Selective Internal Radiation Therapy (SIRT) in Patients With Unresectable Colorectal Cancer Liver Metastases Who Failed Prior Intraarterial Pump Chemotherapy

Inclusion criteria

• Histologic confirmation of colorectal cancer.
• Unequivocal imaging of hepatic metastases.
• Dominant Liver metastases. (Small amount extrahepatic disease allowed.)
• Unresectable liver metastases.
• Liver Metastases non-eligible for, or progressed after ablation
• Failed prior HAC.
• ECOG performance status 0 - 1
• WBC > or = to 1.5 x 109/L
• Platelets > or = to 50 x 109/L
• Creatinine ≤ 1.5 mg/dl
• Bilirubin ≤ 1.5 mg/dl
• Age > or = to 18 years
• Female patients must either be postmenopausal, sterile (surgically or radiation- or chemically-induced), or if sexually active, must agree to use an acceptable method of contraception.
• Male patients must be surgically sterile, or if sexually active, must agree to use an acceptable method of contraception.
• Life expectancy of at least 3 months without any active treatment.
• No chemotherapy regimen administration for at least 4 weeks prior to SIRT administration

Exclusion criteria

• Evidence of severe cirrhosis (CHILDS B and C), portal hypertension with gastroesophageal varices and liver failure as determined by clinical, radiologic or laboratory assessment.
• Previous radiotherapy delivered to the liver.
• Pregnant or breast-feeding.
• Any of the following are contraindications to the use of Yttrium-90 microspheres, and are therefore exclusion criteria:

• With a Tc-99m macroaggregated albumin (MAA) hepatic arterial perfusion scintigraphy that shows any disposition to the gastrointestinal tract that cannot be corrected by angiographic and embolization techniques.
• With more than 20% shunting of blood to the lungs as estimated in the Lung Scintigram performed after the intraarterial injection of Tc MAA. Radiation pneumonitis has been seen in patients receiving doses of Yttrium-90 greater than 30 Gy in a single treatment. This corresponds to the shunt over 20% presence of vascular abnormalities, bleeding diathesis, making catheterization of the hepatic artery contraindication.