Use of Yttrium-90 Radioembolization for Management of Colorectal Liver Metastases

Approximately 20 % of patients diagnosed with colorectal cancer present with metastatic disease at the time of diagnosis, predominantly to the liver. Surgical resection is the only real chance at a cure for a majority of these patients. A subset of patients present with unresectable disease with systemic and local therapy as the only available options. The advent of irinotecan-and oxaliplatin-based systemic therapy has increased median survival from about 5 months to greater than 20 months in metastatic disease. Addition of local therapy has the potential to further improve outcomes. With many avenues of regional therapy available, radioembolization with Yttrium-90 tagged microspheres offers a selective, targeted, and well-tolerated option. In this paper, we discuss the current evidence for radioembolization use as first-line adjunctive therapy and as salvage therapy. Based on current evidence, there appears to be an increase in liver-specific progression-free survival and an increase in overall survival when used as salvage therapy. Considerations for use in downstaging to resectable disease still need further investigation.