Which Factors Affect Outcomes of Y90 Radioembolization in Heavily Pre-Treated Patients?

A nomogram including 6 pre-Y90 radioembolization (RAE) parameters predicted overall survival (OS) post-RAE, according to a study published in Clinical Colorectal Cancer.

A total of 103 patients with colorectal cancer liver metastases treated with RAE from September 15, 2009 to March 21, 2017 were included in this study. Metabolic, anatomic, laboratory, pathologic, genetic, primary disease, procedure-related factors, and pre- and post-RAE therapies were analyzed. Response Evaluation Criteria In Solid Tumors 1.1 and European Organization for Research and Treatment of Cancer criteria were used to define liver progression-free survival (LPFS). Overall survival and LPFS were predicted using univariate Cox regression, adjusted for clustering and competing risk analysis, and tested in multivariate analysis.

R statistical software was used to build the nomogram, which was internally validated using bootstrap resampling.

After being diagnosed with colorectal cancer liver metastases, patients received RAE for a median of 30.9 months (range, 3.4-161.7 months). The median OS was 11.3 months (95% confidence interval, 7.9-15.1 months) and median LPFS was 4 months (95% confidence interval, 3.3-4.8 months).

Forty parameters were tested, with 6 independently associated with OS in multivariate analysis, including number of extrahepatic disease sites (P < 0.001), carcinoembryonic antigen (P < 0.001), albumin (P = 0.005), alanine aminotransferase level (P < 9.001), tumor differentiation level (P < 0.001), and the sum of the 2 largest tumor diameters (P < 0.001).

The 1-year OS of patients with total points <25 was 90% versus 10% for patients with total points >80.

Bootstrap resampling showed good discrimination (optimism corrected c-index = 0.745) and calibration (mean absolute prediction error = 0.299) of the nomogram. Only baseline maximum standardized uptake value was significant in multivariate analysis for LPFS prediction (P < .001; SHR = 1.06).

The 6 pre-RAE parameters provided good prediction of OS post-RAE in patients with colorectal cancer liver metastases. Baseline maximum standardized uptake value was the single significant predictor of LPFS.

“This work provided an extensive, comprehensive analysis of imaging, laboratory, pathologic, genetic, primary-disease-related biomarkers, procedure-related factors as well as prior and post-RAE therapies, associated with overall and liver progression-free survival following RAE of [colorectal cancer liver metastases],” the authors concluded.

--Kelsey Moroz

Reference:

Kurilova I, Beets-Tan RGH, Flynn J, et al. Factors Affecting Oncologic Outcomes of 90Y Radioembolization of Heavily Pre-Treated Patients With Colon Cancer Liver Metastases. Clin Colorectal Cancer. 2018; pii: S1533-0028(18)30250-0. doi: 10.1016/j.clcc.2018.08.004. [Epub ahead of print].

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Kurilova I, Beets-Tan RGH, Flynn J, et al. Factors Affecting Oncologic Outcomes of 90Y Radioembolization of Heavily Pre-Treated Patients With Colon Cancer Liver Metastases. Clin Colorectal Cancer. 2018; pii: S1533-0028(18)30250-0. doi: 10.1016/j.clcc.2018.08.004. [Epub ahead of print].