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Author reply: Radioembolization for colorectal liver metastases

Nature Reviews Clinical Oncology volume 7, page 1 (2010)Cite this article

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We thank Dr. Vente and colleagues for clarification that they used 'any response' (AR) as an end point in their meta-analysis.1 We apologize for this error in our discussion of their study. Although the assessment of disease by cross-sectional imaging using the Response Evaluation Criteria In Solid Tumors (RECIST)2 has improved international standardization in large-scale oncology trials, the anatomical approach to measuring response can be criticized on two levels. Firstly, for many tumors, particularly those treated by radiotherapy or biological agents, there is only a weak relationship between anatomical response and patient benefit. Indeed, clinical trials that use objective response rate (ORR) or AR as their primary end point provide minimal useful information to advise individual patients on how best to improve the prognosis from their condition and direct their personalized care.3,4 Indeed, when patients ask clinicians for guidance about living longer or improving their quality of life, trial statistics on ORR and AR provide little comfort. Secondly, for certain therapies (including radiotherapy) there can be an apparent increase in tumor size, or even the appearance of new lesions, in the event of a favorable patient outcome to treatment. This 'false' increase in size has been well documented following radioembolization (RE) therapy, probably because of intratumoral and peritumoral edema and hemorrhage.5

Although interesting from a research perspective, we do not agree with Dr. Vente and colleagues that functional imaging using fluorine-18 fluorodeoxyglucose (18F-FDG) should be incorporated routinely into tumor assessment. The use of functional and dynamic imaging has not yet been standardized internationally, nor validated prospectively in trials of RE, and it is certainly not recognized by regulatory authorities as a standard of care in the treatment of metastatic colorectal cancer (mCRC). It is not yet clear how 18F-FDG imaging should be incorporated into RE treatment as a means of selecting patients or assessing response, and we recommend that researchers should incorporate 18F-FDG imaging into future clinical trial design to standardize the application of this technique and to establish its utility in evaluating these parameters.

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Acknowledgements

R. A. Sharma is funded by the Higher Education Funding Council for England and the NIHR Biomedical Research Center, Oxford, UK.

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  1. Department of Surgery, Leicester General Hospital, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, UK

Authors and Affiliations

  1. Cancer Research UK-Medical Research Council Gray Institute for Radiation Oncology & Biology, University of Oxford, Old Road Campus Research Building, OX3 7DQ, Oxford, UK

    Nils H. Nicolay, David P. Berry & Ricky A. Sharma

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  1. Nils H. Nicolay
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  2. David P. Berry
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Correspondence to Ricky A. Sharma.

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Competing interests

R. A. Sharma is on the speaker's bureau and receives grant/research support from the following company: Sirtex Medical Ltd. The other authors declare no competing interests.

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Nicolay, N., Berry, D. & Sharma, R. Author reply: Radioembolization for colorectal liver metastases. Nat Rev Clin Oncol 7, 1 (2010). https://doi.org/10.1038/nrclinonc.2009.165-c2

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