Radioembolisation (or selective internal radiation therapy – SIRT) for liver tumours is an effective way of slowing the progression of tumours confined to the liver.

Drs Graham Munneke, George Raja and Julian Hague of LION Oncology successfully performed the first SIRT procedure in the Harley Street Clinic in conjunction with the Leaders in Oncology Care (LOC).

Given the recent excellent results from the SIRFLOX study, it is anticipated that there will be a greater demand for radioembolistion from both Oncologists and patients.

New SIRFLOX Study Data Presented at World Congress of Gastrointestinal Cancer

New data from the SIRFLOX study presented at the European Society for Medical Oncology (ESMO) 17th World Congress of Gastrointestinal Cancer (WCGIC) has shown that patients with unresectable metastatic colorectal cancer (mCRC) that has spread only to the liver experienced the greatest improvement in Progression-Free Survival (PFS) in the liver from the addition of SIR-Spheres Y-90 resin microspheres to a current first-line chemotherapy regimen.

• The 7.9 month improvement in PFS in the liver (from 12.6 to 20.5 months) with the addition of SIR-Spheres Y-90 resin microspheres to first-line chemotherapy applied to all patients in the study, whether they had metastases only in the liver or in other sites as well

• New analyses focused on the impact of two important factors on this treatment benefit:

• Among the 318 patients with metastases that had spread only to the liver at the time they entered the study, median PFS in the liver was 21.1 months for those treated with Y-90 resin microspheres plus chemotherapy compare to 12.4 months for those treated with chemotherapy alone
• The 8.7 month improvement was statistically significant (p-value = 0.003, with a hazard ratio of 0.64) and represents a notable 36 percent reduction in the risk of tumour progression in the liver

New findings were also disclosed regarding the impact of bevacizumab in the chemotherapy regimen used in the SIRFLOX study. 

In both groups – the 292 patients who had an intention to treat using bevacizumab in addition to first-line mFOLFOX6 chemotherapy, and the 238 who did not – the addition of Y-90 resin microspheres resulted in a statistically significant 8.3 month delay and 31% reduction in the risk of disease progression in the liver (hazard ratio 0.69). 

The clinical benefit of adding Y-90 resin microspheres to first-line chemotherapy appears to be independent of the use of bevacizumab.

The clinical benefit observed was accompanied by an acceptable level of adverse events resulting from the addition of Y-90 resin microspheres to first-line chemotherapy in mCRC.

This matters because:

• Oncologists are familiar with the effects of radiation on healthy liver tissue and have traditionally been very cautious of irradiating large liver volumes
• SIRFLOX has now shown that high doses of radiation can be delivered to the liver tumours safely, even with the concurrent administration of a potent chemotherapy regimen

Radiofrequency ablation conferred 2-year OS rates comparable to stereotactic body radiotherapy in patients with medically inoperable non–small cell lung cancer, according to study results. Further, radiofrequency ablation appeared safe and did not adversely affect pulmonary function tests, the study also found.

Stereotactic body radiotherapy or image-guided thermal ablations represent the most common treatment options for patients with lung cancer who refuse surgery, according to study background. However, stereotactic body radiotherapy has been observed to have a deleterious effect on pulmonary function. Radiofrequency ablation (RFA) is the most common image-guided modality used in the treatment of liver, kidney, lung and bone tumors, and early use of RFA as an outpatient treatment for lung cancer exhibited safety and efficacy in select patients.

Donington JS. Cancer. 2015;doi:10.1002/cncr.29501.
Dupuy DE, et al. Cancer. 2015;doi:10.1002/cncr.29507.

A paper has recently been published in the Journal of Vascular and Interventional Radiology by Matsui and colleagues entitled:

Long-Term Survival Following Percutaneous Radiofrequency Ablation of Colorectal Lung Metastases

Colon cancer is the third most common cancer and the second most common cause of cancer-related mortality in the United States. Distant spread is common, and 10-30% of patients with colon cancer have pulmonary metastasis at presentation. Such patients often require multiple surgeries because not all the metastatic disease is detectable at first presentation and because of the high likelihood of recurrence. Furthermore, surgical lung resection may not be possible in patients with certain comorbidities such as severe chronic obstructive pulmonary disease, as metastasectomy carries the risk of complications including bleeding, pulmonary edema, and can result in prolonged recovery periods. Newer, less invasive therapies have been explored to treat patients with pulmonary metastases in an effort to improve long-term survival and quality of life in patients who are not candidates for surgery. Radiofrequency ablation (RFA) is one such technique, and it is associated with favorable local control rates in patients with pulmonary metastases from colorectal cancer. While the short- to mid-term survival data after RFA are promising, long-term survival data remain sparse and was the investigative focus of the present study.

The investigators reviewed patient outcome following the RFA with the primary endpoint being patient survival and explored possible factors associated with survival. The results suggest that RFA of colorectal lung metastases showed clinically significant benefits for long-term survival in the study group with low adverse events incidence. Independent prognostic factors that were negatively associated with long-term survival included CEA level before RFA and the presence of viable extrapulmonary recurrences at the time of procedure. The primary limitation of the study was its retrospective methodology and reliance on inconsistent and incomplete records, as not all imaging were studies were confirmed histopathologically for each patient.  Future prospective, controlled trials are necessary to validate these findings in a larger patient cohort.

Dr Illing presented on the topic of biopsy for small renal masses to an audience of over 400 international physicians and gave an update on the latest techniques for tumour ablation.

LION Oncology in collaboration with the Harley Street Clinic and the Leaders in Oncology Care (LOC) were pleased to host an evening meeting to launch new vascular oncology treatments in the HCA group in central London.

Selective internal radiation therapy (SIRT), drug-eluting bead transarterial chemoembolisation (DEB-TACE) and hepatic chemosaturation for the management of liver cancers are to be undertaken at the Harley Street Clinic under the LION governance pathways.

Dr Andrew Kennedy, Physican-in-Chief of Radiation Oncology at the Sarah Cannon Research Institute, Nashville, Tenesse, was the guest speaker at the meeting and spoke to an audience of oncologists and interventional radiologists about the extensive evidence base for SIRT in the management of liver cancers. There are several large phase III trials about the report on this technique – the first being SIRFLOX, due out in March 2015.