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Analysis of a national programme for selective internal radiation therapy for colorectal cancer liver metastases

White, J, Carolan-Rees, Grace, Dale, H, Morgan, Helen, Patrick, HE, See, TC, Beeton, EL, Swinson, DEB, Bell, JK, Manas, DM, Crellin, A, Slevin, NJ and Sharma, RA 2018. Analysis of a national programme for selective internal radiation therapy for colorectal cancer liver metastases. Clinical Oncology 10.1016/j.clon.2018.09.002

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Aims Patients with chemotherapy-refractory colorectal cancer liver metastases have limited therapeutic options. Selective internal radiation therapy (SIRT) delivers yttrium 90 microspheres as a minimally invasive procedure. This prospective, single-arm, observational, service-evaluation study was part of National Health Service England Commissioning through Evaluation. Methods Patients eligible for treatment had histologically confirmed carcinoma with liver-only/liver-dominant metastases with clinical progression during or following oxaliplatin-based and irinotecan-based chemotherapy. All patients received SIRT plus standard of care. The primary outcome was overall survival; secondary outcomes included safety, progression-free survival (PFS) and liver-specific PFS (LPFS). Results Between December 2013 and March 2017, 399 patients were treated in 10 centres with a median follow-up of 14.3 months (95% confidence interval 9.2–19.4). The median overall survival was 7.6 months (95% confidence interval 6.9–8.3). The median PFS and LPFS were 3.0 months (95% confidence interval 2.8–3.1) and 3.7 months (95% confidence interval 3.2–4.3), respectively. During the follow-up period, 143 patients experienced an adverse event and 8% of the events were grade 3. Conclusion Survival estimates from this pragmatic study show clinical outcomes attainable in the National Health Service comparable with previously published data. This study shows the value of a registry-based commissioning model to aid national commissioning decisions for highly specialist cancer treatments.

Item Type: Article
Date Type: Published Online
Status: Published
Schools: Academic & Student Support Service
Publisher: WB Saunders
ISSN: 0936-6555
Date of Acceptance: 1 August 2018
Last Modified: 14 Aug 2021 01:07

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