Small Particle DEBIRI TACE as Salvage Therapy in Patients with Liver Dominant Colorectal Cancer Metastasis: Retrospective Analysis of Safety and Outcomes.

Nicolas Voizard,Alex Kiss,Natalie Coburn,Michael Jonathon Raphael,Robyn Pugash,Tiffany Ni,Elizabeth David

doi:10.3390/curroncol29010020

Abstract

The aim of this study was to examine the safety and efficacy of 40 µm and 75 µm calibrated irinotecan-eluting beads (DEBIRI-TACE) for the treatment of colorectal cancer metastases. We conducted a retrospective review of 36 patients with unresectable liver metastases from colorectal cancer who were treated with DEBIRI-TACE between 2017 to 2020. Patients who received at least one session of DEBIRI were included in our analysis. A total of 105 DEBIRI sessions were completed. 86% of patients (n = 31) underwent one round of treatment, 14% of patients (n = 5) underwent two distinct rounds of treatment. The majority of patients were discharged the next day (92%, n = 33 patients) with no 30-day post-DEBIRI mortality. Five high-grade adverse events occurred, including longer stay for pain management (n = 2), postembolization syndrome requiring readmission (n = 2), and liver abscess (n = 1). The average survival from diagnosis of metastatic disease was 33.3 months (range 11–95, median 28). Nine of 36 patients are still alive (December 2020) and have an average follow-up time of 36.8 months from T0 (range 12–63, median 39). Small particle DEBIRI is safe and well-tolerated in the salvage setting, with outcomes comparable to that of larger bead sizes.

Highlights

Colorectal cancer (CRC) is the third most commonly diagnosed cancer in Canada [1,2].About one-quarter of CRC are metastatic at the time of diagnosis, and many lower stage cancers will eventually metastasize, most commonly to the liver [3]
This single-centre retrospective study includes 36 patients (9 women and 27 men) with unresectable liver metastases from CRC treated with DEBIRI between December 2017 and December 2020 at Sunnybrook Health Science Center (SHSC), Toronto, Canada
According to indications from the European Society for Medical Oncology and National Comprehensive Cancer network, patients treated with DEBIRI were selected based on the presence of non-resectable disease, disease refractory to conventional lines of chemotherapy, contraindication to surgery or systemic chemotherapy or non-tolerance of systemic chemotherapy with Eastern Cooperative Oncology Group (ECOG) performance status of two or lower, normal hematological values, ALT and GGT < 3 times, and total bilirubin < 2 times the upper limit of normal [10,17]

Summary

Introduction

Colorectal cancer (CRC) is the third most commonly diagnosed cancer in Canada [1,2].About one-quarter of CRC are metastatic at the time of diagnosis, and many lower stage cancers will eventually metastasize, most commonly to the liver [3]. The largest single-center investigation on liver transplant (LT) for CRC demonstrated a low 5-year overall survival of 12%, despite restricting LT to nodenegative primaries. They found that micrometastases were present in 15 of 21 patients initially deemed node-negative. This finding suggests that, even with the widest resection margin attainable, the possibility of recurrence from undetected micrometastases is an ever-present threat in CRC [7]. If CRC has transformed into a chronic disease, treatments need to focus on both survival and preserving the functional status of the liver and the patient. Treatments should be easy to repeat and not limit future options

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