A Cochrane review [Abstract] 1 included 2 studies with a total of 84 subjects. A single study (n=21) compared selective internal radiation therapy (SIRT) and systemic chemotherapy (fluorouracil and leucovorin) with chemotherapy alone. There was a significant improvement in progression free survival (chemo + SIRT: 11.5 months vs. chemo: 4.6 months, p=0.004) and median survival (chemo + SIRT: 29.4 months vs. chemo: 11.8 months, p=0.008) associated with SIRT, both for the total studied population and for those disease limited to the liver. There was an increase in toxicity with the use of SIRT. A second study (n=63) compared SIRT and regional chemotherapy (floxuridine) with regional chemotherapy alone. There was no significant difference in progression free survival (chemo + SIRT: 7.3 months vs. chemo: 5.9 months, p=0.21) and median survival (chemo + SIRT: 17.6 months vs. chemo: 15.9 months, p=0.07) seen with SIRT, in either the total patient group or in the 22 patients with disease limited to the liver. There was no significant increase in toxicity with the addition of SIRT to regional chemotherapy.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes), by indirectness (lack of studies with modern chemotherapy regimens) and by imprecise results (limited study size for each comparison).
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