Survival and Toxicities after 90Y Transarterial Radioembolization of Metastatic Colorectal Cancer in the RESIN Registry

Erica C. Emmons; Steven Bishay; Liping Du; Henry Krebs; Ripal T. Gandhi; Zachary S. Collins; Ryan O’Hara; Nabeel M. Akhter; Eric A. Wang; Christopher Grilli; Jayson S. Brower; Shannon R. Peck; Michael Petroziello; Ahmed K. Abdel Aal; Jafar Golzarian; Andrew S. Kennedy; Lea Matsuoka; Daniel Y. Sze; Daniel B. Brown

doi:10.1148/radiol.220387

Survival and Toxicities after ⁹⁰Y Transarterial Radioembolization of Metastatic Colorectal Cancer in the RESIN Registry

Erica C. Emmons, Steven Bishay, Liping Du, Henry Krebs, Ripal T. Gandhi, Zachary S. Collins, Ryan O’Hara, Nabeel M. Akhter, Eric A. Wang, Christopher Grilli, Jayson S. Brower, Shannon R. Peck, Michael Petroziello, Ahmed K. Abdel Aal, Jafar Golzarian, Andrew S. Kennedy, Lea Matsuoka, Daniel Y. Sze, Daniel B. Brown

Radiology

Research output: Contribution to journal › Article › peer-review

17 Scopus citations

Abstract

Background Patients with unresectable, chemorefractory hepatic metastases from colorectal cancer have considerable mortality. The role of transarterial radioembolization (TARE) with yttrium 90 ( 90Y) microspheres is not defined because most reports are from a single center with limited patient numbers. Purpose To report outcomes in participants with colorectal cancer metastases treated with resin 90Y microspheres from a prospective multicenter observational registry. Materials and Methods This study treated enrolled adult participants with TARE using resin microspheres for liver-dominant metastatic colorectal cancer at 42 centers, with enrollment from July 2015 through August 2020. TARE was used as the first-, second-, or third-line therapy or beyond. Overall survival (OS), progression-free survival (PFS), and toxicity outcomes were assessed by line of therapy by using Kaplan-Meier analysis for OS and PFS and Common Terminology Criteria for Adverse Events, version 5, for toxicities. Results A total of 498 participants (median age, 60 years [IQR, 52-69 years]; 298 men [60%]) were treated. TARE was used in first-line therapy in 74 of 442 participants (17%), second-line therapy in 180 participants (41%), and third-line therapy or beyond in 188 participants (43%). The median OS of the entire cohort was 15.0 months (95% CI: 13.3, 16.9). The median OS by line of therapy was 13.9 months for first-line therapy, 17.4 months for second-line therapy, and 12.5 months for third-line therapy (χ 2 = 9.7; P = .002). Whole-group PFS was 7.4 months (95% CI: 6.4, 9.5). The median PFS by line of therapy was 7.9 months for first-line therapy, 10.0 months for second-line therapy, and 5.9 months for third-line therapy (χ 2 = 8.3; P = .004). TARE-attributable grade 3 or 4 hepatic toxicities were 8.4% for bilirubin (29 of 347 participants) and 3.7% for albumin (13 of 347). Grade 3 and higher toxicities were greater with third-line therapy for bilirubin ( P = .01) and albumin ( P = .008). Conclusion Median overall survival (OS) after transarterial radioembolization (TARE) with yttrium 90 microspheres for liver-dominant metastatic colorectal cancer was 15.0 months. The longest OS was achieved when TARE was part of second-line therapy. Grade 3 or greater hepatic function toxicity rates were less than 10%. Clinical trial registration no. NCT02685631 Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Liddell in this issue.

Original language	English (US)
Pages (from-to)	228-236
Number of pages	9
Journal	Radiology
Volume	305
Issue number	1
DOIs	https://doi.org/10.1148/radiol.220387
State	Published - Oct 2022

Bibliographical note

Funding Information:
From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.). Received February 17, 2022; revision requested April 11; revision received April 23; accepted May 10. Address correspondence to D.B.B. (email: [email protected]). Supported by Sirtex Medical, Woburn, Mass. Conflicts of interest are listed at the end of this article. See also the editorial by Liddell in this issue.

Publisher Copyright:
© 2022 Radiological Society of North America Inc.. All rights reserved.

