Book contents
- Frontmatter
- Contents
- FOREWORD
- ACKNOWLEDGMENTS
- CONTRIBUTORS
- PART I PRINCIPLES OF ONCOLOGY
- PART II PRINCIPLES OF IMAGE-GUIDED THERAPIES
- PART III ORGAN-SPECIFIC CANCERS
- 9 Hepatocellular Carcinoma: Epidemiology, Pathology, Diagnosis and Screening
- 10 Staging Systems for Hepatocellular Carcinoma
- 11 Hepatocellular Carcinoma: Medical Management
- 12 Surgical Management (Resection)
- 13 Liver Transplantation for Hepatocellular Carcinoma
- 14 Image-guided Ablation of Hepatocellular Carcinoma
- 15 Embolization of Liver Tumors: Anatomy
- 16 Transcatheter Arterial Chemoembolization: Technique and Future Potential
- 17 New Concepts in Targeting and Imaging Liver Cancer
- 18 Intrahepatic Cholangiocarcinoma
- 19 Medical Management of Colorectal Liver Metastasis
- 20 Surgical Resection of Hepatic Metastases
- 21 Clinical Management of Patients with Colorectal Liver Metastasis Using Hepatic Arterial Infusion
- 22 Colorectal Metastases: Ablation
- 23 Colorectal Metastases: Chemoembolization
- 24 Radioembolization with 90Yttrium Microspheres for Colorectal Liver Metastases
- 25 Carcinoid and Related Neuroendocrine Tumors
- 26 Interventional Radiology for the Treatment of Liver Metastases from Neuroendocrine Tumors
- 27 Immunoembolization for Melanoma
- 28 Preoperative Portal Vein Embolization
- 29 Cancer of the Extrahepatic Bile Ducts and the Gallbladder: Surgical Management
- 30 Extrahepatic Biliary Cancer: High Dose Rate Brachytherapy and Photodynamic Therapy
- 31 Extrahepatic Biliary Cancer/Biliary Drainage
- 32 Surgical and Medical Treatment
- 33 Percutaneous Renal Ablation
- 34 Embolotherapy in the Management of Renal Cell Carcinoma
- 35 Epidemiology, Diagnosis, Staging and the Medical-Surgical Management of Lung Cancers
- 36 Image-guided Ablation in the Thorax
- 37 Interventional Treatment Methods for Unresectable Lung Tumors
- 38 Interventional Neuroradiology in Head and Neck Oncology
- 39 Percutaneous Ablation of Painful Metastases Involving Bone
- 40 Intra-arterial Therapy for Sarcomas
- 41 Prostate Cryoablation: A Role for the Radiologist in Treating Prostate Cancer?
- PART IV SPECIALIZED INTERVENTIONAL TECHNIQUES IN CANCER CARE
- INDEX
- Plate section
- References
24 - Radioembolization with 90Yttrium Microspheres for Colorectal Liver Metastases
from PART III - ORGAN-SPECIFIC CANCERS
Published online by Cambridge University Press: 18 May 2010
Book contents
- Frontmatter
- Contents
- FOREWORD
- ACKNOWLEDGMENTS
- CONTRIBUTORS
- PART I PRINCIPLES OF ONCOLOGY
- PART II PRINCIPLES OF IMAGE-GUIDED THERAPIES
- PART III ORGAN-SPECIFIC CANCERS
- 9 Hepatocellular Carcinoma: Epidemiology, Pathology, Diagnosis and Screening
- 10 Staging Systems for Hepatocellular Carcinoma
- 11 Hepatocellular Carcinoma: Medical Management
- 12 Surgical Management (Resection)
- 13 Liver Transplantation for Hepatocellular Carcinoma
- 14 Image-guided Ablation of Hepatocellular Carcinoma
- 15 Embolization of Liver Tumors: Anatomy
- 16 Transcatheter Arterial Chemoembolization: Technique and Future Potential
- 17 New Concepts in Targeting and Imaging Liver Cancer
- 18 Intrahepatic Cholangiocarcinoma
- 19 Medical Management of Colorectal Liver Metastasis
- 20 Surgical Resection of Hepatic Metastases
- 21 Clinical Management of Patients with Colorectal Liver Metastasis Using Hepatic Arterial Infusion
- 22 Colorectal Metastases: Ablation
- 23 Colorectal Metastases: Chemoembolization
- 24 Radioembolization with 90Yttrium Microspheres for Colorectal Liver Metastases
- 25 Carcinoid and Related Neuroendocrine Tumors
- 26 Interventional Radiology for the Treatment of Liver Metastases from Neuroendocrine Tumors
- 27 Immunoembolization for Melanoma
- 28 Preoperative Portal Vein Embolization
- 29 Cancer of the Extrahepatic Bile Ducts and the Gallbladder: Surgical Management
- 30 Extrahepatic Biliary Cancer: High Dose Rate Brachytherapy and Photodynamic Therapy
- 31 Extrahepatic Biliary Cancer/Biliary Drainage
- 32 Surgical and Medical Treatment
- 33 Percutaneous Renal Ablation
- 34 Embolotherapy in the Management of Renal Cell Carcinoma
- 35 Epidemiology, Diagnosis, Staging and the Medical-Surgical Management of Lung Cancers
- 36 Image-guided Ablation in the Thorax
- 37 Interventional Treatment Methods for Unresectable Lung Tumors
- 38 Interventional Neuroradiology in Head and Neck Oncology
- 39 Percutaneous Ablation of Painful Metastases Involving Bone
- 40 Intra-arterial Therapy for Sarcomas
- 41 Prostate Cryoablation: A Role for the Radiologist in Treating Prostate Cancer?
