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Addition of Selective Internal Radiotherapy to Chemotherapy May Improve Resectability of Colorectal Cancer Liver Metastases


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In a report published by Garlipp et al in the British Journal of Surgery, the addition of selective internal radiotherapy (SIRT) to modified FOLFOX6-based chemotherapy (mFOLFOX6; oxaliplatin/leucovorin/fluorouracil) improved the resectability of initially unresectable colorectal cancer liver metastases—a problem for 80% to 90% of patients with colorectal cancer liver metastases.

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SIRFLOX Methods

The REsect trial, a retrospective analysis of the SIRFLOX trial patient cohort, consisted of baseline and follow-up hepatic imaging of patients who received mFOLFOX6 with or without bevacizumab vs those who received mFOLFOX6 with or without bevacizumab plus SIRT using yttrium‐90 resin microspheres. Reviewers consisted of 14 hepatopancreatobiliary surgeons, and reviewers were blinded to the other reviewers, treatment assignment, extrahepatic disease status, and information on clinical and scanning timepoints. Technical resectability was defined as at least 60% of reviewers (three of five total or two of three total) assessing a patient’s liver metastases as resectable.

Findings

Among 472 evaluable patients (SIRT arm, n = 244; control arm, n = 228), there was no significant baseline difference in the proportion of technically resectable liver metastases between patients treated with SIRT (n = 29, 11.9%) and those in the control arm (n = 25, 11%; P = .775). At follow-up, more patients in both arms were determined to be technically resectable than at baseline: 159 of 472 (33.7%) and 54 of 472 (11.4%; P = .001). More patients treated with SIRT were ultimately deemed resectable (93 of 244, 38.1%) vs those in the control arm (66 of 228, 28.9%; P < .001).

KEY POINTS

  • At follow-up, more patients in both arms were determined as technically resectable than at baseline: 159 (33.7%) of 472 and 54 (11.4%) of 472.
  • More patients treated with SIRT were ultimately deemed resectable (93 of 244, 38.1%) vs those in the control arm (66 of 228, 28.9%).

The authors concluded, “Adding SIRT to chemotherapy may improve the resectability of unresectable colorectal cancer liver metastases.… The present results provide a rationale for considering the addition of SIRT to FOLFOX‐based chemotherapy (with or without bevacizumab) in such patients, and this approach should be tested in a prospective trial focusing on this population of patients with nondiffuse, technically unresectable, liver‐only metastatic colorectal cancer who are fit for surgery. The protocol for this trial, with secondary resection rate and disease‐free survival following resection as co‐primary endpoints, is currently in development.”

Disclosure: For full disclosures of the study authors, visit onlinelibrary.wiley.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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