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Peer-reviewedCC BY 4.0Journal of Gastrointestinal Cancer

Radioembolization for Colorectal Liver Metastases: Indications and Outcomes

  • Sai Reddy1
  • Xiao Wu2
  • Natasha Rodwell3
  • Abdul Khan3
  • Rakesh Navuluri3
  • Virginia Shaffer4
  • Nicholas Fidelman2
  • Qian Yu3
4 affiliations
  1. 1University of Chicago Pritzker School of Medicine, Chicago, IL USA
  2. 2Department of Vascular & Interventional Radiology, University of California San Francisco, San Francisco, CA USA
  3. 3Department of Vascular & Interventional Radiology, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637 USA
  4. 4Department of Colon & Rectal Surgery, University of Chicago, Chicago, IL USA
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Abstract

Colorectal cancer remains a leading cause of cancer-related mortality, with the liver representing the predominant site of metastatic spread. For patients with colorectal liver metastases (CRLM) who are not candidates for surgical resection, systemic chemotherapy provides disease control but rarely achieves durable hepatic responses. Radioembolization with yttrium-90 (Y-90) microspheres, delivered via the hepatic artery to exploit the preferential arterial supply of liver tumors, has emerged as an important locoregional option in this setting. This review examines the current evidence base for radioembolization in CRLM, covering patient selection, indications across lines of therapy, dosimetric advances, and clinical outcomes. Appropriate candidacy requires careful assessment of performance status, hepatic tumor burden, tumor biology, lung shunt fraction, and extrahepatic disease extent, with the strongest outcomes observed in patients selected earlier in their disease course. Randomized controlled trials support second-line and third-line use, while unselected first-line use has not demonstrated a benefit. Dosimetric advances, including multicompartment personalized dosing, radiation segmentectomy, and radiation lobectomy, are enabling ablative and bridge-to-resection strategies in appropriately selected patients. Future investigation should prioritize biomarker-driven patient selection, personalized dosimetry, and combination strategies with systemic therapy to determine whether durable hepatic disease control can translate into a survival benefit.

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Cite

BibTeXRIS
BibTeX
@article{reddy2026radioembolization,
  title = {{Radioembolization for Colorectal Liver Metastases: Indications and Outcomes}},
  author = {Sai Reddy and Xiao Wu and Natasha Rodwell and Abdul Khan and Rakesh Navuluri and Virginia Shaffer and Nicholas Fidelman and Qian Yu},
  journal = {Journal of Gastrointestinal Cancer},
  year = {2026},
  month = oct,
  doi = {10.1007/s12029-026-01617-5},
  url = {https://doi.org/10.1007/s12029-026-01617-5},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Radioembolization for Colorectal Liver Metastases: Indications and Outcomes
AU  - Sai Reddy
AU  - Xiao Wu
AU  - Natasha Rodwell
AU  - Abdul Khan
AU  - Rakesh Navuluri
AU  - Virginia Shaffer
AU  - Nicholas Fidelman
AU  - Qian Yu
PY  - 2026
DA  - 2026/10/27
JO  - Journal of Gastrointestinal Cancer
DO  - 10.1007/s12029-026-01617-5
UR  - https://doi.org/10.1007/s12029-026-01617-5
AB  - Colorectal cancer remains a leading cause of cancer-related mortality, with the liver representing the predominant site of metastatic spread. For patients with colorectal liver metastases (CRLM) who are not candidates for surgical resection, systemic chemotherapy provides disease control but rarely achieves durable hepatic responses. Radioembolization with yttrium-90 (Y-90) microspheres, delivered via the hepatic artery to exploit the preferential arterial supply of liver tumors, has emerged as an important locoregional option in this setting. This review examines the current evidence base for radioembolization in CRLM, covering patient selection, indications across lines of therapy, dosimetric advances, and clinical outcomes. Appropriate candidacy requires careful assessment of performance status, hepatic tumor burden, tumor biology, lung shunt fraction, and extrahepatic disease extent, with the strongest outcomes observed in patients selected earlier in their disease course. Randomized controlled trials support second-line and third-line use, while unselected first-line use has not demonstrated a benefit. Dosimetric advances, including multicompartment personalized dosing, radiation segmentectomy, and radiation lobectomy, are enabling ablative and bridge-to-resection strategies in appropriately selected patients. Future investigation should prioritize biomarker-driven patient selection, personalized dosimetry, and combination strategies with systemic therapy to determine whether durable hepatic disease control can translate into a survival benefit.
SN  - 1941-6628
SN  - 1941-6636
ER  -