Abstract
Currently, there is no consensus on the use of Y-90 radioembolization for salvage patients with colorectal cancer liver metastases. The purpose of this study was to provide a comprehensive overview of the available data on tumor response and survival after Y-90 radioembolization for this group of patients. Methods: A systematic literature search was conducted in PubMed (Medline), Excerpta Medica (EMBASE), and the Cochrane Library (September 2012) with synonyms for "radioembolization" and "colorectal cancer liver metastases." Results were described separately for patient cohorts treated with Y-90 radioembolization as monotherapy and with Y-90 radioembolization in combination with chemotherapy. Results: The search yielded 13 relevant articles for systematic review on Y-90 radioembolization as monotherapy and 13 relevant articles on Y-90 radioembolization combined with chemotherapy. Disease control rates (i.e., complete response, partial response, and stable disease) ranged from 29% to 90% for Y-90 radioembolization as monotherapy and from 59% to 100% for Y-90 radioembolization combined with chemotherapy. Heterogeneity in the data prohibited pooling of response rates. Survival proportions at 12 mo ranged from 37% to 59% for Y-90 radioembolization as monotherapy and from 43% to 74% for Y-90 radioembolization combined with chemotherapy. Conclusion: In the studies included in this systematic review, approximately 50% of salvage patients with colorectal cancer liver metastases survive more than 12 mo after treatment with Y-90 radioembolization, either as monotherapy or in combination with chemotherapy. Heterogeneity between studies has unfortunately prohibited pooling of data. Future research will discern the precise role of Y-90 radioembolization in general clinical practice in comparison with chemotherapy.