Table 9Local hepatic therapies for unresectable CRC metastases to the liver: Adverse events KQ1 and KQ2

InterventionLocal Recurrence N (%)Biloma (%)Liver Failure (%)Elevated Alkaline Phosphatase N (%)Elevated Bilirubin N (%)Rare Adverse EventsStudy
NΘ (% CRC)
Rating
RFA12 (18)NRNRNRNRNo major complications.Jakobs et al., 200669
68 (100)
Good
Intervention: TACE with DEB; Drug: irinotecan;NRNRNRNR41 (50)NRAliberti et al., 201190
82 (100)
Good
NRNR3NRNRAll AE are from the number of DEB treatments (99) and not from the total 55 patients. 3% of patients had severe liver dysfunction, 1 patient died. 1% had cholecystitis, 1% had gastritis, and 1% had myocardial infarction, which was the cause of death in 1 patient.Martin et al., 201175
55 (100)
Good
NRNRNRNRNRLiver abscess: 5% (1 patient)Fiorentini et al., 200767
20 (100)
Poor
Intervention: TACE; Drug: mitomycin C, doxorubicin, cisplatinNRNRNRGrade 1:10%
Grade 2: 7%
Grade 3: 2%
Grade 1: 1%Prolonged in-hospital visits after major complications occurred in 11% (20) of the 174 treatments. These included hepatic infarction in 4, hematoma at the site of catheterization in 3, infection in 3, acute edema in 2, myocardial infarction in 2, pulmonary embolism in1, transient ischemic attack in 1, hypoxia in 1, and abnormal heart rhythm in 1. Thirty-day mortality was 3.6%.Albert et al., 201163
121 (100)
Fair
Intervention: TACE; Drug: cisplatin, doxorubicin, mitomycin C;NRNRNRNRNR1 (2.7%) pulmonary embolism in the CE group.Hong et al., 200968
21 (100)
Good
Intervention: RE; Drug: Y90NRNRNRNRNRNo major complications.Martin et al., 201286
24 (100)
Fair
NRNRNRNRNRNo major complications.Kucuk et al., 201184
78 (44.9)
Fair
NRNR0NRNRVentricular tachycardia: 1 (2%)Nace et al., 201189
51 (100)
Fair
RNR2NRNRNRCosimelli et al., 201066
50 (100)
Good
NRNR2.4NRNRNRCianniet al., 200965
41 (100)
Fair
NRNRNR6 (8)9 (13)GI ulcerMulcahy, et al., 200976
72 (100)
Good
NRNonspecific to CRCNRNRNonspecific to CRCIncluded non-CRC patients in this article and did not report specific adverse events for CRC mets to the liver
Significant toxicity included grade 3 or 4 bilirubin toxicity, 1 GI ulceration, 1 radiation-induced cholecystitis, 2 bilomas, and 1 hepatic abscess.
Sato et al., 200878,b
137 (37.2)
Fair
NRNRNRNRNR1 (2.7%) pulmonary embolismHong et al., 200968
15 (100)
Good
NRNRNRNR8 (10)One patient (2.4%) presented with acute grade 4 cholecystitis 4 weeks after radioembolization and was referred for surgery.Jakobs et al., 200891
41 (100)
Fair
NRNRNRNRNRGastric/duodenal ulceration: 4 (13%); severe disabling pain, anorexia, and nausea: 1 (3.3%); radiation hepatitis: 1 (3.3%)Lim et al., 200593
30 (100)
Poor
NRNRNRNRNRIncluded non-CRC patients in this article and did not report specific adverse events for CRC mets to the liver.
Four rare adverse events occurred post-SIRT: 1 cholecystitis followed by fibrosis and portal hypertension; 1 peptic ulceration in the lesser curvature of the stomach; and 2 radiation hepatitis.
Jiao et al., 200770,c
21 (47.6)
Poor
NRNRNRNRNRToxicity data were only available for 14 of 24 patients and not reported specifically for CRC mets to the liver.
One patient had a symptomatic gastric ulcer postsurgery and 1 patient had a femoral artery plaque rupture with thromboembolism in the lower extremity.
Rowe et al., 200777,b
24 (29.2)
Good
NRNRNRNRNROne case of radiation-induced ulceration caused by technical error and 1 case of right plural effusion 1 month after treatment.Lewandowski et al., 2005 73
27 (100)
Good
Intervention: HA; Drug: mitomycin C, gemcitabineNRNRNRNRNRNo common toxicity criteria grade III, IV, or V adverse events were observed.Vogl et al., 200883,a
55 (21.8)
Fair
Intervention: HAI; Drug: 5-FU 1000 mg/m2NRNRNRNR1 (1.8)NRNishiofuku et al., 201092
55 (100)
Good
Intervention: SBRT2 (33.3%)NRNRNRNRNRStintzing et al., 201088
6 (100)
Fair
NRNRNRNRNROne patient had cirrhotic failure at 5 months; 1 patient had gastric ulceration; 1 patient had esophagitis; and 1 patient had grade 3 epidermitis. No grade 4 toxicity was observed.Vautravers-Dewas et al., 201182
42 (66.7)
Good
3 (33.3%)NRNRNRNRNo grade 3 or 4 acute complicationsKim et al., 200971
9 (100)
Good

CE = chemoembolization; DEB = drug-eluting beads; HAI = hepatic arterial infusion; NR = not reported; RE = radioembolization; SBRT = stereotactic body radiation therapy; TACE = transarterial chemoembolization.

Θ

This N reflects the total number of patients enrolled in the study from any primary site. The percentage of CRC patients included in this report is presented in parentheses.

a

Treatment through the femoral or axillary artery.

b

Treatment through the hepatic artery.

c

Femoral catheter or hepatic artery port.

From: Results

Cover of Local Hepatic Therapies for Metastases to the Liver From Unresectable Colorectal Cancer
Local Hepatic Therapies for Metastases to the Liver From Unresectable Colorectal Cancer [Internet].
Comparative Effectiveness Reviews, No. 93.
Belinson S, Chopra R, Yang Y, et al.

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