Secondary technical resectability of colorectal cancer liver metastases after chemotherapy with or without selective internal radiotherapy in the randomized SIRFLOX trial
Garlipp B (1), Gibbs P (2), Van Hazel GA (3), Jeyarajah R (4), Martin RCG (5), Bruns CJ (6), Lang H (7), Manas DM (8), Ettorre GM (9), Pardo F (10,11), Donckier V (12), Benckert C (13), van Gulik TM (14), Goéré D (15), Schoen M (16), Pratschke J 17, Bechstein WO (18), de la Cuesta AM (19), Adeyemi S (20), Ricke J (21,22), Seidensticker M (1,21,22).
(1) Otto-von-Guericke-University Hospital, Magdeburg, Germany.
(2) Department of Medical Oncology, Western Health, Melbourne, Victoria, Australia.
(3) Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
(4) Methodist Richardson Medical Center, Dallas, Texas, USA.
(5) Division of Surgical Oncology, University of Louisville, Louisville, Kentucky, USA.
(6) University Hospital Cologne, Cologne, Germany.
(7) General, Visceral and Transplant Surgery, University Medical Centre of Johannes Gutenberg University, Mainz, Germany.
(8) Department of Hepato-Pancreato-Biliary Surgery, Freeman Hospital, Newcastle-upon-Tyne, UK.
(9) Ospedale San Camillo-Forlanini, Rome, Italy.
(10) Hepato-Pancreatico-Biliary Surgery and Oncology, Clinica Universidad de Navarra, Pamplona, Spain.
(11) Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.
(12) Jules Bordet Institute, Brussels, Belgium.
(13) Vivantes Klinikum Am Friedrichshain, Berlin, Germany.
(14) Academic Medical Centre, Amsterdam, the Netherlands.
(15) Institut Gustave Roussy, Villejuif, France.
(16) Städtisches Klinikum Karlsruhe, Karlsruhe, Germany.
(17) Charité Universitätsmedizin Berlin, Berlin, Germany.
(18) Department of General and Visceral Surgery, University Hospital Frankfurt, Frankfurt, Germany.
(19) Radcon Hispania, Pamplona, Spain.
(20) Statsxperts Consulting Limited, Hemel Hempstead, UK.
(21) Deutsche Akademie für Mikrotherapie, Magdeburg, Germany.
(22) Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany.
Secondary resection of initially unresectable colorectal cancer liver metastases (CRLM) can prolong survival. The added value of selective internal radiotherapy (SIRT) to downsize lesions for resection is not known. This study evaluated the change in technical resectability of CRLM with the addition of SIRT to FOLFOX-based chemotherapy.
Baseline and follow-up hepatic imaging of patients who received modified FOLFOX (mFOLFOX6: fluorouracil, leucovorin, oxaliplatin) chemotherapy with or without bevacizumab (control arm) versus mFOLFOX6 (with or without bevacizumab) plus SIRT using yttrium-90 resin microspheres (SIRT arm) in the phase III SIRFLOX trial were reviewed by three or five (of 14) expert hepatopancreatobiliary surgeons for resectability.
Reviewers were blinded to one another, treatment assignment, extrahepatic disease status, and information on clinical and scanning time points. Technical resectability was defined as at least 60 per cent of reviewers (3 of 5, or 2 of 3) assessing a patient's liver metastases as surgically removable.
Some 472 patients were evaluable (SIRT, 244; control, 228). There was no significant baseline difference in the proportion of technically resectable liver metastases between SIRT (29, 11·9 per cent) and control (25, 11·0 per cent) arms (P = 0·775). At follow-up, significantly more patients in both arms were deemed technically resectable compared with baseline: 159 of 472 (33·7 per cent) versus 54 of 472 (11·4 per cent) respectively (P = 0·001).
More patients were resectable in the SIRT than in the control arm: 93 of 244 (38·1 per cent) versus 66 of 228 (28·9 per cent) respectively (P < 0·001).
Adding SIRT to chemotherapy may improve the resectability of unresectable CRLM.
CITA DEL ARTÍCULO Br J Surg. 2019 Dec;106(13):1837-1846. doi: 10.1002/bjs.11283. Epub 2019 Aug 19