Faculty Collaboration Database

Effect of Primary Tumor Side on Survival Outcomes in Untreated Patients With Metastatic Colorectal Cancer When Selective Internal Radiation Therapy Is Added to Chemotherapy: Combined Analysis of Two Randomized Controlled Studies. Clin Colorectal Cancer 2018 Dec;17(4):e617-e629

Date

07/24/2018

Pubmed ID

30033117

DOI

10.1016/j.clcc.2018.06.001

Scopus ID

2-s2.0-85050303016 (requires institutional sign-in at Scopus site)   52 Citations

Abstract

BACKGROUND: The primary tumor side is emerging as a major prognostic factor for patients with metastatic colorectal cancer (mCRC). We examined the survival data from 2 randomized studies to determine whether the outcomes differ between patients with mCRC with right-sided primary (RSP) tumors and those with left-sided primary (LSP) tumors after selective internal radiation therapy (SIRT) plus mFOLFOX6 (folinic acid [leucovorin], 5-fluorouracil, oxaliplatin) chemotherapy, versus chemotherapy alone.

PATIENTS AND METHODS: Separate and combined analyses were performed on the data from the SIRFLOX and FOXFIRE global trials, which compared chemotherapy plus SIRT with chemotherapy alone for patients with mCRC liver metastases. The primary tumor side data were prospectively collected. The principal outcome measure was overall survival (OS) stratified by treatment and primary tumor side.

RESULTS: In the combined analysis of all 739 patients enrolled, SIRT had no effect on OS (median OS, 24.3 vs. 24.6 months; hazard ratio [HR], 1.021; P = .810). For the 179 patients (24.2%) with a RSP tumor, OS was improved with the addition of SIRT (median, 22.0 vs. 17.1 months HR, 0.641; P = .008). The addition of SIRT was not associated with a significant difference in OS among the 540 patients with a LSP tumor (median, 24.6 vs. 26.6 months; HR, 1.120; P = .264). A test of treatment interaction by primary tumor side was statistically significant for RSP and SIRT (P = .002).

CONCLUSION: The addition of SIRT for patients with RSP tumors, but not for those with LSP tumors, was associated with a statistically and clinically significant OS gain.

Author List

Gibbs P, Heinemann V, Sharma NK, Taieb J, Ricke J, Peeters M, Findlay M, Robinson B, Jackson C, Strickland A, Gebski V, Van Buskirk M, Zhao H, van Hazel G, SIRFLOX and FOXFIRE Global Trial Investigators

Author

William S. Rilling MD, FSIR Vice Chair, Professor in the Radiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Antineoplastic Combined Chemotherapy Protocols
Brachytherapy
Chemoradiotherapy
Cohort Studies
Colorectal Neoplasms
Female
Follow-Up Studies
Humans
Liver Neoplasms
Male
Prognosis
Survival Rate