Radioembolization of Yttrium-90 Microspheres for Hepatic Malignancy

ABSTRACT

The liver represents a frequent site for primary and secondary neoplasia. Cytoreductive techniques positively influence the outcome of disease progression in these patients. Transhepatic arterial radioembolotherapy utilizing yttrium-90 microspheres represents a recently available in situ therapy that has shown encouraging results in the treatment of these patients. Harnessing the skills of many different specialties, such as interventional radiology, surgical oncology, medical oncology, nuclear medicine, radiation oncology, medical physics, and radiation safety, brings invaluable expertise to the treatment process for a safe and effective radioembolization treatment program.

KEYWORDS

Liver cancer - yttrium-90 - radioembolization

REFERENCES

• 1 Gilbert H A, Kagan A R. Metastasis: incidence, detection and evaluation without histological confirmation. In: Weiss L Fundamental Aspects of Metastasis. Amsterdam; North Holland 1976: 385-405
• 2 Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun M J. Cancer statistics, 2007.  CA Cancer J Clin. 2007;  57(1) 43-66
• 3 Fong Y, Cohen A, Fortner J et al.. Liver resection for colorectal metastases.  J Clin Oncol. 1997;  15(3) 938-946
• 4 Abdalla E K, Vauthey J N, Ellis L M et al.. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases.  Ann Surg. 2004;  239(6) 818-825
• 5 El-Serag H B, Davila J A, Petersen N J, McGlynn K A. The continuing increase in the incidence of hepatocellular carcinoma in the United States: an update.  Ann Intern Med. 2003;  139(10) 817-823
• 6 Breedis C. The blood supply of neoplasms in the liver.  Am J Pathol. 1954;  30 969-77
• 7 Dawson L A, Normolle D, Balter J M, McGinn C J, Lawrence T S, Ten Haken R K. Analysis of radiation-induced liver disease using the Lyman NTCP model.  Int J Radiat Oncol Biol Phys. 2002;  53(4) 810-821
• 8 Fox R A, Klemp P F, Egan G, Mina L L, Burton M A, Gray B N. Dose distribution following selective internal radiation therapy.  Int J Radiat Oncol Biol Phys. 1991;  21(2) 463-467
• 9 Kennedy A S, Nutting C, Coldwell D, Gaiser J, Drachenberg C. Pathologic response and microdosimetry of (90)Y microspheres in man: review of four explanted whole livers.  Int J Radiat Oncol Biol Phys. 2004;  60(5) 1552-1563
• 10 Kennedy A, Salem R, Murthy R et al.. Recommendations for radioembolization of hepatic malignancies using yttrium-90 (Y90) microsphere brachytherapy: a Consensus Panel Report from the Radioembolization Brachytherapy Oncology Consortium.  Int J Radiat Oncol Biol Phys. 2007;  68(1) 13-23
• 11 Leung T W, Lau W Y, Ho S K et al.. Radiation pneumonitis after selective internal radiation treatment with intraarterial 90yttrium-microspheres for inoperable hepatic tumors.  Int J Radiat Oncol Biol Phys. 1995;  33(4) 919-924
• 12 Nutting C KA, Coldwell D, Jones B, Quarnberg D. Coil embolization prevents GI ulcers during yttrium-90 hepatic radioembolization.  J Vasc Interv Radiol. 2004;  15(suppl) 2
• 13 Sarfaraz M, Kennedy A, Lodge M, Li X, Wu X, Yu C. Radiation absorbed dose distribution in a patient treated with yttrium-90 microspheres for hepatocellular carcinoma.  Med Phys. 2004;  31(9) 2449-2453
• 14 Sato K, Lewandowski R J, Bui J T et al.. Treatment of unresectable primary and metastatic liver cancer with yttrium-90 microspheres (TheraSphere): assessment of hepatic arterial embolization.  Cardiovasc Intervent Radiol. 2006;  29(4) 522-529
• 15 Murthy R, Xiong H, Nunez R et al.. Yttrium 90 resin microspheres for the treatment of unresectable colorectal hepatic metastases after failure of multiple chemotherapy regimens: preliminary results.  J Vasc Interv Radiol. 2005;  16(7) 937-945
• 16 Marn C S, Andrews J C, Francis I R, Hollett M D, Walker S C, Ensminger W D. Hepatic parenchymal changes after intraarterial Y-90 therapy: CT findings.  Radiology. 1993;  187(1) 125-128
