Background
Methods
Patient cohort
Local and locoregional therapies
Radiofrequency ablation
CT guided high-dose rate brachytherapy
Y90-radioembolization
Comorbidity measurement
Statistical analysis
Results
Treatment outcome
Median overall survival (months)a | ||||||
---|---|---|---|---|---|---|
Patients | Procedures | Patient age | Comorbidity | |||
n
|
n
| ≥ 70 years | < 70 years | CCI ≥ 3 | CCI < 3 | |
RFA | 60 | 99 | 26.7 m | 24.3 m | 24.0 m | 26.2 m |
liver | 18 | 21 | (p = 0.76) | (p = 0.16) | ||
lung | 42 | 77 | ||||
other | 1 | 1 | ||||
HDR-BT | 192 | 491 | 19.1 m | 18.2 m | 16.4 m | 18.9 m |
liver | 176 | 422 | (p = 0.83) | (p = 0.43) | ||
lung | 29 | 52 | ||||
lymph node | 9 | 9 | ||||
other | 8 | 8 | ||||
Y90-RE | 96 | 142 | 6.9 m | 6.5 m | 5.3 m | 6.9 m |
(p = 0.86) | (p = 0.21) |
RFA patients
CT-guided HDR brachytherapy patients
Radioembolization patients
Impact of palliative chemotherapy after first interventional treatment
Outcome by patient characteristics
n
| % | |
---|---|---|
All patients | 266 | 100.00 |
Male | 179 | 67.30 |
Female | 87 | 32.70 |
First diagnosis | ||
Mean age (SD) in years | 63.0 (+/− 9.7) | |
Primary tumor | ||
located in Colon (C18) | 151 | 56.77 |
Rectosigmoid junction (C19) | 18 | 6.77 |
Rectum (C20) | 98 | 36.84 |
T1,T2 | 29 | 10.90 |
T3,T4 | 227 | 85.30 |
T missing | 10 | 3.80 |
N0 | 74 | 27.80 |
N1,2 | 179 | 67.30 |
N status missing | 13 | 4.90 |
Synchronous metastases | 166 | 62.41 |
Prior treatment | ||
Systemic chemotherapy | 248 | 93.23 |
Median lines of chemotherapy (range) | 2 (0–8) | |
Radiochemotherapy | 30 | 11.28 |
Surgery for colorectal primary | 263 | 98.87 |
Radiation therapy for colorectal primary | 21 | 7.89 |
Surgery for liver metastases | 91 | 34.21 |
Other local treatment for liver metastases | 40 | 15.04 |
Surgery for lung metastases | 14 | 5.26 |
Surgery for other metastases | 20 | 7.52 |
Local therapy for other metastases | 5 | 1.88 |
First interventional treatment | ||
Mean age (SD) in years | 66,5 (+/−9.6) | |
Age > 70 years | 89 | 33.5 |
Median Karnofsky index (range) in % | 80 (50–100) | |
Liver metastases | 251 | 96.99 |
Liver metastases only | 121 | 45.50 |
Liver involvement > 25% | 45 | 16.92 |
Lung involvement | 100 | 37.60 |
Other | 83 | 31.20 |
≥ 2 organ systems involved | 140 | 52.63 |
Age analysis
Comorbidity analysis (CCI, CACI)
CCIa | condition |
n
| % | p-value° | HR (95% CI) |
---|---|---|---|---|---|
1 | myocardial infarction, coronary artery disease | 36 | 13,5 | 0.38 | 0.85 (0.58–1.23) |
congestive heart failure | 15 | 5,6 | 0.62 | 0.87 (0.51–1.50) | |
peripheral vascular disease | 55 | 20,7 | 0.81 | 0.96 (0.71–1.31) | |
cerebrovascular disease | 13 | 4,9 | 0.58 | 0.85 (0.48–1.52) | |
dementia | 0 | 0 | |||
chronic pulmonary disease | 21 | 7,9 | 0.046 | 0.61 (0.38–0.99) | |
connective tissue disorder | 2 | 0,8 | 0.93 | 0.94 (0.23–3.78) | |
peptic ulcer disease | 2 | 0,8 | 0.006 | 7.40 (1.80–30.50) | |
mild liver disease | 10 | 3,8 | 0.26 | 1.44 (0.76–2.72) | |
diabetes without complications | 42 | 15,8 | 0.94 | 0.99 (0.70–1.40) | |
2 | diabetes with end-organ damage | 17 | 6,4 | 0.74 | 0.92 (0.55–1.52) |
hemiplegia | 1 | 0,4 | 0.70 | 1.48 (0.21–10.61) | |
moderate/severe renal disease | 12 | 4,5 | 0.005 | 2.3 (1.29–4.13) | |
any tumor without metastases (incl. Leukemia, lymphoma) | 34 | 12,8 | 0.89 | 1.03 (0.71–1.50) | |
3 | moderate/severe liver disease | 3 | 1,1 | 0.33 | 1.77 (0.57–5.55) |
6 | metastatic solid tumor (mCRC excluded) | 0 | 0 | ||
AIDS | 0 | 0 | |||
8 | AIDS and any tumor | 0 | 0 |
Variable | Univariate p | HR (95% CI) | Multivariate p* | HR (95% CI) |
---|---|---|---|---|
CCI items p < 0.1 | ||||
Chronic pulmonary disease | 0.046* | 0.61 (0.38–0.99) | 0.30 | 0.76 (0.45–1.28) |
Peptic ulcer disease | 0.006* | 7.40 (1.80–30.50) | 0.17 | 2.75 (0.65–11.69) |
Moderate/severe renal disease | 0.005* | 2.3 (1.29–4.13) | 0.005 | 2.46 (1.32–4.57) |
Comorbidities not included in CCI | ||||
Hypertension | 0.54 | 0.93 (0.72–1.20) | ||
Obesity | 0.32 | 0.77 (0.47–1.28) | ||
Hyperlipidemia | 0.48 | 0.84 (0.51–1.37) | ||
Patient and treatment characteristics | ||||
Age > 70 years | 0.19 | 0.84 (0.64–1.10) | ||
CCI ≥ 3 | 0.41 | 1.15 (0.82–1.62) | ||
Positive N stage of primary | 0.004* | 1.27 (1.08–1.50) | 0.25 | 1.11 (0.93–1.33) |
Synchronous metastases | 0.036* | 1.36 (1.02–1.81) | 0.90 | 0.98 (0.71–1.35) |
Metachronous lymph node metastases | 0.032* | 1.44 (1.03–2.00) | 0.17 | 1.31 (0.89–1.91) |
Metachronous pulmonary metastases | 0.55 | 1.09 (0.83–1.43) | ||
1st/2nd Line vs. 3rd Line treatment | 0.001* | 0.83 (0.77–0.90) | 0.30 | 0.89 (0.72–1.1) |
Salvage treatment in Y90-RE | 0.001* | 2.17 (1.37–3.45) | < 0.001 | 4.35 (3.06–6.17) |