Selective internal radiation therapy for liver tumours

Abstract

Primary and secondary liver malignancies are common and associated with a poor prognosis. Surgical resection is the treatment of choice; however, many patients have unresectable disease. In these cases, several liver directed therapies are available, including selective internal radiation therapy (SIRT). SIRT is a multidisciplinary treatment involving nuclear medicine, interventional radiology and oncology. High doses of localised internal radiation are selectively delivered to liver tumour tissues, with relative sparing of adjacent normal liver parenchyma. Side effects are minimal and radiation protection measures following treatment are straightforward. In patients who have progressed following chemotherapy, clinical trials demonstrate prolonged liver progression-free survival. SIRT is offered at 10 centres in England via the NHS England Commissioning through Evaluation programme and is approved by the National Institute for Health and Care Excellence for certain liver malignancies. SIRT holds unique promise for personalised treatment of liver tumours.

Minimal-activity PET/CT for efficacy control after SIRT (MAPECSI) – clinical implementation of a resource-saving, liver-focused protocol

“…Even though this technique using the β-emitter yttrium-90 (Y-90) is known since the 1980 s, its comprehensive clinical use has only become relevant in the past 10 years [5,6]. SIRT is applied for primary malignancies like HCC or cholangiocellular carcinoma (CCC) as well as for secondary tumors of extrahepatic primaries, e. g. colorectal cancer, breast cancer, uveal melanomas, and neuroendocrine tumors [7]. F-18-fludeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is diagnostic gold standard of many oncological diseases [8,9].…”

Atenção multiprofissional a paciente portador de carcinoma hepatocelular: um relato de experiência

“…Quando as microesferas migram para o fígado, elas são agitadas em maioria nos pequenos vasos sanguíneos e arteríolas que alimentam o tumor. Dessa maneira, a emissão de partículas βdepositando altas doses diretamente no tumor e o bloqueio das vias que o alimentam perpassa impedem o crescimento do mesmo causando a aniquilação das células cancerosas (Sundram;Buscombe, 2017). Sendo assim, tanto a forma das partículas vítreas, preferencialmente esféricas para evitar arestas cortantes, impedindo danos nos tecidos sadios e hemorragias desnecessárias durante o translado na corrente sanguínea, como o tamanho das partículas são muito importantes para o sucesso da radioembolização (Kim, 2017).…”

Loco-Regional Treatments for Hepatocellular Carcinoma in People Living with HIV

“…However, it seems that IRE has a post-procedural complication rate comparable to that of MWA/RFA, despite the higher number of punctures and the lack of track cauterization in IRE [ 104 ]. Conversely, IRE has an earlier reparative process in the ablation area with consequent earlier shrinkage of the area itself, compared to RFA, appreciable in contrast-enhanced ultrasound (CEUS) [ 105 , 106 ]. Moreover, compared to RFA/MWA, IRE is a more difficult method to deliver the treatment, and is more expensive since it requires general anesthesia to ensure blockage of the musculature during the procedure, as stimulation induced by electrical impulses causes muscle contraction [ 22 ].…”

“…The most widely used radionuclide is represented by yttrium-90 marked on resin microspheres (SIR-Spheres) or embedded in glass microspheres (TheraSpheres™). The size of the microspheres (20–60 µm) allows a peritumoral vascular arrangement, preventing the passage into the venous circulation: they remain in fact confined in the liver and are neither metabolized nor excreted [ 106 ].…”