Intervention Review

Selective internal radiation therapy for liver metastases from colorectal cancer

  1. Amanda Townsend1,*,
  2. Timothy Price2,
  3. Christos Karapetis3

Editorial Group: Cochrane Colorectal Cancer Group

Published Online: 7 OCT 2009

Assessed as up-to-date: 9 JUL 2009

DOI: 10.1002/14651858.CD007045.pub2


How to Cite

Townsend A, Price T, Karapetis C. Selective internal radiation therapy for liver metastases from colorectal cancer. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD007045. DOI: 10.1002/14651858.CD007045.pub2.

Author Information

  1. 1

    The Queen Elizabeth Hospital, Woodville, SA, Australia

  2. 2

    The Queen Elizabeth Hospital, Medical Oncology, Woodville, South Australia, Australia

  3. 3

    Flinders Medical Centre, Medical Oncology, Bedford Park, SA, Australia

*Amanda Townsend, The Queen Elizabeth Hospital, 28 Woodville Road,, Woodville, SA, 5011, Australia. Amanda.Townsend@health.sa.gov.au. Amanda.Townsend@nwahs.sa.gov.au.

Publication History

  1. Publication Status: New
  2. Published Online: 7 OCT 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Liver metastases are often the dominant site of metastatic disease in colorectal cancer. Selective internal radiation therapy (SIRT) involves embolising radiolabeled spheres (SIR-Spheres) into the arterial supply of the liver with the aim of improving the control of liver metastases.

Objectives

To assess the effectiveness and toxicity of SIRT in the treatment of metastatic colorectal cancer liver metastasis when given alone or with systemic or regional hepatic artery chemotherapy.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane library 2008 issue 2, MEDLINE (1966 to October 2008), EMBASE (1980 to October 2008), and Pubmed (October 2008). The proceedings of ASCO (1985 to 2008) and ASCO GI (2004 to 2008) were also searched. The manufacturers of SIR-Spheres were contacted and asked whether they were aware of any other unpublished studies.

Selection criteria

Randomised controlled trials comparing SIRT and chemotherapy (systemic and/or regional) with chemotherapy alone, or comparing SIRT alone with best supportive care in patients with metastatic colorectal cancer.

Data collection and analysis

Two authors (AT/TP) extracted data and assessed the trial quality. The study authors were contacted and individual patient data was obtained. Results were analysed separately for patients with and without extra-hepatic disease.

Main results

A single study of 21 patients compared SIRT and systemic chemotherapy (fluorouracil and leucovorin) with chemotherapy alone. There was a significant improvement in progression free survival and median survival associated with SIRT, both for the total studied population and for those disease limited to the liver. There was an increase in toxicity with the use of SIRT. A second study of 63 eligible patients compared SIRT and regional chemotherapy (floxuridine) with regional chemotherapy alone. There was no significant difference in progression free survival and median survival seen with SIRT, in either the total patient group or in the 22 patients with disease limited to the liver. There was no significant increase in toxicity with the addition of SIRT to regional chemotherapy. There were no randomised studies comparing SIRT with best supportive care in patients with refractory disease, and no randomised studies assessing the effect of SIRT in patients with resectable liver metastases.

Authors' conclusions

There is a need for well designed, adequately powered phase III trials assessing the effect of SIRT when used with modern combination chemotherapy regimens. Further studies are also needed for patients with refractory disease with a particular focus on the impact on quality of life.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Radioactive beads given in addition to chemotherapy does not improve control of cancer nor survival in patients with colorectal cancer and metastasis in the liver.

Bowel cancer commonly spreads to the liver. In most patients this cannot be removed by an operation and cure is not possible. Chemotherapy treatment can help control the growth of the cancer and improve survival. Radioactive beads can be injected into the blood vessels of the liver to try and control the cancer in the liver. In one study that had 21 participants, radioactive beads (injected into the blood vessels of the liver) given with chemotherapy (into the veins of the arm) was more effective at controlling the cancer and improving how long people lived than chemotherapy given on it's own. However, in this study more people who received the radioactive beads suffered from side effects and this study used an older type of chemotherapy that is less effective than the newer treatments that are now available. In a second study with 63 participants, radioactive beads were given with chemotherapy that was injected directly into the blood vessels of the liver. In this study there was no extra benefit in the control of cancer growth or survival for those participants who received radioactive beads in addition to the chemotherapy. More studies are needed with a particular focus on whether radioactive beads provides extra benefit when given with newer chemotherapy treatments, and if radioactive beads provide benefit when given on their own.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

