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Semin intervent Radiol 2008; 25(1): 048-057
DOI: 10.1055/s-2008-1052306
© Thieme Medical Publishers

Radioembolization of Yttrium-90 Microspheres for Hepatic Malignancy

Ravi Murthy1 , Paresh Kamat1 , Rodolfo Nuñez2 , Riad Salem3
  • 1Division of Diagnostic Radiology, Section of Interventional Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
  • 2Department of Nuclear Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
  • 3Division of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
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Publication History

Publication Date:
19 March 2008 (online)

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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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 3 Fong Y, Cohen A, Fortner J et al.. Liver resection for colorectal metastases.  J Clin Oncol. 1997;  15(3) 938-946
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 6 Breedis C. The blood supply of neoplasms in the liver.  Am J Pathol. 1954;  30 969-77
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 18 Grady E D. Internal radiation therapy of hepatic cancer.  Dis Colon Rectum. 1979;  22(6) 371-375
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 27 Van Hazel G. Selective internal radiation therapy (SIRT) plus systemic chemotherapy with Irinotecan: a phase I dose escalation study. ASCO GI Symposium 2005
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar

Ravi MurthyM.D. 

Division of Diagnostic Imaging, Section of Interventional Radiology, The University of Texas M. D. Anderson Cancer Center

1515 Holcombe Boulevard, Unit 325, Houston, TX 77030-4009

Email: rmurthy@di.mdacc.tmc.edu

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