Medicina nuclear y radioterapia

Multi-modality Therapy of Hepatic Metastases from Colorectal Carcinoma: Optimal Combination of Systemic Chemotherapy with Radio-embolization

Abstract

Esme J. Hill and Ricky A. Sharma

The commonest cause of death from advanced colorectal cancer is disease progression of hepatic metastases. A number of technologies are in clinical development to improve local control of liver metastases and potentially improve overall survival. Radio-embolization (RE) is a technique for administering resin or glass microspheres that contain yttrium-90 to unresectable primary or secondary hepatic malignancies internally via the liver's arterial supply in a single procedure. Clinical trials of RE used with concomitant radiosensitizing chemotherapy have shown promising results in patients with metastatic colorectal cancer. In this article, the evidence base for combining RE with systemic chemotherapy in the first line therapy of metastatic colorectal cancer is appraised and the scientific rationale for combining RE with chemotherapy in first and subsequent lines of therapy is outlined. Clinical trials of RE and chemotherapy currently recruiting patients with metastatic colorectal cancer are discussed in detail and practical recommendations offered on how best to combine RE and systemic chemotherapy.