Y90 Radioembolization in chemo-refractory metastastic, liver dominant colorectal cancer patients: outcome assessment applying a predictive scoring system

In treatment-refractory liver dominant metastatic colorectal cancer, the role of liver directed therapies still is unclear. We sought to determine a prognostic score for Y90 radioembolization in these patients. We analyzed 106 patients with refractory liver dominant mCRC who had undergone a total of...

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Veröffentlicht in:BMC cancer 2016-07, Vol.16 (1), p.509, Article 509
Hauptverfasser: Damm, Robert, Seidensticker, Ricarda, Ulrich, Gerhard, Breier, Leonie, Steffen, Ingo G, Seidensticker, Max, Garlipp, Benjamin, Mohnike, Konrad, Pech, Maciej, Amthauer, Holger, Ricke, Jens
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container_title BMC cancer
container_volume 16
creator Damm, Robert
Seidensticker, Ricarda
Ulrich, Gerhard
Breier, Leonie
Steffen, Ingo G
Seidensticker, Max
Garlipp, Benjamin
Mohnike, Konrad
Pech, Maciej
Amthauer, Holger
Ricke, Jens
description In treatment-refractory liver dominant metastatic colorectal cancer, the role of liver directed therapies still is unclear. We sought to determine a prognostic score for Y90 radioembolization in these patients. We analyzed 106 patients with refractory liver dominant mCRC who had undergone a total of 178 Y90 radioembolizations with resin microspheres was collected. Potential factors influencing survival were analyzed using a Cox regression. The Log rank test served to establish prognostic factors and to form a clinical score for outcome prediction after Y90 radioembolization. Median survival of all patients was 6.7 months. Neither age nor prior surgical or systemic therapy nor metastatic spread had an effect on survival. In contrast, hepatic tumor load, Karnofsky index as well as CEA and CA19-9 serums level had a significant influence (p 130 ng/ml or CA19-9 > 200U/ml and Karnofsky index
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We sought to determine a prognostic score for Y90 radioembolization in these patients. We analyzed 106 patients with refractory liver dominant mCRC who had undergone a total of 178 Y90 radioembolizations with resin microspheres was collected. Potential factors influencing survival were analyzed using a Cox regression. The Log rank test served to establish prognostic factors and to form a clinical score for outcome prediction after Y90 radioembolization. Median survival of all patients was 6.7 months. Neither age nor prior surgical or systemic therapy nor metastatic spread had an effect on survival. In contrast, hepatic tumor load, Karnofsky index as well as CEA and CA19-9 serums level had a significant influence (p &lt; 0.001, p = 0.037, p = 0.023 and p &lt; 0.001, respectively). These three factors formed a score with 1 point each for tumor load &gt;20 %, CEA &gt;130 ng/ml or CA19-9 &gt; 200U/ml and Karnofsky index &lt;80 %. Patients with a score of 0 and 1 displayed a median OS of 10.4 months. Patients with a score of 2 and 3 demonstrated a median OS of 5.1 months only (p &lt; 0.001). Overaggressive patient selection for Y90 radioembolization of liver dominant chemorefractory mCRC is of questionable benefit. A scoring system comprising hepatic tumor load, CEA and CA19-9 serum levels and Karnofsky index (TuCK-score) may support an improved patient selection. In our cohort of liver only versus liver dominant disease, extrahepatic lung or lymphatic metastases did not significantly alter the prognosis.</description><identifier>ISSN: 1471-2407</identifier><identifier>EISSN: 1471-2407</identifier><identifier>DOI: 10.1186/s12885-016-2549-x</identifier><identifier>PMID: 27439702</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adult ; Aged ; Antigens ; Biomarkers ; CA-19-9 Antigen - blood ; Cancer ; Cancer therapies ; Carcinoembryonic Antigen - blood ; Care and treatment ; Chemotherapy ; Colorectal cancer ; Colorectal Neoplasms - pathology ; Colorectal Neoplasms - therapy ; Complications and side effects ; Drug Resistance, Neoplasm ; Embolization, Therapeutic - methods ; Female ; Health aspects ; Humans ; Kaplan-Meier Estimate ; Karnofsky Performance Status ; Liver ; Liver - pathology ; Liver Neoplasms - secondary ; Liver Neoplasms - therapy ; Magnetic resonance imaging ; Male ; Metastasis ; Middle Aged ; Multivariate Analysis ; Neoplasm Metastasis ; Outcome Assessment (Health Care) - methods ; Outcome Assessment (Health Care) - statistics &amp; numerical data ; Patient outcomes ; Patients ; Prognosis ; Proportional Hazards Models ; Regression analysis ; Risk factors ; Yttrium Radioisotopes - therapeutic use</subject><ispartof>BMC cancer, 2016-07, Vol.16 (1), p.509, Article 509</ispartof><rights>COPYRIGHT 2016 BioMed Central Ltd.