Repeated radioembolization in advanced liver cancer

Masthoff, Max; Schindler, Philipp; Harders, Fabian; Heindel, Walter; Wilms, Christian; Schmidt, Hartmut; Pascher, Andreas; Stegger, Lars; Rahbar, Kambiz; Wildgruber, Moritz; Köhler, Michael

doi:10.21037/atm-20-2658

Cited by 10 publications

(8 citation statements)

References 25 publications

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“…Limited data on the feasibility of retreatment with radioembolization is available [114][115][116][117]. Based on the published literature, retreatment with radioembolization is feasible, has an acceptable toxicity profile and can be considered, especially in patients who responded to the first radioembolization treatment.…”

Section: Repeated Treatmentmentioning

confidence: 99%

EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds

Weber

Lam

Chiesa

et al. 2022

Eur J Nucl Med Mol Imaging

112

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Primary liver tumours (i.e. hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC)) are among the most frequent cancers worldwide. However, only 10–20% of patients are amenable to curative treatment, such as resection or transplant. Liver metastases are most frequently caused by colorectal cancer, which accounts for the second most cancer-related deaths in Europe. In both primary and secondary tumours, radioembolization has been shown to be a safe and effective treatment option. The vast potential of personalized dosimetry has also been shown, resulting in markedly increased response rates and overall survival. In a rapidly evolving therapeutic landscape, the role of radioembolization will be subject to changes. Therefore, the decision for radioembolization should be taken by a multidisciplinary tumour board in accordance with the current clinical guidelines. The purpose of this procedure guideline is to assist the nuclear medicine physician in treating and managing patients undergoing radioembolization treatment. Preamble The European Association of Nuclear Medicine (EANM) is a professional non-profit medical association that facilitates communication worldwide among individuals pursuing clinical and research excellence in nuclear medicine. The EANM was founded in 1985. These guidelines are intended to assist practitioners in providing appropriate nuclear medicine care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by medical professionals taking into account the unique circumstances of each case. Thus, there is no implication that an approach differing from the guidelines, standing alone, is below the standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set out in the guidelines when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources or advances in knowledge or technology subsequent to publication of the guidelines. The practice of medicine involves not only the science but also the art of dealing with the prevention, diagnosis, alleviation and treatment of disease. The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment. Therefore, it should be recognised that adherence to these guidelines will not ensure an accurate diagnosis or a successful outcome. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources and the needs of the patient to deliver effective and safe medical care. The sole purpose of these guidelines is to assist practitioners in achieving this objective.

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Section: Repeated Treatmentmentioning

confidence: 99%

EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds

Weber

Lam

Chiesa

et al. 2022

Eur J Nucl Med Mol Imaging

112

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“…Most cases require a single session, but, if needed, repeat sessions may be performed in patients with preserved liver, hematologic, and renal function. 10 Theoretical mechanisms for TARE treatment extend beyond cellular damage, including signal transmission from irradiated to non-irradiated cells, p53 production, and immune modulation. Irradiated tumor cells affect the tumor microenvironment and may act as an immunogenic hub, inducing an abscopal effect.…”

Section: Radioembolizationmentioning

confidence: 99%

Practical Considerations When Choosing Chemoembolization versus Radioembolization for Hepatocellular Carcinoma

Behzadi,

Haghani,

D'Souza

et al. 2024

Semin intervent Radiol

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Transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) are common liver-directed therapies (LDTs) for unresectable HCC. While both deliver intra-arterial treatment directly to the site of the tumor, they differ in mechanisms of action and side effects. Several studies have compared their side effect profile, time to progression, and overall survival data, but often these lack practical considerations when choosing which treatment modality to use. Many factors can impact operator's choice for treatment, and the choice depends on treatment availability, cost, insurance coverage, operator's comfort level, patient-specific factors, tumor location, tumor biology, and disease stage. This review discusses survival data, time to progression data, as well as more practical patient and tumor characteristics for personalized LDT with TACE or TARE.

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“…Locoregional intra-arterial therapy is a good option for patients with intrahepatic recurrence who are unable to undergo repeat hepatectomy and may have larger lesions not amenable to ablation. It can also be safely repeated if necessary (147). One retrospective study compared TACE and percutaneous MWA among 275 patients with unresectable intrahepatic recurrence after resection for iCCA (148).…”

Section: Arterially Directed Embolic Therapymentioning

confidence: 99%

Liver-Directed Treatment Options Following Liver Tumor Recurrence: A Review of the Literature

2022

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Recurrence following curative-intent hepatectomy for colorectal cancer liver metastasis, hepatocellular carcinoma, or cholangiocarcinoma is unfortunately common with a reported incidence as high as 75%. Various treatment modalities can improve survival following disease recurrence. A review of the literature was performed using PubMed. In addition to systemic therapy, liver-directed treatment options for recurrent liver disease include repeat hepatectomy, salvage liver transplantation, radiofrequency or microwave ablation, intra-arterial therapy, and stereotactic body radiation therapy. Repeat resection can be consider for patients with limited recurrent disease that meets resection criteria, as this therapeutic approach can provide a survival benefit and is potentially curative in a subset of patients. Salvage liver transplantation for recurrent hepatocellular carcinoma is another option, which has been associated with a 5-year survival of 50%. Salvage transplantation may be an option in particular for patients who are not candidates for resection due to underlying liver dysfunction but meet criteria for transplantation. Ablation is another modality to treat patients who recur with smaller tumors and are not surgical candidates due to comorbidity, liver dysfunction, or tumor location. For patients with inoperable disease, transarterial chemoembolization, or radioembolization with Yttrium-90 are liver-directed intra-arterial therapy modalities with relatively low risks that can be utilized. Stereotactic body radiation therapy is another palliative treatment option that can provide a response and local tumor control for smaller tumors.

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Repeated radioembolization in advanced liver cancer

Cited by 10 publications

References 25 publications

EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds

EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds

Practical Considerations When Choosing Chemoembolization versus Radioembolization for Hepatocellular Carcinoma

Liver-Directed Treatment Options Following Liver Tumor Recurrence: A Review of the Literature

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