Keywords

Adult
Albumins
Bilirubin
Colonic Neoplasms/drug therapy
Embolization, Therapeutic/methods
Humans
Liver Neoplasms/secondary
Male
Microspheres
Middle Aged
Prospective Studies
Rectal Neoplasms/therapy
Registries
Retrospective Studies
Treatment Outcome
Yttrium Radioisotopes/therapeutic use

PubMed: MeSH publication types

Research Support, Non-U.S. Gov't
Multicenter Study
Journal Article

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Publisher link

10.1148/radiol.220387

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Cite this

Emmons, E. C., Bishay, S., Du, L., Krebs, H., Gandhi, R. T., Collins, Z. S., O’Hara, R., Akhter, N. M., Wang, E. A., Grilli, C., Brower, J. S., Peck, S. R., Petroziello, M., Abdel Aal, A. K., Golzarian, J., Kennedy, A. S., Matsuoka, L., Sze, D. Y., & Brown, D. B. (2022). Survival and Toxicities after ⁹⁰Y Transarterial Radioembolization of Metastatic Colorectal Cancer in the RESIN Registry. Radiology, 305(1), 228-236. https://doi.org/10.1148/radiol.220387

Emmons, EC, Bishay, S, Du, L, Krebs, H, Gandhi, RT, Collins, ZS, O’Hara, R, Akhter, NM, Wang, EA, Grilli, C, Brower, JS, Peck, SR, Petroziello, M, Abdel Aal, AK, Golzarian, J, Kennedy, AS, Matsuoka, L, Sze, DY & Brown, DB 2022, 'Survival and Toxicities after ⁹⁰Y Transarterial Radioembolization of Metastatic Colorectal Cancer in the RESIN Registry', Radiology, vol. 305, no. 1, pp. 228-236. https://doi.org/10.1148/radiol.220387

@article{0638da1574884ad8a543e1999eadbe41,

title = "Survival and Toxicities after 90Y Transarterial Radioembolization of Metastatic Colorectal Cancer in the RESIN Registry",

abstract = "Background Patients with unresectable, chemorefractory hepatic metastases from colorectal cancer have considerable mortality. The role of transarterial radioembolization (TARE) with yttrium 90 ( 90Y) microspheres is not defined because most reports are from a single center with limited patient numbers. Purpose To report outcomes in participants with colorectal cancer metastases treated with resin 90Y microspheres from a prospective multicenter observational registry. Materials and Methods This study treated enrolled adult participants with TARE using resin microspheres for liver-dominant metastatic colorectal cancer at 42 centers, with enrollment from July 2015 through August 2020. TARE was used as the first-, second-, or third-line therapy or beyond. Overall survival (OS), progression-free survival (PFS), and toxicity outcomes were assessed by line of therapy by using Kaplan-Meier analysis for OS and PFS and Common Terminology Criteria for Adverse Events, version 5, for toxicities. Results A total of 498 participants (median age, 60 years [IQR, 52-69 years]; 298 men [60%]) were treated. TARE was used in first-line therapy in 74 of 442 participants (17%), second-line therapy in 180 participants (41%), and third-line therapy or beyond in 188 participants (43%). The median OS of the entire cohort was 15.0 months (95% CI: 13.3, 16.9). The median OS by line of therapy was 13.9 months for first-line therapy, 17.4 months for second-line therapy, and 12.5 months for third-line therapy (χ 2 = 9.7; P = .002). Whole-group PFS was 7.4 months (95% CI: 6.4, 9.5). The median PFS by line of therapy was 7.9 months for first-line therapy, 10.0 months for second-line therapy, and 5.9 months for third-line therapy (χ 2 = 8.3; P = .004). TARE-attributable grade 3 or 4 hepatic toxicities were 8.4% for bilirubin (29 of 347 participants) and 3.7% for albumin (13 of 347). Grade 3 and higher toxicities were greater with third-line therapy for bilirubin ( P = .01) and albumin ( P = .008). Conclusion Median overall survival (OS) after transarterial radioembolization (TARE) with yttrium 90 microspheres for liver-dominant metastatic colorectal cancer was 15.0 months. The longest OS was achieved when TARE was part of second-line therapy. Grade 3 or greater hepatic function toxicity rates were less than 10%. Clinical trial registration no. NCT02685631 Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Liddell in this issue. ",

keywords = "Adult, Albumins, Bilirubin, Colonic Neoplasms/drug therapy, Embolization, Therapeutic/methods, Humans, Liver Neoplasms/secondary, Male, Microspheres, Middle Aged, Prospective Studies, Rectal Neoplasms/therapy, Registries, Retrospective Studies, Treatment Outcome, Yttrium Radioisotopes/therapeutic use",

