Is everything said in the treatment of colorectal cancer liver metastases with radioembolization, after the EPOCH results?
Javier Orcajo-Rincon 1 , Macarena Rodríguez-Fraile 2
As has been extensively described in the literature, hepatic radioembolization (RE) has undergone continuous evolution. It has gone from being a merely palliative treatment to one of radical intention 1, 2. The oncological results, objectively measured from a radiological and even anatomopathological point of view, have demonstrated to be similar to those of ablative treatments3.
The results of the international, multicenter, randomized, phase III EPOCH trial have recently been published. The patients included had irresectable liver metastases of colorectal cancer (CRC), had progressed to a first line of chemotherapy (CHT) and were randomly assigned to a second standard line (oxaliplatin or irinotecan with or without biological therapy) with or without RE with glass microspheres labeled with Yttrium-90 (90Y). The results of the 428 patients finally included demonstrated that the addition of hepatic RE to second line CHT increased progression-free survival (PFS) and hepatic PFS (statistically significant increase with hazard ratios of 0.69 and 0.59, respectively) but not overall survival (OS).
These results have been critically reviewed in at least two editorials4, 5, supporting their observations in not achieving an increase in the OS with a low cost-benefit and non-negligible hepatic toxicity. This last aspect is what Ruiz-Casado et al.5 consider the most problematic, requiring a robust study of the risk factors for its development, despite stating that it is a methodologically correct study with positive results.