⁹⁰Y radioembolization of colorectal hepatic metastases using glass microspheres: Safety and survival outcomes from a 531-patient multicenter study

Hepatic metastases of colorectal carcinoma are a leading cause of cancer-related mortality. Most colorectal liver metastases become refractory to chemotherapy and biologic agents, at which point the median overall survival declines to 4 5 mo. Radioembolization with ⁹⁰Y has been used in the salvage setting with favorable outcomes. This study reports the survival and safety outcomes of 531 patients treated with glass-based ⁹⁰Y microspheres at 8 institutions, making it the largest ⁹⁰Y study for patients with colorectal liver metastases. Methods: Data were retrospectively compiled from 8 institutions for all ⁹⁰Y glass microsphere treatments for colorectal liver metastases. Exposure to chemotherapeutic or biologic agents, prior liver therapies, biochemical parameters before and after treatment, radiation dosimetry, and complications were recorded. Uni- and multivariate analyses for predictors of survival were performed. Survival outcomes and clinical or biochemical adverse events were recorded. Results: In total, 531 patients received ⁹⁰Y radioembolization for colorectal liver metastases. The most common clinical adverse events were fatigue (55%), abdominal pain (34%), and nausea (19%). Grade 3 or 4 hyperbilirubinemia occurred in 13%of patients at any time. The median overall survival from the first ⁹⁰Y treatment was 10.6 mo (95% confidence interval, 8.8 12.4). Performance status, no more than 25% tumor burden, no extrahepatic metastases, albumin greater than 3 g/dL, and receipt of no more than 2 chemotherapeutic agents independently predicted better survival outcomes. Conclusion: This multiinstitutional review of a large cohort of patients with colorectal liver metastases treated with ⁹⁰Y radioembolization using glass microspheres has demonstrated promising survival outcomes with low toxicity and low side effects. The outcomes were reproducible and consistent with prior reports of radioembolization. 2016 by the Society of Nuclear Medicine and Molecular Imaging, Inc.