Selective Internal Radiation Therapy With 90Y Resin Micropheres for Refractory Colorectal Cancer Liver Metastases

Prior treatment

• Previous radiation therapy to the lungs and/or to the upper abdomen overlapping with dose to the liver at interventionist´s decision
• Lung shunt greater than 20% or \> 30 Gray radiation absorbed dose to the lungs, at estimated by Tc-99m-MAA
• Current or previously evidence of ascites on CT-scan or physical examination

Other illness

• Symptomatic lung disease precluding SIRT at interventionist´s decision
• Active uncontrolled infection
• Conditions precluding translational samples

Lab values

• Pretherapeutic work-up procedure with Tc-99m macroaggregated albumin (MAA) scintigraphy showing extrahepatic foci in GI-tract
• Evidence of any detectable Tc-99m macroaggregated albumin deposition in the stomach or duodenum, after application of established angiographic techniques to stop such deposition
• Any pre-treatment laboratory findings within 30 days of treatment demonstrating: alanine aminotransferase level greater than 5 times upper normal limit and/or serum bilirubin greater than 2 mg/dl (\>34 umol/l)

Other

• Pregnancy
• Tumour volume greater than 50% of liver volume

• Diagnosis of metastatic colorectal adenocarcinoma with liver dominant disease
• Diagnosis of liver metastasis may be made by histo- or cyto-pathology, or by clinical and imaging criteria.
• The Liver metastasis are not eligible for resection, RFA or SBRT
• All patients must be off all chemotherapeutic regimens for 14 days prior to SIRT treatment
• All patients must be off vascular endothelial growth factor inhibitors for 6 weeks prior to SIRT treatment
• Progressive disease, severe intolerance during or following all standard lines of chemo-therapy
• Eastern Cooperative Oncology Group (ECOG) performance status of 0-1
• Age 18 years or older
• Able to understand written information
• Consent to samples for translational research