Novosti - News

Yttrium-90 studies show promising results to advance in the treatment of liver cancer

Advances in Yttrium-90 (Y-90) radioembolization for liver cancer, a leading cause of
cancer deaths worldwide, are reported in studies in the October Journal of Vascular and
Interventional Radiology (JVIR).

“Results of these two new studies may be beneficial to patients with liver tumors that cannot
be surgically removed,” said Daniel Sze, professor of interventional radiology at Stanford
University Medical Center, Stanford, California, USA. “These studies address methods to
modify the blood vessels of the liver in order to maximise delivery of tumor-killing material

to the targets and to make treatment simpler and safer,” he added. One study showed
promising results in a group of 35 patients in whom the “thirsty tumors” had recruited blood
vessels from outside the liver, a situation that interferes with complete delivery of Y-90
microspheres to the tumors, explained Sze. “These ‘parasitised’ blood vessels were
successfully embolized, or closed off, before administration of Y-90 microspheres,
reestablishing the blood supply from within the liver to enable the successful delivery of the
microspheres to the targeted tumors,” said Sze, senior author of "Embolization of parasitized
extrahepatic arteries to reestablish intrahepatic arterial supply to tumors before Yttrium-90
radioembolization.” “While large, multicentre studies will be necessary to further confirm the
proof of the concept, it is notable because the Stanford University researchers investigated the
idea of simplifying blood supply in order to permit a direct injection of microspheres into the
tumor,” said Salem. “Blood supply to tumors can be complex and can present challenges for
interventional radiologists,” said Riad Salem, who wrote an accompanying commentary in
JVIR. “This research advances the field and provides information that is immediately
applicable to all interventional radiologists when treating their cancer patients,” said Salem,
professor of radiology, medicine and surgery and director of Interventional Oncology,
Division of Interventional Radiology, in the Department of Radiology at Northwestern
University in Chicago, Illinois, USA. “Such research allows interventional radiologists to
tailor treatments to help even the sickest patients achieve a better quality of life,” he
explained. In a related report, “Consolidation of hepatic arterial inflow by embolization of
variant hepatic arteries in preparation for Yttrium-90 radioembolization,” the same team was
able to make treatment simpler and safer by blocking extra (variant) arteries that almost half
of normal people have and utilising collateral (detour) vessels inside the liver to assist in
microsphere delivery. “After blocking these variant arteries, we were able to treat nearly
100% of tumors through the main hepatic artery—taking advantage of the networks of blood
vessels within the liver,” reported Sze. “By embolizing small, less important vessels to the
tumors, one main arterial channel was created that could treat the entire area in a technically
simple and practical way,” Salem explained. He also noted that these principles may be
applicable to other embolization procedures, such as drug-eluting bead chemoembolization
using microspheres that have been impregnated with a chemotherapy agent rather than
radioactivity. “Based on this research, more people who are not good candidates for surgery
will benefit in several ways,” he explained. “Whenever we can administer chemotherapy
directly to a tumor, we limit the drug’s entrance into the patient’s bloodstream and thus lessen
the spread throughout the body and the associated consequences and side effects. This method
of delivering chemotherapy provides an additional advantage by releasing the drug slowly,
destroying the tumor over a greater period of time. The new techniques applied to
radioembolization may also be applied to chemoembolization,” said Salem. In “Toxicities
following radioembolization with yttrium-90 sir-spheres: incidence and contributing risk
factors at a single center,” Thomas Jefferson University researchers examined the results of
liver function tests from 29-571 days following treatment in 81 patients who received 122 Y-
90 infusions to treat primary or metastatic liver tumors. “Radioembolization with resin
microspheres is a safe treatment for patients with unresectable, or inoperable, hepatic
malignancies,” concluded Daniel B Brown, an interventional radiologist and chief of
interventional radiology and interventional oncology at Thomas Jefferson University Hospital
in Philadelphia, USA. “More than 90% of the individuals in our study who received infusions
showed no, or few, changes in liver function. And, generally speaking, almost all patients
receiving Y-90 infusions to treat primary or metastatic liver tumors were asymptomatic after
treatment,” he added. “Studies such as these allow interventional radiologists, whose hallmark
is minimally invasive, targeted treatment of disease, to tailor treatments to help even those
who are not candidates for surgery live longer and achieve a better quality of life,”

commented, Ziv J Haskal, JVIR editor-in-chief, professor of radiology and surgery at the
University of Maryland School of Medicine and vice chair of strategic development and chief
of vascular and interventional radiology, image-guided therapy and interventional oncology at
the University of Maryland Medical Center, Baltimore, USA.