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Colorectal Liver Metastasis Survival After Yittrium-90 Radioembolization: A Complete 3-year Experience
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  • Jessica Heard,
  • Sahar Darian,
  • Houssam Osman,
  • Travis Van Meter,
  • Dhiresh Jeyarajah
Jessica Heard
Methodist Richardson Medical Center
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Sahar Darian
Texas Christian University School of Medicine
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Houssam Osman
Methodist Richardson Medical Center
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Travis Van Meter
PLLC Interventional Radiology
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Dhiresh Jeyarajah
Methodist Richardson Medical Center

Corresponding Author:[email protected]

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Abstract

Background: The role and benefit of yittrium-90 (Y-90) remain in question amongst patients with metastatic chemo-refractory colorectal liver metastases (CRLM). We aim to report a complete experience and outcomes following lobar, segmental, combination administration, and repeated Y-90 radioembolizations utilizing a minimal prescribed dose in the treatment of CRLM. Methods and Results: This is a retrospective analysis of all patients who underwent Y-90 radioembolization of CRLM at a single institution. Tumor response was evaluated using a modified RECIST criteria 2-6 months post-radioembolization. Progression-free survival (PFS) was the primary outcome of interest. Tumor response, conversion to resectable disease, and overall survival (OS) were analyzed as a secondary outcomes. 4 rectal and 7 colonic adenocarcinoma CRLM patients with significant previous systemic therapy exposure were included. The median tumor number and size was 3 and 4.0 cm, respectively. 7 segmental and 12 lobar radioembolizations were performed (range 1-6 per patient) with a mean administered activity of 22.1 mCi. Tumor regression occurred in 71.4% of cases with 4 complete radiographic responses. The median hepatic PFS was 5.5 months. The median OS from the time of primary cancer diagnosis and initial Y-90 was 3.2 and 1.2 years, respectively. 18% of initially unresectable patients were converted to surgically resectable. Conclusions: Y-90 results in reliable tumor regression and repeated radioembolizations are safe when conservative doses are utilized in a multidisciplinary setting. This study supports the ‘neoadjuvant’ use of Y-90 to allow for the conversion of borderline resectable patients to resectable. The results suggest that Y-90 maybe associated with an OS benefit in chem-refractory CRLM patients.
20 May 2023Submitted to Cancer Reports
23 May 2023Submission Checks Completed
23 May 2023Assigned to Editor
23 May 2023Review(s) Completed, Editorial Evaluation Pending
23 May 2023Reviewer(s) Assigned
26 Jun 2023Editorial Decision: Revise Major