Clinical care and technical recommendations for ⁹⁰yttrium microsphere treatment of liver cancer

Abstract

SummarySelective internal radiation therapy (SIRT) with 90 yttrium microspheres is a relatively new clinical modality for treating non-resectable malignant liver tumours. This interventional radiology technique employs percutaneous microcatheterisation of the hepatic arterial vasculature to selectively deliver radioembolic microspheres into neoplastic tissue. SIRT results in measurable tumour responses or delayed disease progression in the majority of eligible patients with hepatocellular carcinoma or hepatic metastases arising from colorectal cancer. It has also been successfully used as palliative therapy for non-colorectal malignancies metastatic to the liver. Although most adverse events are mild and transient, SIRT also carries some risks for serious andrarely -fatal outcomes. In particular, entry of microspheres into non-target vessels may result in radiation-induced tissue damage, such as severe gastric ulceration or radiation cholecystitis. Radiation-induced liver disease poses another significant risk. By careful case selection, considered dose calculation and meticulous angiographic technique, it is possible to minimise the incidence of such complications to less than 10% of all treatments. As the number of physicians employing SIRT expands, there is an increasing need to consolidate clinical experience and expertise to optimise patient outcomes. Authored by a panel of clinicians experienced in treating liver tumours via SIRT, this paper collates experience in vessel mapping, embolisation, dosimetry, microsphere delivery and minimisation of non-target delivery. In addition to these clinical recommendations, the authors propose institutional criteria for introducing SIRT at new centres and for incorporating the technique into multidisciplinary care plans for patients with hepatic neoplasms.

Treatment for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: The Emerging Role for Radioembolization Using Yttrium-90

“…Approximately 50% of patients may experience a mild postembolization syndrome following TARE; however, this is less severe than that observed with TACE and is usually limited to fatigue and constitutional symptoms [37,38]. More severe late complications, such as radiation pneumonitis and gastritis, can be minimized with careful pretreatment mesenteric angiography and technetium-99m macroaggregated albumin scans; these assess gastrointestinal flow and lung shunting and enable accurate calculation of the activity delivered [39,40]. As with all treatments for HCC, patients with a good functional status and adequate liver reserve (Child-Pugh class A to B) and function (normal bilirubin), low tumor burden and no extrahepatic spread are ideal candidates for radioembolization [35].…”

Image-Guided Personalized Predictive Dosimetry by Artery-Specific SPECT/CT Partition Modeling for Safe and Effective 90Y Radioembolization

“…Contemporary techniques, outcomes, and safety data of 90 Y radioembolization are well described in recent literature (1)(2)(3)(4)(5)(6)(7)(8). Disregard for radiobiologic principles of arterial territory-specific 90 Y radionuclide internal dosimetry risks toxicity and fatality (9,10).…”

Clinical implications of the body surface area method versus partition model dosimetry for yttrium-90 radioembolization using resin microspheres: a technical review

“…Current techniques, outcomes and safety data are well described in recent literature [1][2][3][4][5][6].…”

“…It is not the aim of this article to educate the reader on its formulae, as it is well covered elsewhere [2][3][4]7]. Future dosimetric techniques for Y-90 radioembolization based on emerging technologies are also discussed.…”