Surefire Infusion System vs. Standard Microcatheter Use During Holmium-166 Radioembolization

Inclusion Criteria:

* Written informed consent
* Histopathologically confirmed diagnosis of adenocarcinoma of the colon or rectum
* Hepatic metastases with measurable morphological appearance (≥ 1 cm) on cross sectional imaging, located in the right and left hepatic arterial perfusion territory
* Unresectable, liver dominant disease
* Progressive disease after second line chemotherapy or no further chemotherapeutical treatment options due to severe side effects or unwillingness of the patient to undergo systemic chemotherapy
* Age ≥ 18 years
* Expected adequacy of follow-up

Exclusion Criteria:

* World health organization performance score \> 2
* Inadequate bone marrow function (hemoglobin \< 6.0 mmol/l, leukocyte count \< 3.0 x 109/l, platelet count \< 75x 109/l), inadequate liver function (bilirubin \> 35 µmol/l, aspartate aminotransferase / alanine aminotransferase (AST/ALT) \> 5 x upper limit of normal (ULN)) or inadequate renal function (creatinine \> 1.5 x ULN)
* Prior hemihepatectomy
* Compromised biliary system (biliary stent or hepaticojejunostomy)
* Child Pugh score B7 or worse
* Active hepatitis B or C
* Main portal vein thrombosis on CT (or previous portal vein embolization)
* Severe celiac axis stenosis on CT
* Unsuitable hepatic arterial anatomy on CT
* Treatment with systemic chemotherapy within 4 weeks prior to radioembolization
* Previous participation in a study classified as class III by a radiation safety committee
* Bleeding diathesis
* Pregnancy or breast feeding
* Life expectancy \< 3 months
* Patients who are declared incompetent
* Any condition that prevents from safe treatment with radioembolization