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Impact of Genomic Mutation and Timing of Y90 Radioembolization in Colorectal Liver Metastases

  • Clinical Investigation
  • Interventional Oncology
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To investigate timing of Yttrium-90 radioembolization (Y90) during treatment course, genomics, and other clinical factors as predictors of overall survival (OS) in colorectal liver metastasis (CRLM) that have progressed on at least one line of chemotherapy.

Materials and Methods

This was a retrospective study from 2013 to 2018 of patients with CRLM and genomic analysis prior to Y90 at a multihospital tertiary referral center. OS from liver metastasis diagnosis and predictors of OS were analyzed using Kaplan–Meier estimation with log-rank and Cox regression analyses.

Results

Overall, 58 patients with CRLM who progressed on at least one line of chemotherapy who had genomic analysis prior to Y90 were identified. Median OS after hepatic metastasis was 29.9 months. Of these, 16 (28%) patients received Y90 after failure of the first-line systemic chemotherapy. There was significantly prolonged OS in patients receiving Y90 immediately following failure of the first-line chemotherapy folinic acid, fluorouracil, oxaliplatin ((FOLFOX) ± bevacizumab) versus following multiple lines of chemotherapy (median OS of 46.3 vs. 26.6 months, P = 0.005). The presence of genetic mutation in tumor, MAPK pathway wild type, left-sided primary tumor, low MELD score, and non-diffuse unilobar disease were also found to be predictors prolonged survival on log-rank analysis (P’s < 0.05). On multivariate analysis, receiving Y90 after failure of the first line of chemotherapy, low baseline MELD score, and baseline ECOG performance score of 0 were all found to be independent predictors of prolonged OS from the time of metastatic disease diagnosis (P’s < 0.05).

Conclusion

In patients with CRLM, receiving Y90 after failing the first line of chemotherapy, lack of genetic mutation, low MELD score, and lower tumor burden appear to be independent predictors of prolonged OS.

Level of Evidence

Level 4, case–control study.

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Department of Radiology and Imaging Sciences, Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, 1364 Clifton Rd. NE, Suite #D112, Atlanta, GA, USA

    Alexander Dabrowiecki, Tina Sankhla, Kaitlin Shinn, Zachary L. Bercu, Mitchell Ermentrout, Janice Newsome & Nima Kokabi

  2. Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA

    Walid Shaib

  3. Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, 1364 Clifton Rd. NE, Atlanta, GA, 30322, USA

    Kenneth Cardona

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  1. Alexander Dabrowiecki
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  2. Tina Sankhla
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  4. Zachary L. Bercu
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Correspondence to Alexander Dabrowiecki.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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This study has obtained IRB approval from the relevant board, and the need for informed consent was waived.

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Dabrowiecki, A., Sankhla, T., Shinn, K. et al. Impact of Genomic Mutation and Timing of Y90 Radioembolization in Colorectal Liver Metastases. Cardiovasc Intervent Radiol 43, 1006–1014 (2020). https://doi.org/10.1007/s00270-020-02463-z

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