The Role of Radioembolisation Using SIR-Spheres® in Secondary Liver Metastases of Non-colorectal Cancer Origin – Emerging Clinical Data

The Role of Radioembolisation Using SIR-Spheres® in Secondary Liver Metastases of Non-colorectal Cancer Origin – Emerging Clinical Data

Wasan Harpreet S
European Oncology - Volume 4 - Issue II
Published: June 2009
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Whether primary or metastatic in nature, hepatic tumours are a leading cause of cancer morbidity and mortality. Most liver metastases are multiple, involving both lobes in 77% patients; only 10% are solitary. A few tumour types, such as colon cancer, carcinoid tumours and hepatocellular carcinoma (HCC), may present with lesions confined to the liver. Most tumours that metastasise to the liver, such as breast and lung cancers, often spread to other sites at the same time.1 Indeed, circulating cancer cells can be detected in most cases even if the disease is thought to be early or localised.

The liver provides fertile ground for the formation of metastases, not only because of its dual blood supply but also because of humoral factors that promote cell growth required for constant cell-line function and regeneration. The blood supply of the liver is exceeded only by that of the lung in terms of blood flow per minute.2 The fenestrations in the sinusoidal endothelium allow circulating tumour cells and/or tumour emboli, arriving via the blood stream, to take a foothold in the space of Disse. These circulating tumour cells are often physically obstructed and destroyed by the Kupffer cells, but if tumour emboli are large, they tend to become lodged in the portal venous branches.

Consequently, the liver is one of the most commonly involved organs for metastatic disease, second only to the lymph nodes. The liver may be the site of metastasis from virtually any primary malignant neoplasm, but the most common primary sites implicated are the eye, colon, stomach, pancreas, breast and lung.1,3 In children, the most common liver metastases are from a neuroblastoma, a Wilms tumour or leukemia.

For a minority of patients, the number of liver metastases is limited and some form of local ablative treatment such as surgical removal, cryotherapy or radiofrequency ablation (RFA) can offer a chance of long-term survival. However, for most patients with metastatic liver cancer, by the time it is diagnosed the disease has progressed well beyond the point at which any form of ablative therapy can be used. Therefore, the majority of patients with liver metastases are managed with systemic chemotherapy, which has evolved over the past decade with the development of new agents and biologicals. However, these agents usually control the growth of cancer rather than eradicating it. Despite valuable gains with new chemotherapies and biologicals, metastatic cancer is usually fatal, with up to 80% of patients with colorectal cancer and liver metastases dying of liver failure caused by the local effects of hepatic tumours.4 Depending on the site of the primary tumour, between 30 and 70% of patients have liver metastases when they die.

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