Here is my highlight from the december issue of HPB
Radioembolization is still searching for its precise niche in the armoury of treatments for colorectal liver metastases. The majority of protocols advise its use in patients who have non-resectable and chemotherapy-resistant liver metastases with some requiring failure of first line chemotherapy and some second line chemotherapy. Guidance on its use in patients with extrahepatic sites of disease is also somewhat variable. Economic considerations influence patient selection in a number of healthcare models in addition to outcome data.
In this edition of HPB, Tohme and colleagues from the University of Pittsburgh explore outcomes of older patients treated with radioembolization. They have reported outcomes of more than 100 patients older or younger than 70 years treated with one or more episodes of radioembolization for non-resectable liver metastases which have proved resistant to one or two chemotherapy regimens. Fatigue is a frequently reported complicating symptom of radioembolization. It might be considered that elderly patients have less physical reserve. However, the Pittsburgh group found no difference in either frequency or severity of fatigue in treated patients based on age. Other side effect profiles were also similar suggesting that this treatment modality is well tolerated by the elderly. In terms of patient survival, again there was no difference in outcome based on patient age. The major determinant of poor outcome appeared to be the presence of extrahepatic disease but this was the same irrespective of age.
This article provides evidence that radioembolization is effective and reasonably well tolerated in patients with colorectal liver metastases and should be considered in motivated patients regardless of age.
Survival and tolerability of liver radioembolization: a comparison of elderly and younger patients with metastatic colorectal cancer
Volume 16, Issue 12, pages 1110–1116, December 2014
Further patient information at http://www.macmillan.org.uk/Cancerinformation/Cancertreatment/Treatmenttypes/Radiotherapy/Internalradiotherapy/SIRT.aspx