CRC liver metastases: adding SIRT to chemotherapy improves resectability

  • Garlipp B & al.
  • Br J Surg
  • 19 Aug 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Adding selective internal radiotherapy (SIRT) to modified FOLFOX6 (mFOLFOX6: fluorouracil, leucovorin, oxaliplatin)±bevacizumab improves resectability rates in patients with unresectable colorectal cancer (CRC) liver metastases.

Why this matters

  • Few studies have examined the added value of SIRT for downsizing CRC liver metastases.

Study design

  • Retrospective analysis of the phase 3 SIRFLOX trial (n=472).
  • Patients were randomly assigned to receive mFOLFOX6±bevacizumab with or without SIRT using yttrium-90 resin microspheres.
  • Funding: Sirtex Medical.

Key results

  • Proportion of technically resectable liver tumors was similar between groups at baseline (P=.775).
  • At a median 23.5-month follow-up, the technical resectability rate increased with both SIRT+mFOLFOX6 (from 11.9% to 38.1%) and mFOLFOX6 alone (from 11.0% to 28.9%; both P<.001>
  • The resectability rate was significantly higher with SIRT+mFOLFOX6 (relative risk, 1.25; P<.001>
  • Conversion rate from unresectable to resectable liver metastases was higher with SIRT+mFOLFOX6 vs mFOLFOX6 alone (31.2% vs 22.7%; P<.001>
  • There was no between-group difference in actual resection rate, possibly because of clinical factors.

Limitations

  • Retrospective analysis.