Selective internal radiation therapy with 90Y microspheres for colorectal liver metastases:: Single-centre experience with 100 patients

Background: Many patients with colorectal liver metastases die from liver-only disease. Selective internal radiation therapy (SIRT) is an evolving method suitable for treating patients with non-resectable metastatic liver disease. Methods: One hundred patients with advanced colorectal liver metastases were treated with SIRT. A single dose of between 2.0 and 3.0 GBq of Y-90 microspheres was given into the hepatic artery either by a surgically implanted portacath or a percutaneous femoral catheter. When a port was used (n = 87), SIRT was followed by hepatic arterial chemotherapy with 5-fluorouracil. Results: Treatment-related morbidity occurred in 11 patients. Responses to SIRT were assessed by serial computed tomography scans and carcinoembryonic antigen (CEA) measurement. Median CEA level 3 months after SIRT (expressed as percentage of initial CEA) was 18%. Only 5 of 80 patients (6.25%) scanned at 3 months showed disease progression. Survival was significantly more in those who experienced a good tumour marker response and in those who were slow to develop extrahepatic disease. Survival was independently influenced by the use of ongoing hepatic arterial chemotherapy, the extent of liver involvement and the lymph node status of the original primary tumour. Conclusion: Selective internal radiation therapy is a very effective and well-tolerated regional treatment for colorectal liver metastases, which should be considered for those with liver-only metastatic disease.