18 juni 2013: Wie goed medisch engels begrijpt kan i.v.m. onderstaand artikel ook dit artikel lezen: The Interventional Radiologist Role in Treating Liver Metastases for Colorectal Cancer met interessante conclusies over de rol die behandelingen door een interventie radioloog (IR) kan spelen:

Conclusion

IRs are playing an increasing role in the management of patients with colorectal liver metastases. The increasing clinical role of the IR as a consultant—seeing patients in clinic— has increased their role as an important contributor to the
multidisciplinary management and the customization of treatment for these patients. The IR armamentarium includes
ablative tools that can focally destroy small numbers of liver metastases. The use of ablation in a “test of time” paradigm
may limit unnecessary and morbid resections signiﬁcantly contributing to the preservation of patient quality of life.
Locoregional arterially directed therapies for liver-dominant metastases also allow the physician to manage the unresectable patient to extend disease-free periods and OS and, hopefully, convert him or her to a resection candidate for a potential cure. As all of these tools and techniques have become available and perfected over the past decade, it will become important for them to be investigated in clinical trials to best determine the appropriate use in the care of the patient with colorectal cancer with liver metastases.

18 juni 2013: Bron: Anticancer Res. 2012 Apr;32(4):1387-95

Arteriële Chemo Embolisatie met irinitocan (DEBIRI) geeft significant betere resultaten op overlevingstijd, ziektevrij tijd en kwaliteit van leven bij patiënten met darmkanker met leveruitzaaiingen in vergelijking met systemische chemo
met FOLFIRI (irinotecan, fluorouracil en leucovorin ). Dit blijkt uit een gerandomiseerde fase III studie met totaal 74 patiënten met dikke darmkanker met uitzaaiingen in de lever. Deze studie werd uitgevoerd in meerdere ziekenhuizen n Italie en gecoördioneerd door dr. Fiorentini van het Department of Oncology-Hematology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy.

Studieresultaten:

ACHTERGROND:
Metastasen naar de lever krijgen het meest van hun bloedvoorziening via de arteriële route, dus voor patiënten met levermetastasen van dikke darm kanker, kan hepatische arteriële infusie met drug-eluting beads (bolletjes gevuld met chemo) geladen met irinotecan (DEBIRI) een kans op genezing bieden.

Patiënten en methoden:
In een multi-institutionele studie, werden 74 patiënten willekeurig toegewezen aan de DEBIRI groep (36) versus groep van 38 patiënten die systemische chemo irinotecan, fluorouracil en leucovorin (FOLFIRI) kregen. Het primaire eindpunt was overleving; secundaire eindpunten waren respons, recidief, toxiciteit, kwaliteit van leven, kosten en de invloed van moleculaire merkers.

Resultaten:
Mediane overleving voor de DEBIRI groep was 22 maanden (95% Confidence Interval CI=21-23) tegenover 15 maanden (95% CI=12-18) voor de FOLFIRI groep. Het resultaat is statistisch significant ((p=0.031, log-rank). Progressie vrije tijd was 7 maanden (95% CI=3-11) voor de DEBIRI groep tegenover 4 maanden (95% CI=3-5). Dit blijkt ook statistisch significant (p = 0,006, log-rank). De mediane tijd voor de duur van de verbetering van de kwaliteit van leven was 8 maanden (95% CI = 3-13) in de DEBIRI groep en 3 maanden (95 % CI = 2-4) in de FOLFIRI groep. Ook dit blijkt statistisch significant (p = 0,00002, log-rank).
Extrahepatische progressie deed zich voor bij alle patiënten aan het einde van de studie: mediaan 13 maanden (95% CI = 10-16) in de DEBIRI groep vergeleken met 9 maanden (95% CI 5-13) in de FOLFIRI groep. Dit blijkt geen statistisch significant verschil te zijn (p = 0,064, log-rank).

Het volledige studierapport: Intra-arterial infusion of irinotecan-loaded drug-eluting beads (DEBIRI) versus intravenous therapy (FOLFIRI) for hepatic metastases from colorectal cancer: final results of a phase III study kunt u tegen betaling inzien. hier het abstract van de studie:

This study showed a statistically significant difference between DEBIRI and FOLFIRI for overall survival (7 months), progression-free survival (3 months) and quality of life (5 months). In addition, a clinically significant improvement in time to extrahepatic progression (4 months) was observed for DEBIRI, a reversal of the expectation for a regional treatment

Anticancer Research April 2012 vol. 32 no. 4 1387-1395

Intra-arterial infusion of irinotecan-loaded drug-eluting beads (DEBIRI) versus intravenous therapy (FOLFIRI) for hepatic metastases from colorectal cancer: final results of a phase III study.

Fiorentini G, Aliberti C, Tilli M, Mulazzani L, Graziano F, Giordani P, Mambrini A, Montagnani F, Alessandroni P, Catalano V, Coschiera P.

Source

Department of Oncology-Hematology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy. g.fiorentini@alice.it

Abstract

BACKGROUND:

Metastases to the liver receive most of their blood supply from the arterial route, therefore for patients with hepatic metastases from large bowel cancer, hepatic arterial infusion adopting drug-eluting beads preloaded with irinotecan (DEBIRI) may offer a chance of cure.

PATIENTS AND METHODS:

In a multi-institutional study, 74 patients were randomly assigned to receive DEBIRI (36) versus systemic irinotecan, fluorouracil and leucovorin (FOLFIRI, 38). The primary end-point was survival; secondary end points were response, recurrence, toxicity, quality of life, cost and influence of molecular markers.

RESULTS:

At 50 months, overall survival was significantly longer for patients treated with DEBIRI than for those treated with FOLFIRI (p=0.031, log-rank). Median survival was 22 (95% Confidence Interval CI=21-23) months, for DEBIRI and 15 (95% CI=12-18) months for FOLFIRI. Progression-free survival was 7 (95% CI=3-11) months in the DEBIRI group compared to 4 (95% CI=3-5) months in the FOLFIRI group and the difference between groups was statistically significant (p=0.006, log-rank). Extrahepatic progression had occurred in all patients by the end of the study, at a median time of 13 (95% CI=10-16) months in the DEBIRI group compared to 9 (95% CI 5-13) months in the FOLFIRI group. A statistically significant difference between groups was not observed (p=0.064, log-rank).The median time for duration of improvement to quality of life was 8 (95% CI=3-13) months in the DEBIRI group and 3 (95% CI=2-4) months in the FOLFIRI group. The difference in duration of improvement was statistically significant (p=0.00002, log-rank).

CONCLUSION:

This study showed a statistically significant difference between DEBIRI and FOLFIRI for overall survival (7 months), progression-free survival (3 months) and quality of life (5 months). In addition, a clinically significant improvement in time to extrahepatic progression (4 months) was observed for DEBIRI, a reversal of the expectation for a regional treatment. This suggests a benefit of DEBIRI treatment over standard chemotherapy and serves to establish the expected difference between these two treatment options for planning future large randomized studies.