Caren van Roekel

59 Radioembolization In the SIRveNIB trial, there was no significant difference in OS either. Median OS was 8.8 months for radioembolization and 10 months for sorafenib. Tumor- response rate was much better for the radioembolization group: 16.5% versus 1.7% (p<0.001) Like the SARAH trial, patients who received radioembolization had significantly fewer (serious) adverse events when compared with those treated with sorafenib (122). Unfortunately, these trials are not without limitations. In both studies, a larger proportion of patients in radioembolization group did not receive the allocated intervention compared to the patients randomized to sorafenib (SARAH trial: 22.0% versus 4.6%; SIRveNIB trial: 28.6% versus 9.0%) (121, 122). Furthermore, in both studies, the BSA method was used for activity calculation. This method often leads to over- or underdosing and does not differentiate between tumorous and non-tumorous tissue, which may have led to suboptimal treatment outcomes. Also, time to progression in the liver was significantly longer in the radioembolization groups, but progression at any site was comparable or shorter in the radioembolization group. This is not unexpected when comparing a regional versus a systemic therapy and one may advocate the addition of a systemic therapy to radioembolization. 8.1. Metastatic colorectal carcinoma The majority of patients with hepatic metastases of colorectal carcinoma is not suitable for surgical therapy. Resection of hepatic metastases is the only possible curative treatment option. The 5-year survival is only 10% for patients with unresectable disease. Treatment with radioembolization is possible even after several lines of chemotherapy. To date, two randomized controlled trials have investigated the value of radioembolization in the salvage setting. The first trial was published in 2001. This study looked at the added value of radioembolization to hepatic artery chemotherapy with floxuridine versus chemotherapy with floxuridine alone. Tumor response rate and progression free survival was significantly better in the combination group. Moreover, although not significantly different , the five-year survival rates in the combination and chemotherapy group were 3.5% versus 0% (58). 2