- PART IV SPECIALIZED INTERVENTIONAL TECHNIQUES IN CANCER CARE
- INDEX
- Plate section
- References
Summary
90Yttrium (90Y) microspheres are 20- to 40-μ particles that emit beta radiation. Because the microspheres are delivered via the hepatic arterial route, the process can be considered “internal” rather than external radiation. The treatment algorithm is analogous to that followed with transarterial chemoembolization (TACE). Clinical history, physical examination, laboratory values and performance status are obtained. Patients are initially evaluated and staged using cross-sectional imaging techniques (computerized tomography [CT], magnetic resonance imaging [MRI], positron emission tomography [PET]). Once a patient is considered a possible candidate for therapy, evaluation using mesenteric angiography followed by treatment on a lobar basis is undertaken. Patients are followed clinically to assess toxicities and response prior to proceeding with treatment to the other lobe. A comprehensive review of the technical and methodological considerations in 90Y has been previously published (1–3).
Two devices are commercially available. Thera- Sphere (glass) was approved in 1999 by the Food and Drug Administration (FDA) under a Humanitarian Device Exemption (HDE) for the treatment of unresectable hepatocellular carcinoma (HCC) in patients with or without portal vein thrombosis who can have appropriately positioned hepatic arterial catheters (4). SIR-Spheres (resin) were granted full pre-marketing approval in 2002 by the FDA for the treatment of colorectal metastases in conjunction with intrahepatic floxuridine (FUDR) (5). Both devices have European approval for liver neoplasia and approvals in various Asian countries.
OVERVIEW
Patients with metastatic cancer to the liver from a colorectal primary tumor may be treated using surgical resection alone, providing a chance for long-term cure.
- Type
- Chapter
- Information
- Interventional OncologyPrinciples and Practice, pp. 280 - 289Publisher: Cambridge University PressPrint publication year: 2008
References
and . Radioembolization with 90yttrium microspheres: A state-of-the-art brachytherapy treatment for primary and secondary liver malignancies: Part 1: Technical and methodologic considerations. J Vasc Interv Radiol, 2006; 17(8): 1251–1278.CrossRefGoogle ScholarPubMed
and . Radioembolization with 90Yttrium microspheres: A state-of-the-art brachytherapy treatment for primary and secondary liver malignancies: Part 2: Special topics. J Vasc Interv Radiol, 2006; 17(9): 1425–1439.CrossRefGoogle ScholarPubMed
and . Radioembolization with yttrium-90 microspheres: A state-of-the-art brachytherapy treatment for primary and secondary liver malignancies: Part 3: Comprehensive literature review and future direction. J Vasc Interv Radiol, 2006; 17(10): 1571–1593.CrossRefGoogle ScholarPubMed
TheraSphere Yttrium-90 microspheres package insert, MDS Nordion, Kanata, Canada. 2004.
SIR-Spheres Yttrium-90 microspheres package insert, SIRTeX Medical, Lane Cove, Australia. 2004.
