Evidence-Based Integration of Yttrium-90 Radioembolization in the Contemporary Management of Hepatic Metastases from Colorectal Cancer

Hepatic metastases are common in patients with metastatic colorectal cancer and are frequently the most life-threatening source of morbidity and mortality. The contemporary management of patients with liver-dominant or liver-only metastatic colorectal cancer is characterized by resection of metastases when feasible and successive lines of systemic treatment regimens consisting of chemotherapy drugs and/or targeted biological agents. Yttrium-90 radioembolization has emerged as a promising liver-directed therapy for patients with unresectable colorectal cancer liver metastases (CLM). The integration of radioembolization into the current treatment algorithm for unresectable CLM is dependent on the line of therapy it is being considered and whether it is to be used alone or in combination with systemic treatment options. This article provides background information on the current management of CLM and uses this framework to discuss the existing data that define when and how radioembolization can benefit patients with CLM.