4
|
Narsinh KH, Van Buskirk M, Kennedy AS, Suhail M, Alsaikhan N, Hoh CK, Thurston K, Minocha J, Ball DS, Cohen SJ, Cohn M, Coldwell DM, Drooz A, Ehrenwald E, Kanani S, Nutting CW, Moeslein FM, Savin MA, Schirm S, Putnam SG, Sharma NK, Wang EA, Rose SC. Hepatopulmonary Shunting: A Prognostic Indicator of Survival in Patients with Metastatic Colorectal Adenocarcinoma Treated with 90Y Radioembolization. Radiology 2016; 282:281-288. [PMID: 27440733 DOI: 10.1148/radiol.2016152100] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose To determine if high lung shunt fraction (LSF) is an independent prognostic indicator of poor survival in patients who undergo yttrium 90 radioembolization for unresectable liver-dominant metastatic colorectal cancer. Materials and Methods Retrospective data were analyzed from 606 patients (62% men; mean age, 62 years) who underwent radioembolization to treat liver metastases from colorectal adenocarcinoma between July 2002 and December 2011 at 11 U.S. centers. Institutional review board exemptions were granted prior to the collection of data at each site. Overall survival was estimated by using Kaplan-Meier survival and univariate Cox proportional hazards models to examine the effect of LSF on survival and to compare this to other potential prognostic indicators. Multivariate analysis was also performed to determine whether LSF is an independent risk factor for poor survival. Results LSF higher than 10% was predictive of significantly decreased survival (median, 6.9 months vs 10.0 months; hazard ratio, 1.60; P < .001) and demonstrated a mild but significant correlation to serum carcinoembryonic antigen levels and tumor-to-liver volume ratio (Pearson correlation coefficients, 0.105 and 0.113, respectively; P < .05). A progressive decrease in survival was observed as LSF increased from less than 5% to more than 20% (P < .05). LSF did not correlate with the presence of extrahepatic metastases or prior administration of bevacizumab. Conclusion Increased LSF is an independent prognostic indicator of worse survival in patients undergoing radioembolization for liver-dominant metastatic colorectal adenocarcinoma. High LSF correlates poorly to other potential markers of tumor size, such as tumor-to-liver volume ratio or serum carcinoembryonic antigen level, and does not correlate to the presence of extrahepatic metastases. © RSNA, 2016 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Kazim H Narsinh
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Mark Van Buskirk
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Andrew S Kennedy
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Mohammed Suhail
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Naif Alsaikhan
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Carl K Hoh
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Kenneth Thurston
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Jeet Minocha
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - David S Ball
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Steven J Cohen
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Michael Cohn
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Douglas M Coldwell
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Alain Drooz
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Eduardo Ehrenwald
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Samir Kanani
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Charles W Nutting
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Fred M Moeslein
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Michael A Savin
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Sabine Schirm
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Samuel G Putnam
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Navesh K Sharma
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Eric A Wang
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Steven C Rose
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| |
Collapse
|
6
|
van Hazel GA, Heinemann V, Sharma NK, Findlay MP, Ricke J, Peeters M, Perez D, Robinson BA, Strickland AH, Ferguson T, Rodríguez J, Kröning H, Wolf I, Ganju V, Walpole E, Boucher E, Tichler T, Shacham-Shmueli E, Powell A, Eliadis P, Isaacs R, Price D, Moeslein F, Taieb J, Bower G, Gebski V, Van Buskirk M, Cade DN, Thurston K, Gibbs P. SIRFLOX: Randomized Phase III Trial Comparing First-Line mFOLFOX6 (Plus or Minus Bevacizumab) Versus mFOLFOX6 (Plus or Minus Bevacizumab) Plus Selective Internal Radiation Therapy in Patients With Metastatic Colorectal Cancer. J Clin Oncol 2016; 34:1723-31. [PMID: 26903575 DOI: 10.1200/jco.2015.66.1181] [Citation(s) in RCA: 242] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose SIRFLOX was a randomized, multicenter trial designed to assess the efficacy and safety of adding selective internal radiation therapy (SIRT) using yttrium-90 resin microspheres to standard fluorouracil, leucovorin, and oxaliplatin (FOLFOX)–based chemotherapy in patients with previously untreated metastatic colorectal cancer. Patients and Methods Chemotherapy-naïve patients with liver metastases plus or minus limited extrahepatic metastases were randomly assigned to receive either modified FOLFOX (mFOLFOX6; control) or mFOLFOX6 plus SIRT (SIRT) plus or minus bevacizumab. The primary end point was progression-free survival (PFS) at any site as assessed by independent centralized radiology review blinded to study arm. Results Between October 2006 and April 2013, 530 patients were randomly assigned to treatment (control, 263; SIRT, 267). Median PFS at any site was 10.2 v 10.7 months in control versus SIRT (hazard ratio, 0.93; 95% CI, 0.77 to 1.12; P = .43). Median PFS in the liver by competing risk analysis was 12.6 v 20.5 months in control versus SIRT (hazard ratio, 0.69; 95% CI, 0.55 to 0.90; P = .002). Objective response rates (ORRs) at any site were similar (68.1% v 76.4% in control v SIRT; P = .113). ORR in the liver was improved with the addition of SIRT (68.8% v 78.7% in control v SIRT; P = .042). Grade ≥ 3 adverse events, including recognized SIRT-related effects, were reported in 73.4% and 85.4% of patients in control versus SIRT. Conclusion The addition of SIRT to FOLFOX-based first-line chemotherapy in patients with liver-dominant or liver-only metastatic colorectal cancer did not improve PFS at any site but significantly delayed disease progression in the liver. The safety profile was as expected and was consistent with previous studies.
Collapse
Affiliation(s)
- Guy A. van Hazel
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Volker Heinemann
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Navesh K. Sharma
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Michael P.N. Findlay
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Jens Ricke
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Marc Peeters
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - David Perez
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Bridget A. Robinson
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Andrew H. Strickland
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Tom Ferguson
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Javier Rodríguez
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Hendrik Kröning
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Ido Wolf
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Vinod Ganju
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Euan Walpole
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Eveline Boucher
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Thomas Tichler
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Einat Shacham-Shmueli
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Alex Powell
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Paul Eliadis
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Richard Isaacs
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - David Price
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Fred Moeslein
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Julien Taieb
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Geoff Bower
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Val Gebski
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Mark Van Buskirk
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - David N. Cade
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Kenneth Thurston
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Peter Gibbs
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| |
Collapse
|