, , and . Recent advances in the pharmacological treatment of colorectal cancer. Expert Opin Investig Drugs, 2003; 12(3): 423–434.CrossRefGoogle ScholarPubMed
and , 3rd. Bevacizumab in the treatment of colorectal cancer. Expert Opin Biol Ther, 2005; 5(7): 997–1005.CrossRefGoogle ScholarPubMed
. Future directions in the use of antiangiogenic agents in patients with colorectal cancer. Semin Oncol, 2004; 31(6 Suppl 17): 17–21.CrossRefGoogle ScholarPubMed
and . Surgical treatment of liver metastases. Semin Oncol, 2002; 29(2): 107–118.CrossRefGoogle ScholarPubMed
, , , et al. 90Y Microsphere (TheraSphere) treatment for unresectable colorectal cancer metastases of the liver: Response to treatment at targeted doses of 135–150 Gy as measured by (18f) fluorodeoxyglucose positron emission tomography and computed tomographic imaging. J Vasc Interv Radiol, 2005; 16(12): 1641–1651.CrossRefGoogle ScholarPubMed
, , , et al. Reduction of metastatic load to liver after intraarterial hepatic Yttrium-90 radioembolization as evaluated by (18F) fluorodeoxyglucose positron emission tomographic imaging. J Vasc Interv Radiol, 2005; 16(8): 1101–1106.CrossRefGoogle ScholarPubMed
, , , et al. Metabolic response after intraarterial 90Y-glass microsphere treatment for colorectal liver metastases: comparison of quantitative and visual analyses by 18F-FDG PET. J Nucl Med, 2004; 45(11): 1892–1897.Google ScholarPubMed
, , , et al. Evaluating 90Y-glass microsphere treatment response of unresectable colorectal liver metastases by (18F) FDG PET: A comparison with CT or MRI. Eur J Nucl Med Mol Imaging, 2002; 29(6): 815–820.CrossRefGoogle ScholarPubMed
, , , et al. Evaluation of therapy for lymphoma. Semin Nucl Med, 2005; 35(3): 186–196.CrossRefGoogle ScholarPubMed
, , , et al. Phase II trial of chemoembolization for the treatment of metastatic colorectal carcinoma to the liver and review of the literature. Cancer, 1998; 82(7): 1250–1259.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
and . Management of hepatocellular carcinoma. Rev Gastroenterol Disord, 2003; 3(1): 8–24.Google ScholarPubMed
, , , et al. Angiographic considerations in patients undergoing liver-directed therapy. J Vasc Interv Radiol, 2005; 16(7): 911–935.CrossRefGoogle ScholarPubMed
, , , et al. Yttrium-90 microspheres: Radiation therapy for unresectable liver cancer. J Vasc Interv Radiol, 2002; 13(9 Pt 2): S223–229.CrossRefGoogle ScholarPubMed
, , , et al. The effect of catheter-directed CT angiography on Yttrium-90 radioembolization treatment of hepatocellular carcinoma. J Vasc Interv Radiol, 2005; 16(8): 1085–1091.CrossRefGoogle ScholarPubMed
, , , et al. Radioembolization with 90Y microspheres: Angiographic and technical considerations. Cardiovasc Intervent Radiol, 2007; 30(4): 571–592.CrossRefGoogle ScholarPubMed
, , , et al. Recognizing extrahepatic collateral vessels that supply hepatocellular carcinoma to avoid complications of transcatheter arterial chemoembolization. Radiographics, 2005; 25 Suppl 1: S25–39.CrossRefGoogle ScholarPubMed
, , , et al. Yttrium-90 microsphere therapy for hepatic malignancy: Devices, indications, technical considerations, and potential complications. Radiographics, 2005; 25 Suppl 1: S41–55.CrossRefGoogle ScholarPubMed
, , , et al. Technical aspects of radioembolization with 90Y microspheres. Tech Vasc Interv Radiol, 2007 Mar;10(1):12–29.CrossRefGoogle Scholar
, , , et al. Partition model for estimating radiation doses from yttrium-90 microspheres in treating hepatic tumours. Eur J Nucl Med, 1996; 23(8): 947–952.CrossRefGoogle ScholarPubMed
, , , et al. Clinical evaluation of the partition model for estimating radiation doses from yttrium-90 microspheres in the treatment of hepatic cancer. Eur J Nucl Med, 1997; 24(3): 293–298.Google ScholarPubMed
, , , et al. Randomised phase 2 trial of SIR-Spheres plus fluorouracil/leucovorin chemotherapy versus fluorouracil/leucovorin chemotherapy alone in advanced colorectal cancer. J Surg Oncol, 2004; 88(2): 78–85.CrossRefGoogle ScholarPubMed
. Distribution of absorbed dose around point sources of electrons and beta particles in water and other media. J Nucl Med, 1971; Suppl 5: 5–23.Google ScholarPubMed
, , . S Absorbed Dose Per Unit Cumulated Activity for Selected Radionuclides and Organs. New York: Society of Nuclear Medicine, 1975–1976.Google Scholar
, , , et al. Radiation-induced ulceration of the stomach secondary to hepatic embolization with radioactive yttrium microspheres in the treatment of metastatic colon cancer. J Gastroenterol Hepatol, 2004; 19(3): 347–349.CrossRefGoogle ScholarPubMed
SIRTeX Medical Training Manual, SIRTeX Medical, Lane Cove, Australia, 2005.