author = "Emmons, {Erica C.} and Steven Bishay and Liping Du and Henry Krebs and Gandhi, {Ripal T.} and Collins, {Zachary S.} and Ryan O{\textquoteright}Hara and Akhter, {Nabeel M.} and Wang, {Eric A.} and Christopher Grilli and Brower, {Jayson S.} and Peck, {Shannon R.} and Michael Petroziello and {Abdel Aal}, {Ahmed K.} and Jafar Golzarian and Kennedy, {Andrew S.} and Lea Matsuoka and Sze, {Daniel Y.} and Brown, {Daniel B.}",

note = "Funding Information: From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.). Received February 17, 2022; revision requested April 11; revision received April 23; accepted May 10. Address correspondence to D.B.B. (email: [email protected]). Supported by Sirtex Medical, Woburn, Mass. Conflicts of interest are listed at the end of this article. See also the editorial by Liddell in this issue. Publisher Copyright: {\textcopyright} 2022 Radiological Society of North America Inc.. All rights reserved.",

year = "2022",

month = oct,

doi = "10.1148/radiol.220387",

language = "English (US)",

volume = "305",

pages = "228--236",

journal = "Radiology",

issn = "0033-8419",

publisher = "Radiological Society of North America Inc.",

number = "1",

}

TY - JOUR

T1 - Survival and Toxicities after 90Y Transarterial Radioembolization of Metastatic Colorectal Cancer in the RESIN Registry

AU - Emmons, Erica C.

AU - Bishay, Steven

AU - Du, Liping

AU - Krebs, Henry

AU - Gandhi, Ripal T.

AU - Collins, Zachary S.

AU - O’Hara, Ryan

AU - Akhter, Nabeel M.

AU - Wang, Eric A.

AU - Grilli, Christopher

AU - Brower, Jayson S.

AU - Peck, Shannon R.

AU - Petroziello, Michael

AU - Abdel Aal, Ahmed K.

AU - Golzarian, Jafar

AU - Kennedy, Andrew S.

AU - Matsuoka, Lea

AU - Sze, Daniel Y.

AU - Brown, Daniel B.

N1 - Funding Information: From the Departments of Interventional Radiology (E.C.E., D.B.B.), Biostatistics (L.D.), and Transplant Surgery (L.M.), Vanderbilt University Medical Center, 1161 21st Ave S, CCC-1118 Medical Center North, Nashville, TN 37232; Vanderbilt University School of Medicine, Nashville, Tenn (S.B.); Department of Interventional Radiology, Cancer Treatment Centers of America, Atlanta, Ga (H.K.); Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla (R.T.G.); Department of Interventional Radiology, University of Kansas, Kansas City, Kan (Z.S.C.); Department of Interventional Radiology, University of Utah, Salt Lake City, Utah (R.O.); Department of Interventional Radiology, University of Maryland, Baltimore, Md (N.M.A.); Department of Interventional Radiology, Carolinas Medical Center, Charlotte, NC (E.A.W.); Department of Interventional Radiology, Christiana Medical Center, Newark, Del (C.G.); Department of Interventional Radiology, Providence Sacred Heart, Spokane, Wash (J.S.B.); Department of Interventional Radiology, Sanford Health, Sioux Falls, SD (S.R.P.); Department of Interventional Radiology, Roswell Park Memorial Institute, Buffalo, NY (M.P.); Department of Interventional Radiology, University of Texas, Houston, Tex (A.K.A.A.); Department of Interventional Radiology, University of Minnesota, Minneapolis, Minn (J.G.); Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tenn (A.S.K.); and Department of Interventional Radiology, Stanford University, Palo Alto, Calif (D.Y.S.). Received February 17, 2022; revision requested April 11; revision received April 23; accepted May 10. Address correspondence to D.B.B. (email: [email protected]). Supported by Sirtex Medical, Woburn, Mass. Conflicts of interest are listed at the end of this article. See also the editorial by Liddell in this issue. Publisher Copyright: © 2022 Radiological Society of North America Inc.. All rights reserved.

