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Mahmood et al. | Journal of Clinical and Translational Research 2023; 9(5): 322-326 325
multiagent systemic treatment (two or three drug regimens) plus Conflicts of Interest
an appropriate biologic agent based on the tumors mutational
status for 3–4 months. After this initial induction phase with FD reports honoraria from Astrazeneca, Eisai, Exelixis,
reduction in the tumor burden, the patients are re-evaluated Servier, Sirtex, and Ipsen. NAJ has received research funding to
with repeat imaging at the MDT. If resectable, they will proceed the institution from Sirtex and Theraspheres. All other authors
at this stage with liver resection. However, patients deemed declare no disclosures.
still unresectable by the MDT are evaluated for the absence Ethics Approval and Consent to Participate
of extrahepatic metastases, preserved performance status of
ECOG 0-1, adequate kidney and liver function (including total This work was performed under an IRB approved protocol at
bilirubin <2 mg/mL), and referred for TARE for consolidation. the University of California Irvine.
Maintenance single agent fluopyrmidine treatment is usually Consent for Publication
given before TARE and in between TARE treatments (i.e., both
lobes of the liver, if indicated). The extent of TARE, dosing, and Due to retrospective nature of the study, this protocol was
choice of spheres is based on the treating physician’s discretion. deemed IRB exempt for obtaining patient consents.
After TARE, the patients continue maintenance chemotherapy,
and about 2–3 months later are evaluated for response. At that References
time, those with further tumor response deemed resectable are [1] Benson AB, Venook AP, Al-Hawary MM, Arain MA,
referred for liver resection. In addition, if after about 6–8 months Chen YJ, Ciombor KK, et al. Colon Cancer, Version
of treatment as outlined here the patients are in partial or complete 2.2021, NCCN Clinical Practice Guidelines in Oncology.
remission, they are referred for resection of the primary tumor, J Natl Compr Canc Netw 2021;19:329-59.
hence rendering the patient disease-free.
Thus, the approach to incorporating TARE at our MDT is [2] Del Rosario MP, Abi-Jaoudeh N, Cho MT, Jutric Z,
focused on appropriate patient selection which includes an Dayyani F. Yttrium-90 Internal Radiation Therapy as Part
intensive initial systemic tumor debulking and careful patient of the Multimodality Treatment of Metastatic Colorectal
selection based on the clinical criteria above. This approach is very Carcinoma. Onco 2021;1:207-18.
different from the Sirflox trial where patients were randomized to [3] Mulcahy MF, Mahvash A, Pracht M, Montazeri AH,
nd
TARE within the first two cycles of chemotherapy and received Bandula S, Martin 2 RC, et al. Radioembolization
suboptimal doses of systemic treatment during the first three with Chemotherapy for Colorectal Liver Metastases:
cycles of systemic treatment. In addition, about a third of the A Randomized, Open-Label, International, Multicenter,
patients had extrahepatic disease. Taken together, we believe these Phase III Trial. J Clin Oncol 2021;39:3897-907.
differences in patient selection and treatment might explain the [4] Van Hazel GA, Heinemann V, Sharma NK, Findlay MP,
survival outcomes in our cohort. Ricke J, Peeters M, et al. SIRFLOX: Randomized Phase
The main purpose was to focus on the major endpoint of OS, III Trial Comparing First-line mFOLFOX6 (Plus or
which can be objectively determined and hence is not biased Minus Bevacizumab) Versus mFOLFOX6 (Plus or Minus
by the frequency of scheduled diagnostic studies and their Bevacizumab) Plus Selective Internal Radiation Therapy
subjective interpretation. Furthermore, while there were no in Patients with Metastatic Colorectal Cancer. J Clin Oncol
apparent differences in prognostic subgroups (e.g., by tumor 2016,34:1723-31.
sidedness; data not shown), it is important to note that due to [5] Riaz A, Lewandowski RJ, Kulik LM, Mulcahy MF,
relatively small numbers in each subgroup, the study did not Sato KT, Ryu RK, et al. Complications Following
have the power to detect potentially different outcomes based on Radioembolization with Yttrium-90 Microspheres:
clinical variables. A Comprehensive Literature Review. J Vasc Interv Radiol
5. Conclusion 2009;20:1121-30.
[6] Kennedy AS, Coldwell D, Nutting C, Murthy R,
The herein presented data suggest that even relatively early Wertman DE Jr., Loehr SP, et al. Resin 90Y-Microsphere
integration of TARE in appropriately selected patients with Brachytherapy for Unresectable Colorectal Liver
CRLM who are reviewed by MDT and treated at an experienced Metastases: Modern USA Experience. Int J Radiat Oncol
academic center does not appear to negatively affect subsequent Biol Phys 2006;65:412-25.
treatment or long-term outcomes. [7] Lewandowski RJ, Sato KT, Atassi B, Ryu RK,
Acknowledgments Nemcek AA Jr., Kulik L, et al. Radioembolization with 90Y
Microspheres: Angiographic and Technical Considerations.
None. Cardiovasc Intervent Radiol 2007;30:571-92.

Funding [8] Salem R, Lewandowski RJ, Sato KT, Atassi B, Ryu RK,
Ibrahim S, et al. Technical Aspects of Radioembolization
None. with 90Y Microspheres. Tech Vasc Interv Radiol
DOI: http://dx.doi.org/10.18053/jctres.09.202305.23-00066