</rights><rights>Copyright BioMed Central 2016</rights><rights>The Author(s). 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c559t-230f2d838bd33b5c8d24d6cf94e6bf0ba784fed6086bbfc2df93c61a51fba4d23</citedby><cites>FETCH-LOGICAL-c559t-230f2d838bd33b5c8d24d6cf94e6bf0ba784fed6086bbfc2df93c61a51fba4d23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4955133/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4955133/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27915,27916,53782,53784</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27439702$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Damm, Robert</creatorcontrib><creatorcontrib>Seidensticker, Ricarda</creatorcontrib><creatorcontrib>Ulrich, Gerhard</creatorcontrib><creatorcontrib>Breier, Leonie</creatorcontrib><creatorcontrib>Steffen, Ingo G</creatorcontrib><creatorcontrib>Seidensticker, Max</creatorcontrib><creatorcontrib>Garlipp, Benjamin</creatorcontrib><creatorcontrib>Mohnike, Konrad</creatorcontrib><creatorcontrib>Pech, Maciej</creatorcontrib><creatorcontrib>Amthauer, Holger</creatorcontrib><creatorcontrib>Ricke, Jens</creatorcontrib><title>Y90 Radioembolization in chemo-refractory metastastic, liver dominant colorectal cancer patients: outcome assessment applying a predictive scoring system</title><title>BMC cancer</title><addtitle>BMC Cancer</addtitle><description>In treatment-refractory liver dominant metastatic colorectal cancer, the role of liver directed therapies still is unclear. We sought to determine a prognostic score for Y90 radioembolization in these patients. We analyzed 106 patients with refractory liver dominant mCRC who had undergone a total of 178 Y90 radioembolizations with resin microspheres was collected. Potential factors influencing survival were analyzed using a Cox regression. The Log rank test served to establish prognostic factors and to form a clinical score for outcome prediction after Y90 radioembolization. Median survival of all patients was 6.7 months. Neither age nor prior surgical or systemic therapy nor metastatic spread had an effect on survival. In contrast, hepatic tumor load, Karnofsky index as well as CEA and CA19-9 serums level had a significant influence (p &lt; 0.001, p = 0.037, p = 0.023 and p &lt; 0.001, respectively). These three factors formed a score with 1 point each for tumor load &gt;20 %, CEA &gt;130 ng/ml or CA19-9 &gt; 200U/ml and Karnofsky index &lt;80 %. Patients with a score of 0 and 1 displayed a median OS of 10.4 months. Patients with a score of 2 and 3 demonstrated a median OS of 5.1 months only (p &lt; 0.001). Overaggressive patient selection for Y90 radioembolization of liver dominant chemorefractory mCRC is of questionable benefit. A scoring system comprising hepatic tumor load, CEA and CA19-9 serum levels and Karnofsky index (TuCK-score) may support an improved patient selection. In our cohort of liver only versus liver dominant disease, extrahepatic lung or lymphatic metastases did not significantly alter the prognosis.</description><subject>Adult</subject><subject>Aged</subject><subject>Antigens</subject><subject>Biomarkers</subject><subject>CA-19-9 Antigen - blood</subject><subject>Cancer</subject><subject>Cancer therapies</subject><subject>Carcinoembryonic Antigen - blood</subject><subject>Care and treatment</subject><subject>Chemotherapy</subject><subject>Colorectal cancer</subject><subject>Colorectal Neoplasms - pathology</subject><subject>Colorectal Neoplasms - therapy</subject><subject>Complications and side effects</subject><subject>Drug Resistance, Neoplasm</subject><subject>Embolization, Therapeutic - methods</subject><subject>Female</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Karnofsky Performance Status</subject><subject>Liver</subject><subject>Liver - pathology</subject><subject>Liver Neoplasms - secondary</subject><subject>Liver Neoplasms - therapy</subject><subject>Magnetic resonance imaging</subject><subject>Male</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neoplasm