Selective internal radiation therapy with SIR-Spheres in hepatocellular carcinoma and cholangiocarcinoma

Abstract

Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) often present at stages where patients have limited treatment options. Use of selective internal radiation therapy (SIRT) with yttrium-90 (Y-90) resin microspheres has progressed as data increasingly speak to its utility in patients with both intermediate and late stage disease in these cancers. In anticipation of the pending completion of several prospective randomized controlled multicenter studies exploring the use of Y-90 resin microspheres in primary liver cancers, this article outlines mechanisms involved in SIRT administration and reviews key efficacy and safety data that are currently available in the literature involving use of this therapy in both HCC and ICC.

Prognostic Factors for Overall Survival in Advanced Intrahepatic Cholangiocarcinoma Treated with Yttrium-90 Radioembolization

“…There are a number of different local-ablative treatment options for unresectable and chemorefractory ICC, i.e., radiofrequency ablation (RFA), intra-arterial chemotherapy, transarterial chemoembolization (TACE), and radioembolization (TARE). Since the first reports, 90 Y radioembolization has been shown to be an effective method for both primary liver cancer, especially HCC, as well as secondary liver cancer, with the most existing evidence in metastatic colorectal cancer [8,9]. There is an increasing number of reports on the use of 90 Y radioembolization for intrahepatic cholangiocarcinoma, but the evidence of resin-based 90 Y microspheres in the treatment of unresectable and chemorefractory ICC is still limited [3,[10][11][12][13][14].…”

Histopathological changes resulting from selective internal radiotherapy (SIRT)

“…Delivery of radiation directly to liver tumors with Y 90 microspheres allows a therapeutic dose that should be preferentially absorbed by the tumor tissue . Clinical experience with Y 90 microspheres dates to the 1960s, and SIRT has emerged as a widely used therapeutic strategy . Even though many patients have been treated by SIRT, there is surprisingly little data on specific anatomic and histopathologic changes after SIRT.…”

“…2 Clinical experience with Y 90 microspheres dates to the 1960s, and SIRT has emerged as a widely used therapeutic strategy. [5][6][7] Even though many patients have been treated by SIRT, there is surprisingly little data on specific anatomic and histopathologic changes after SIRT. As most patients with metastatic cancer or primary liver tumors treated by SIRT are not scheduled for liver surgery, little tissue is available for studying the effects of internal radiation on both tumor and non-tumor liver tissues.…”

Transarterial radioembolization for liver tumors as neoadjuvant therapy: three case reports

“…In general, indication for this procedure occurs due to progression of liver lesions, in cases of failure with conventional systemic therapy, surgical therapy (resection or transplantation) or even other locoregional modalities, such as chemoembolization or ablation. (1,4,5) The neoadjuvant objective of this treatment is still controversy, but selected cases of injures initially considered unresectable, when undergoing TARE, are reclassified as candidates to the curative therapy. (4,6,7) ❚ OBJECTIVE To report 3 cases of liver tumors in which transarterial radioembolization of the liver was used as a neoadjuvant therapy.…”