Abstract
BackgroundSelective Internal Radiation Therapy (SIRT) is a new and effective locoregional anticancer therapy for colorectal cancer patients with liver metastases. Markers for prediction of therapy response and prognosis are needed for the individual management of those patients undergoing SIRT.MethodsBlood samples were prospectively and consecutively taken from 49 colorectal cancer patients with extensive hepatic metastases before, three, six, 24 and 48 h after SIRT to analyze the concentrations of nucleosomes and further laboratory parameters, and to compare them with the response to therapy regularly determined 3 months after therapy and with overall survival.ResultsCirculating nucleosomes, cytokeratin-19 fragments (CYFRA 21-1), carcinoembryonic antigen (CEA), C-reactive protein (CRP) and various liver markers increased already 24 h after SIRT. Pretherapeutical levels of CYFRA 21-1, CEA, cancer antigen 19-9 (CA 19-9), asparate-aminotransferase (AST) and lactate dehydrogenase (LDH) as well as 24 h values of nucleosomes were significantly higher in patients suffering from disease progression (N = 35) than in non-progressive patients (N = 14). Concerning overall survival, CEA, CA 19-9, CYFRA 21-1, CRP, LDH, AST, choline esterase (CHE), gamma-glutamyl-transferase, alkaline phosphatase, and amylase (all 0 h, 24 h) and nucleosomes (24 h) were found to be prognostic relevant markers in univariate analyses. In multivariate Cox-Regression analysis, the best prognostic model was obtained for the combination of CRP and AST. When 24 h values were additionally included, nucleosomes (24 h) further improved the existing model.ConclusionPanels of biochemical markers are helpful to stratify pretherapeutically colorectal cancer patients for SIR-therapy and to early estimate the response to SIR-therapy.
Highlights
Selective Internal Radiation Therapy (SIRT) is a new and effective locoregional anticancer therapy for colorectal cancer patients with liver metastases
A study in metastasized colorectal cancer patients comparing SIRT and systemic chemotherapy consisting of fluorouracil and folinic acid with chemotherapy alone showed a significant improvement in progression-free and overall survival associated with SIRT, both for the total population studied as well as for those patients with disease limited to the liver [12]
Patients In the present study cohort, 49 colorectal cancer patients suffering from liver metastases (33 males and 16 females, median age 62.6 years, range 35-77 years) treated with SIR therapy at the University Hospital Munich-Grosshadern between May 2006 and May 2008 were prospectively and consecutively included in the study
Summary
Selective Internal Radiation Therapy (SIRT) is a new and effective locoregional anticancer therapy for colorectal cancer patients with liver metastases. Undesirable side effects of SIRT are rare and due to misguided radiating microspheres into the stomach causing gastrointestinal ulcers [14] and into the lungs leading to radiation pneumonitis [15]. To prevent these undesirable side effects, an angiography is performed prior to SIRT to evaluate the individual vascular anatomy and to determine the appropriate placement for the catheter tip. As these gamma radiation emitters have the same particle size compared to the resin microspheres, they allow to predict microsphere distribution and quantify hepato-pulmonaryshunting by doing a scintigraphy shortly after the injection [17]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