Metastasis</subject><subject>Outcome Assessment (Health Care) - methods</subject><subject>Outcome Assessment (Health Care) - statistics &amp; 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Seidensticker, Ricarda ; Ulrich, Gerhard ; Breier, Leonie ; Steffen, Ingo G ; Seidensticker, Max ; Garlipp, Benjamin ; Mohnike, Konrad ; Pech, Maciej ; Amthauer, Holger ; Ricke, Jens</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c559t-230f2d838bd33b5c8d24d6cf94e6bf0ba784fed6086bbfc2df93c61a51fba4d23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antigens</topic><topic>Biomarkers</topic><topic>CA-19-9 Antigen - blood</topic><topic>Cancer</topic><topic>Cancer therapies</topic><topic>Carcinoembryonic Antigen - blood</topic><topic>Care and treatment</topic><topic>Chemotherapy</topic><topic>Colorectal cancer</topic><topic>Colorectal Neoplasms - pathology</topic><topic>Colorectal Neoplasms - therapy</topic><topic>Complications and side effects</topic><topic>Drug Resistance, Neoplasm</topic><topic>Embolization, Therapeutic - methods</topic><topic>Female</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Karnofsky Performance Status</topic><topic>Liver</topic><topic>Liver - pathology</topic><topic>Liver Neoplasms - secondary</topic><topic>Liver Neoplasms - therapy</topic><topic>Magnetic resonance imaging</topic><topic>Male</topic><topic>Metastasis</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neoplasm Metastasis</topic><topic>Outcome Assessment (Health Care) - methods</topic><topic>Outcome Assessment (Health Care) - statistics &amp; 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We sought to determine a prognostic score for Y90 radioembolization in these patients. We analyzed 106 patients with refractory liver dominant mCRC who had undergone a total of 178 Y90 radioembolizations with resin microspheres was collected. Potential factors influencing survival were analyzed using a Cox regression. The Log rank test served to establish prognostic factors and to form a clinical score for outcome prediction after Y90 radioembolization. Median survival of all patients was 6.7 months. Neither age nor prior surgical or systemic therapy nor metastatic spread had an effect on survival. In contrast, hepatic tumor load, Karnofsky index as well as CEA and CA19-9 serums level had a significant influence (p &lt; 0.001, p = 0.037, p = 0.023 and p &lt; 0.001, respectively). These three factors formed a score with 1 point each for tumor load &gt;20 %, CEA &gt;130 ng/ml or CA19-9 &gt; 200U/ml and Karnofsky index &lt;80 %. Patients with a score of 0 and 1 displayed a median OS of 10.4 months. Patients with a score of 2 and 3 demonstrated a median OS of 5.1 months only (p &lt; 0.001). Overaggressive patient selection for Y90 radioembolization of liver dominant chemorefractory mCRC is of questionable benefit. A scoring system comprising hepatic tumor load, CEA and CA19-9 serum levels and Karnofsky index (TuCK-score) may support an improved patient selection. In our cohort of liver only versus liver dominant disease, extrahepatic lung or lymphatic metastases did not significantly alter the prognosis.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>27439702</pmid><doi>10.1186/s12885-016-2549-x</doi><oa>free_for_read</oa></addata></record>
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subjects Adult
Aged
Antigens
Biomarkers
CA-19-9 Antigen - blood
Cancer
Cancer therapies
Carcinoembryonic Antigen - blood
Care and treatment
Chemotherapy
Colorectal cancer
Colorectal Neoplasms - pathology
Colorectal Neoplasms - therapy
Complications and side effects
Drug Resistance, Neoplasm
Embolization, Therapeutic - methods
Female
Health aspects
Humans
Kaplan-Meier Estimate
Karnofsky Performance Status
Liver
Liver - pathology
Liver Neoplasms - secondary
Liver Neoplasms - therapy
Magnetic resonance imaging
Male
Metastasis
Middle Aged
Multivariate Analysis
Neoplasm Metastasis
Outcome Assessment (Health Care) - methods
Outcome Assessment (Health Care) - statistics & numerical data
Patient outcomes
Patients
Prognosis
Proportional Hazards Models
Regression analysis
Risk factors
Yttrium Radioisotopes - therapeutic use
title Y90 Radioembolization in chemo-refractory metastastic, liver dominant colorectal cancer patients: outcome assessment applying a predictive scoring system
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