Selective internal radiation therapy for unresectable colorectal metastases in the liver

NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 8 sources, which was discussed by the committee. The evidence included 3 publications from 4 randomised controlled trials (3 were analysed together in a single report and 2 of these 3 were also used for a post-hoc analysis, reported in a single study), 2 non-randomised comparative studies and 3 case series. It is presented in table 2 of the overview. Other relevant literature is in the appendix of the overview.

The specialist advisers and the committee considered the key efficacy outcomes to be: quality of life, survival and reduction in tumour volume.

The specialist advisers and the committee considered the key safety outcomes to be: hepatic toxicity, abdominal pain and haematological toxicity.

Patient commentary was sought but none was received.

The committee was advised that the benefit is greater for patients with limited extrahepatic disease and tumour‑to‑liver volumes below 25%.

There are different types of microspheres used. There are also different types of radionuclides used, but the evidence discussed by the committee only included studies using yttrium.

The committee was told that dosimetry in this procedure is complex and needs significant expertise.

The committee noted that many studies did not report quality of life and it considers this to be an important outcome.

The committee noted that adverse events may be attributable to selective internal radiation therapy, chemotherapy, or both.