Clinical

Radioactive microsphere therapy an option for liver cancer with poor portal flow

Last Updated: 2004-04-28 12:50:08 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Intra-arterial injection of radioactive Yttrium-90 glass microspheres (ThereSphere, MDS Nordion, Ottawa, Canada) appears to be safe and well tolerated in patients with unresectable hepatocellular carcinoma (HCC) and portal vein thrombosis (PVT), new research indicates.

This relatively new treatment involves the delivery of Yttrium-90 loaded insoluble glass microspheres directly to the tumor via the hepatic artery. The radioactive beads stick to the tumors where they release pure beta radiation, producing a highly localized effect while sparing normal tissue.

The treatment is currently approved in the U.S. for use only in patients with inoperable HCC who have an adequate level of liver function.

The aim of the current study was to determine the safety and tolerability of Yttrium-90 microsphere therapy in patients with unresectable HCC with compromised portal venous flow in one or both first order and related segmental portal venous branches without evidence of cavernous transformation.

"This analysis is important," Dr. Riad Salem of Northwestern Memorial Hospital in Chicago and colleagues write, because patients in this category are usually considered too high risk for embolization therapy.

Fifteen such patients received a total of 29 infusions of Yttrium-90 microsphere therapy. There were no procedural complications and treatment was well tolerated by all patients, the team reports in the April issue of the Journal of Vascular and Interventional Radiology.

In patients without evidence of disease progression, there appeared to be no clinically significant change in bilirubin, a marker of liver toxicity.

In a statement, Dr. Salem said he is "encouraged" by these preliminary results of from a single center study.

In his experience, "many patients that are failing other treatments are having good disease control with Yttrium-90 microsphere treatment. While most aren't cured," he said, "we are extending their lives and improving their quality of life. Hopefully we will be able to offer this to more patients with inoperable primary hepatocellular carcinoma with obstructed blood flow, who have been labeled 'high risk' for other treatment options."

J Vasc Interv Radiol 2004;15:335-345.