PY - 2022/10

Y1 - 2022/10

N2 - Background Patients with unresectable, chemorefractory hepatic metastases from colorectal cancer have considerable mortality. The role of transarterial radioembolization (TARE) with yttrium 90 ( 90Y) microspheres is not defined because most reports are from a single center with limited patient numbers. Purpose To report outcomes in participants with colorectal cancer metastases treated with resin 90Y microspheres from a prospective multicenter observational registry. Materials and Methods This study treated enrolled adult participants with TARE using resin microspheres for liver-dominant metastatic colorectal cancer at 42 centers, with enrollment from July 2015 through August 2020. TARE was used as the first-, second-, or third-line therapy or beyond. Overall survival (OS), progression-free survival (PFS), and toxicity outcomes were assessed by line of therapy by using Kaplan-Meier analysis for OS and PFS and Common Terminology Criteria for Adverse Events, version 5, for toxicities. Results A total of 498 participants (median age, 60 years [IQR, 52-69 years]; 298 men [60%]) were treated. TARE was used in first-line therapy in 74 of 442 participants (17%), second-line therapy in 180 participants (41%), and third-line therapy or beyond in 188 participants (43%). The median OS of the entire cohort was 15.0 months (95% CI: 13.3, 16.9). The median OS by line of therapy was 13.9 months for first-line therapy, 17.4 months for second-line therapy, and 12.5 months for third-line therapy (χ 2 = 9.7; P = .002). Whole-group PFS was 7.4 months (95% CI: 6.4, 9.5). The median PFS by line of therapy was 7.9 months for first-line therapy, 10.0 months for second-line therapy, and 5.9 months for third-line therapy (χ 2 = 8.3; P = .004). TARE-attributable grade 3 or 4 hepatic toxicities were 8.4% for bilirubin (29 of 347 participants) and 3.7% for albumin (13 of 347). Grade 3 and higher toxicities were greater with third-line therapy for bilirubin ( P = .01) and albumin ( P = .008). Conclusion Median overall survival (OS) after transarterial radioembolization (TARE) with yttrium 90 microspheres for liver-dominant metastatic colorectal cancer was 15.0 months. The longest OS was achieved when TARE was part of second-line therapy. Grade 3 or greater hepatic function toxicity rates were less than 10%. Clinical trial registration no. NCT02685631 Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Liddell in this issue.

AB - Background Patients with unresectable, chemorefractory hepatic metastases from colorectal cancer have considerable mortality. The role of transarterial radioembolization (TARE) with yttrium 90 ( 90Y) microspheres is not defined because most reports are from a single center with limited patient numbers. Purpose To report outcomes in participants with colorectal cancer metastases treated with resin 90Y microspheres from a prospective multicenter observational registry. Materials and Methods This study treated enrolled adult participants with TARE using resin microspheres for liver-dominant metastatic colorectal cancer at 42 centers, with enrollment from July 2015 through August 2020. TARE was used as the first-, second-, or third-line therapy or beyond. Overall survival (OS), progression-free survival (PFS), and toxicity outcomes were assessed by line of therapy by using Kaplan-Meier analysis for OS and PFS and Common Terminology Criteria for Adverse Events, version 5, for toxicities. Results A total of 498 participants (median age, 60 years [IQR, 52-69 years]; 298 men [60%]) were treated. TARE was used in first-line therapy in 74 of 442 participants (17%), second-line therapy in 180 participants (41%), and third-line therapy or beyond in 188 participants (43%). The median OS of the entire cohort was 15.0 months (95% CI: 13.3, 16.9). The median OS by line of therapy was 13.9 months for first-line therapy, 17.4 months for second-line therapy, and 12.5 months for third-line therapy (χ 2 = 9.7; P = .002). Whole-group PFS was 7.4 months (95% CI: 6.4, 9.5). The median PFS by line of therapy was 7.9 months for first-line therapy, 10.0 months for second-line therapy, and 5.9 months for third-line therapy (χ 2 = 8.3; P = .004). TARE-attributable grade 3 or 4 hepatic toxicities were 8.4% for bilirubin (29 of 347 participants) and 3.7% for albumin (13 of 347). Grade 3 and higher toxicities were greater with third-line therapy for bilirubin ( P = .01) and albumin ( P = .008). Conclusion Median overall survival (OS) after transarterial radioembolization (TARE) with yttrium 90 microspheres for liver-dominant metastatic colorectal cancer was 15.0 months. The longest OS was achieved when TARE was part of second-line therapy. Grade 3 or greater hepatic function toxicity rates were less than 10%. Clinical trial registration no. NCT02685631 Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Liddell in this issue.

KW - Adult

KW - Albumins

KW - Bilirubin

KW - Colonic Neoplasms/drug therapy

KW - Embolization, Therapeutic/methods

KW - Humans

KW - Liver Neoplasms/secondary

KW - Male

KW - Microspheres

KW - Middle Aged

KW - Prospective Studies

KW - Rectal Neoplasms/therapy

KW - Registries

KW - Retrospective Studies

KW - Treatment Outcome

KW - Yttrium Radioisotopes/therapeutic use

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