SIR: Interventional radiology treatment bests traditional liver cancer treatments
According to researchers from the Robert H. Lurie Comprehensive Cancer Center at Northwestern Memorial Hospital in Chicago, using the intra-arterial yttrium-90 (Y-90) radioactive isotope to deliver radiation directly to a tumor allows for a higher dose of radiation to be used, and shows promise in prolonging life for many patients with liver cancer.  The findings were showcased at the at the 35th Annual Society of Interventional Radiology’s (SIR) Scientific Meeting in Tampa, Fla.

This interventional radiology treatment allows patients to be treated without the added risk of further liver damage and toxicity, something that traditional chemotherapy drugs and external radiation therapy have proven to bring on in some cases of inoperable liver cancer, said Riad Salem, MD, director of interventional oncology at the center.

"This unique interventional radiology treatment…is a particularly elegant way to give patients a cancer treatment that doesn't harm the healthy cells,” explained Salem. “Patients don't feel sick or have many of the side effects that happen with standard cancer treatments.”

Salem and colleagues recruited 291 hepatocellular carcinoma lung cancer patients and treated each patient with an average of 1.8 Y-90 microspheres (the width of approximately five red blood cells). Each microsphere was inserted through a catheter from the groin into the liver artery supplying the tumor. The isotope then provide local radiation within the tumor vessels and bring on cell death, or “internal radiation,” explained the authors. The researchers reviewed 1,250 scans to assess response and time-to-progression for each patient and survival by stage was assessed.

The researchers said that overall time-to-progression was 7.9 months, “a very promising finding,” noted Salem. Survival times were found to vary by cancer stage. Child-Pugh A patients survived an average of 17.2 months, Child-Pugh B,  7.7 months and by Barcelona Clinic Liver Cancer staging, A, 26.9 months and B, 17.2 months.

The toxicities that were reported included fatigue (57 percent), transient pain (23 percent), nausea/vomiting (20 percent) and exhibited grade 3/4 bilirubin toxicity (5 percent), wrote the authors.

Patients with Child-Pugh A disease, with or without portal vein thrombosis, benefited the most from Y-90 treatment, said Salem, who noted that these findings can be used to design future Y-90 trials utilize the isotope as a potential treatment option to liver cancer patients, as it has been cleared by the FDA for the treatment of inoperable hepatocellular carcinoma.

"For these patients, minimally invasive treatments offer them an option that can give them more time," said Salem. “Liver cancer treatment options are limited. While patients aren't cured, their lives are being extended and their quality of life is improving with the Y-90 microsphere treatment.”