利用選擇性體內放射線治療法(Selective internal radiation therapy)來治療由大腸直腸移轉至肝臟的癌細胞

肝臟轉移通常是大腸直腸癌轉移的主要轉移結果,選擇性體內放射線治療法(Selective internal radiation therapy,SIRT)是將帶有放射線的球體(SIRPgheres)的管子插入肝臟動脈中,以提升對於肝臟移轉的控制效果

目標

本研究的主要目的在於評估將SIRT單獨使用和與全身性或區域性肝臟動脈治療法併用時,對於移轉性大腸直腸癌的肝臟移轉治療功效及毒性,

搜尋策略

我們檢索了Cochrane Central Register of Controlled Trials (CENTRAL)、Cochrane library 2008年第2期, MEDLINE (1966年至2008年10月), EMBASE (1980 年至2008年10月)和Pubmed (2008年10月)資料庫,也調閱了ASCO (1985 至 2008) 和ASCO GI (2004至2008)的會議記錄,並且聯繫SIRspheres的製造商以詢問其是否有發現任何其他未公開的研究資訊

選擇標準

比較SIRT和化學治療法(全身性和局部性)併用和單獨使用化學治療法的治療效果的隨機性對照試驗會被納入本研究中,另外,比較單獨使用SIRT和最佳支持性照護對移轉性大腸直腸癌患者影響的隨機性對照試驗也會被納入研究中

資料收集與分析

有2位作者(AT/TP)會進行資料萃取及評估試驗品質的工作,並聯繫試驗作者以取得個別患者的數據,根據患者有沒有患有其他肝臟疾病來將數據進行分別的分析

主要結論

有1個納入21位患者的試驗係比較SIRT和全身性化學治療(使用fluorouracil和leucovorin藥物)併用以及單獨進行化學治療的影響,搭配使用SIRT可以使患者的無惡化存活率和中期存活率明顯提升,這樣的結果適用於所有的試驗患者,也適用於那些限定有肝臟疾病的患者,在使用SIRT時會出現毒性增加的現象,有一個針對63名適當患者進行的試驗係比較使用SIRT併行局部性化學治療(使用floxuridine藥劑)和單獨進行局部性化學治療的效果,對於有接受SIRT治療的患者來說,在全體受試病患和22個患有肝臟疾病的病患身上,其無惡化存活率和中期存活率並沒有明顯的變化, 將SIRT併行局部性化學治療也沒有出現明顯的毒性增加情形,目前並沒有比較SIRT和支持性照護對於患有不易治癒疾病(refractory disease)治療效果的隨機性試驗,也沒有試驗評估SIRT對於可以接受切除治療的肝臟轉移患者的影響

作者結論

基於上述結果,還需要更多具有良好試驗設計及適當效力第三期試驗,來評估使用SIRT和現行併用的化學性治療療程的影響,也需要更多的試驗針對那些患有不易治癒的患者,瞭解SIRT治療對於其生活品質的影響

翻譯人

本摘要由臺中榮民總醫院薛榮華翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

放射線小球與化學性治療藥劑併用並無法提升癌症的控制,對於患有大腸直腸癌和肝臟轉移的患者來說也無法提升存活率:大腸癌通常會擴散至肝臟,在大多數的患者身上,擴散到肝臟的癌細胞並無法利用手術來移除因此不容易被治癒,一般來說,化學治療可以協助控制癌細胞的生長並且提升存活率,放射線小球則可以被注射至肝臟的血管中以試圖達到控制肝臟中癌細胞的目的。在一個以21位患者為受試者的試驗中,嘗試將放射線小球(被注射至肝臟的血管中)與化學治療藥劑(被注射至手臂的靜脈)併用,試驗結果發現這樣的方法比單獨使用化學治療藥劑,更能夠達到癌細胞控制和延長患者存活時間的效果,但是,在這個試驗中大多數的患者在接受放射線小球治療後都出現了副作用,而這個試驗係使用一種較為舊型且較現行使用的話治療藥劑效果為差的化學治療藥劑。在另一個試驗中,針對63位患者進行的試驗係將放射線小球與直接注射至肝臟血管的化學治療藥劑併用,但是這個試驗的結果並沒有發現這樣的治療方法對於癌細胞生長的控制或是存活率有額外的益處。因此有必要利用更多的試驗,並且著重於探討在提供新的化學性藥劑治療時,併用放射線小球是否可以提升更多的好處,也需要瞭解放射線小球本身是否便對患者的癌症治療有任何好處