdoctoral Research Fellow
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
Aparna Kalyan, MD
Disclosure information not submitted.
Kent Sato, MD
Professor of Radiology
Northwestern Memorial Hospital
Disclosure information not submitted.
Ahsun Riaz, MD
Associate Professor, Interventional Radiology
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
Elias Hohlastos, MD
Professor
Northwestern University Feinberg School of Medicine
Disclosure information not submitted.
Riad Salem, MD, FSIR, MBA
Professor
Northwestern Memorial Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
Robert Lewandowski, MD, FSIR
Professor
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
With IRB approval, retrospective chart review included all patients with liver-dominant mCRC treated with RS (up to 2 Couinaud segments) from September 2009 to November 2019. Patient demographics, treatment details, CTCAE v5 adverse events, imaging response by RECIST, and overall survival (OS) were analyzed. Kaplan-Meier curves were generated from the date of RS and censored at last follow-up. Prognosticators for OS were examined by log-rank test and Cox proportional hazards regression.
Results:
45 patients met inclusion criteria (median age 61 years; 59% male); 37 (95%) had prior resection of primary site of disease. 49% had extrahepatic disease, 41% had prior liver resection, 24% had prior ablation, 77% had prior chemotherapy, and 59% were ECOG 0. The mean tumor size was 5.6 cm (range 1.2 to 13.5 cm). 70% of patients had liver tumor burden < 25%. Treatment was technically successful in all cases. 30-day mortality was 5%. Clinical adverse events were low-grade and included fatigue (G1 62%, G3 3%), abdominal pain (G1/2 24%), vomiting (G1/2 5%), and fever (G1 5%). The mean increase in neutrophil-to-lymphocyte ratio (NLR) was 3.2 (SD 5.2). Antitumor response included post-treatment decrease in CEA in 81%. The median number of imaging follow-ups was 3 (range 0 to 7). RECIST imaging response was PD 4%, SD 81%, PR 15%, CR 0%. The median OS after RS was 41.9 months (95% CI 15.4-44.4). Extrahepatic disease was a significant predictor of reduced OS (15.7 vs 43.1 months median OS, p=0.0043; HR 6.6, 95% 1.5 to 28.4, p0.011). Increased NLR was associated with worse OS HR 1.2 (95% 1.08-1.42, p=0.003).
Conclusion:
RS had an acceptable safety profile in heavily pretreated mCRC patients after systemic chemotherapy, locoregional therapy, and surgery. Extrahepatic disease and change in NLR were significant adverse prognosticators. Future investigation into the role of ablative Y90 in mCRC should be considered in select patients given promising OS outcomes.