, , , et al. Treatment of unresectable hepatocellular carcinoma with use of 90Y microspheres (TheraSphere): Safety, tumor response, and survival. J Vasc Interv Radiol, 2005; 16(12): 1627–1639.CrossRefGoogle Scholar
, , , et al. Yttrium 90 resin microspheres for the treatment of unresectable colorectal hepatic metastases after failure of multiple chemotherapy regimens: Preliminary results. J Vasc Interv Radiol, 2005; 16(7): 937–945.CrossRefGoogle ScholarPubMed
, , , et al. Resin 90Y-microsphere brachytherapy for unresectable colorectal liver metastases: Modern USA experience. Int J Radiat Oncol Biol Phys, 2006; 65(2): 412–425.CrossRefGoogle ScholarPubMed
, , , et al. Analysis of radiation-induced liver disease using the Lyman NTCP model. Int J Radiat Oncol Biol Phys, 2002; 53(4): 810–821.CrossRefGoogle ScholarPubMed
and . Incidence of radiation cholecystitis in patients receiving Y-90 treatment for unresectable liver malignancies. J Vasc Interv Radiol, 2004; 15(2 pt 2): S162.Google Scholar
, , , et al. Chemoembolization of liver tumor in a rabbit model: Assessment of tumor cell death with diffusion-weighted MR imaging and histologic analysis. J Vasc Interv Radiol, 2000; 11(10): 1245–1255.CrossRefGoogle Scholar
, , , et al. Randomised trial of SIR-Spheres plus chemotherapy vs. chemotherapy alone for treating patients with liver metastases from primary large bowel cancer. Ann Oncol, 2001; 12(12): 1711–1720.CrossRefGoogle ScholarPubMed
, , and . Selective internal radiation therapy with 90yttrium microspheres for extensive colorectal liver metastases. J Gastrointest Surg, 2001; 5(3): 294–302.CrossRefGoogle ScholarPubMed
, , and . Selective internal radiation therapy (SIRT) with 90yttrium microspheres for extensive colorectal liver metastases. Hepatogastroenterology, 2001; 48(38): 333–337.Google ScholarPubMed
, , . Selective internal radiation therapy (SIRT) for liver metastases with concomitant systemic oxaliplatin, 5-fluorouracil and folinic acid: A phase I/II dose escalation study. ASCO GI Symposium 2005, Miami, Florida.Google Scholar
, , . Selective internal radiation therapy (SIRT) plus systemic chemotherapy with irinotecan: A phase I dose escalation study. American Society of Clinical Oncology, 2005, Orlando, Florida.Google Scholar
, , , , et al. A prospective evaluation of treatment with selective internal radiation therapy (SIR-Spheres) in patients with unresectable liver metastases from colorectal cancer previously treated with 5-FU based chemotherapy. BMC Cancer, 2005; 5(1): 132.CrossRefGoogle ScholarPubMed
, , , et al. Resin 90Y-microsphere brachytherapy for unresectable colorectal liver metastases: Modern USA experience. Int J Radiat Oncol Biol Phys, 2006; 65(2): 412–425.CrossRefGoogle ScholarPubMed
, , , et al. Radioembolization of liver metastases from colorectal cancer using yttrium-90 microspheres with concomitant systemic oxaliplatin, fluorouracil, and leucovorin chemotherapy. J Clin Oncol, 2007; 25(9): 1099–1106.CrossRefGoogle ScholarPubMed
, , , et al. A multicentric phase II clinical trial on intra-arterial hepatic radiotherapy with 90yttrium SIR-Spheres in unresectable, colorectal liver metastases refractory to i.v. chemotherapy: Preliminary results on toxicity and response rates. In Vivo, 2006; 20(6A): 711–714.Google Scholar
, , , et al. Treatment of unresectable metastatic colorectal carcinoma to the liver with intrahepatic Y-90 microspheres: A dose-ranging study. World J Nucl Med, 2003; 2: 216–225.Google Scholar
, , . Treatment with Yttrium-90 microspheres of unresectable metastatic colorectal cancer to the liver: Safety, treatment response and survival. ASCO GI Symposium 2006, San Francisco, California.Google Scholar