• 17 Wong C Y, Salem R, Raman S, Gates V L, Dworkin H J. Evaluating 90Y-glass microsphere treatment response of unresectable colorectal liver metastases by [18F]FDG PET: a comparison with CT or MRI.  Eur J Nucl Med Mol Imaging. 2002;  29(6) 815-820
• 18 Grady E D. Internal radiation therapy of hepatic cancer.  Dis Colon Rectum. 1979;  22(6) 371-375
• 19 Mantravadi R V, Spigos D G, Tan W S, Felix E L. Intraarterial yttrium 90 in the treatment of hepatic malignancy.  Radiology. 1982;  142(3) 783-786
• 20 Gray B N, Burton M A, Kelleher D K, Anderson J, Klemp P. Selective internal radiation (SIR) therapy for treatment of liver metastases: measurement of response rate.  J Surg Oncol. 1989;  42(3) 192-196
• 21 Gray B N, Anderson J E, Burton M A et al.. Regression of liver metastases following treatment with yttrium-90 microspheres.  Aust N Z J Surg. 1992;  62(2) 105-110
• 22 Gray B, Van Hazel G, Buck M, Paton G, Burton M, Anderson J. Treatment of colorectal liver metastases with SIR-Spheres plus chemotherapy.  GI Cancer. 2000;  3(4) 249-257
• 23 Gray B, Van Hazel G, Hope M et al.. Randomised trial of SIR-Spheres plus chemotherapy vs. chemotherapy alone for treating patients with liver metastases from primary large bowel cancer.  Ann Oncol. 2001;  12(12) 1711-1720
• 24 Stubbs R S, Cannan R J, Mitchell A W. Selective internal radiation therapy with 90yttrium microspheres for extensive colorectal liver metastases.  J Gastrointest Surg. 2001;  5(3) 294-302
• 25 Van Hazel G, Blackwell A, Anderson J et al.. Randomised phase 2 trial of SIR-Spheres plus fluorouracil/leucovorin chemotherapy versus fluorouracil/leucovorin chemotherapy alone in advanced colorectal cancer.  J Surg Oncol. 2004;  88(2) 78-85
• 26 Sharma R A, Van Hazel G A, Morgan B et al.. Radioembolization of liver metastases from colorectal cancer using yttrium-90 microspheres with concomitant systemic oxaliplatin, fluorouracil, and leucovorin chemotherapy.  J Clin Oncol. 2007;  25(9) 1099-1106
• 27 Van Hazel G. Selective internal radiation therapy (SIRT) plus systemic chemotherapy with Irinotecan: a phase I dose escalation study. ASCO GI Symposium 2005
• 28 Kennedy A S, Coldwell D, Nutting C et al.. Resin 90Y-microsphere brachytherapy for unresectable colorectal liver metastases: modern USA experience.  Int J Radiat Oncol Biol Phys. 2006;  65(2) 412-425
• 29 Lau W Y, Leung W T, Ho S et al.. Treatment of inoperable hepatocellular carcinoma with intrahepatic arterial yttrium-90 microspheres: a phase I and II study.  Br J Cancer. 1994;  70(5) 994-999
• 30 Lau W Y, Ho S, Leung T et al.. Selective internal radiation therapy for nonresectable hepatocellular carcinoma with intraarterial infusion of 90yttrium microspheres.  Int J Radiat Oncol Biol Phys. 1998;  40(3) 583-592
• 31 Dancey J E, Shepherd F A, Paul K et al.. Treatment of nonresectable hepatocellular carcinoma with intrahepatic 90Y-microspheres.  J Nucl Med. 2000;  41(10) 1673-1681
• 32 Carr B I. Hepatic arterial 90Yttrium glass microspheres (TheraSphere) for unresectable hepatocellular carcinoma: interim safety and survival data on 65 patients.  Liver Transpl. 2004;  10(suppl 1) S107-S110
• 33 Geschwind J F, Salem R, Carr B I et al.. Yttrium-90 microspheres for the treatment of hepatocellular carcinoma.  Gastroenterology. 2004;  127(suppl 1) S194-S205
• 34 Goin J E, Salem R, Carr B I et al.. Treatment of unresectable hepatocellular carcinoma with intrahepatic yttrium 90 microspheres: factors associated with liver toxicities.  J Vasc Interv Radiol. 2005;  16 205-213
• 35 Lau W Y, Ho S K, Yu S C, Lai E C, Liew C T, Leung T W. Salvage surgery following downstaging of unresectable hepatocellular carcinoma.  Ann Surg. 2004;  240 299-305
• 36 Kim D Y, Kwon D S, Salem R, Ma C K, Abouljoud M S. Successful embolization of hepatocellular carcinoma with yttrium-90 glass microspheres prior to liver transplantation.  J Gastrointest Surg. 2006;  10 413-416
• 37 Thamboo T, Tan K B, Wang S C, Salto-Tellez M. Extra-hepatic embolisation of Y-90 microspheres from selective internal radiation therapy (SIRT) of the liver.  Pathology. 2003;  35(4) 351-353