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Y90 for Liver Cancer
Written by Kristi Runyon
Tuesday, 21 June 2011 10:39
They may be tiny, but they're powerful. There's big news about microscopic spheres helping doctors treat the sickest liver cancer patients.
Liver Cancer
Cancer is classified as being primary (the site of origin) or metastatic (spread from another area of the body). The American Cancer Society estimates that 24,120 new cases of primary liver cancer would be diagnosed in the US in 2010. The cancer is more than twice as common in men (17,430 cases in men and 6,690 in women). The average age at the time of diagnosis is 63.
Treating Liver Cancer
The main treatment for primary liver cancer is surgery. If possible, doctors will remove the tumor and a small margin of healthy tissue. However, many patients with liver cancer have significant cirrhosis and the remaining liver may be too diseased to continue performing all the liver’s functions.
Patients with significant liver damage may be candidates for a liver transplant. A cadaveric transplant uses a liver from a deceased donor. A living transplant involves taking a section of liver from a healthy living donor and placing it into the recipient’s body. Liver transplants are typically reserved for patients with smaller tumors that are still localized. Current five-year survival rates after a liver transplant are 60 to 70 percent.
If surgery and transplant are not options, a patient may be a candidate for some type of interventional radiology procedure. Cryoablation is the use of freezing cold temperatures. Radiofrequency ablation is the use of high energy radiofrequency waves to cook the tumor. In both cases, a needle is inserted into the liver to the site of the tumor. Then the cold/heat treatment is applied through the needle.
Another treatment for some patients is chemoembolization. In this procedure, a catheter is fed through the circulatory system to the main blood vessel feeding the tumor. A high dose of an anticancer drug is injected into the catheter. Then, tiny synthetic particles (called an embolic agent) are injected into the catheter. The particles block the flow of blood. This process kills the tumor in two ways. First, it traps a high concentration of the chemotherapy drug inside the tumor. Second, it deprives the tumor of the oxygen and nutrients it needs to survive.
Y90 Radioembolization
Doctors at Indiana University Medical Center in Indianapolis are offering a treatment, called radioembolization, for some patients with liver cancer. The technique uses tiny microspheres of Yttrium-90 (Y90), a radiotherapeutic drug. First, a contrast agent is injected into the blood vessels to enable physicians to visualize the blood vessels. Then a catheter is directed into the artery feeding the tumor. Next, the Y90 microspheres are injected through the catheter into the artery, where they are taken into the tumor. Matthew Johnson, M.D., Professor of Radiology and Surgery, says each microsphere contains a high dose of radiation. When the spheres congregate in the tumor, they release a very high dose of radiation to the cancer cells, hopefully killing much of the tumor.
Johnson says chemoembolization provides a similar method of treatment, except that it uses drugs rather than radiation. However, patients who receive chemoembolization often get very sick from the anticancer medications. Radioembolization, on the other hand causes some fatigue and much less nausea, vomiting or abdominal pain. In addition, tumors tend to take longer to grow back after radioembolization, buying patients more time to get a liver transplant.
Radioembolization is not yet widely available in the U.S. because it requires extra training for interventional radiologists. Johnson says training sessions are being offered for physicians, so he hopes it will eventually be available to more patients.
Research compiled and edited by Barbara J. Fister
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