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Liver Cancer
Figure 2: Technique and Results of Yttrium-90 Transarterial Radioembolization
A B
CDE
A. Right hepatic arteriogram demonstrating a vascular mass in the medial portion of the
right lobe.
B. Subselective catheterization of the artery supplying the hepatocellular carcinoma (HCC).
Yttrium-90 (
90
Y) infusion was carried out from this position to spare as much normal liver
as possible.
C. Contrast-enhanced computed tomography (CT) scan prior to treatment demonstrating the
HCC with good correlation with the angiogram.
D. Contrast-enhanced CT scan four weeks following
90
Y infusion. Note there is still some
contrast enhancement in the rim and surrounding the tumor. This may represent persistent
enhancing tumor, or radiation-induced hepatitis in the zone of liver surrounding the tumor.
E. Contrast-enhanced CT scan six months following therapy. Note the absence of enhancement
in the tumor. There is a small degree of tumor shrinkage as well.
For their entire 108-patient cohort, a significant trend toward longer eight of 34 patients were transplanted. In this group of patients the overall
median survival was seen in the non-PVT group (467 days, 15.6 months) survival was 84, 54, and 27% at one, two, and three years, respectively.
compared with the others (p=0.005). Interestingly, this trend was not Median survival for the entire 35-patient cohort was 800 days.
5
We
maintained in the group of patients with cirrhosis (385 days, 12.8 reported the case of a patient who is alive and remains tumor-free 24
months; p=0.10), but was maintained in patients without cirrhosis months post-orthotopic liver transplantation (OLT) after
90
Y microsphere
(p=0.02). The authors concluded that patients without cirrhosis and radioembolization applied for treatment of a large HCC.
55
without PVT had the highest survival observed in the study (813 days,
27.1 months; p=0.02).
53
Adverse Events
Based on clinical experience with
90
Y microspheres, certain possible
It has also been reported that in a 150-patient cohort with unresectable adverse reactions have been identified. In previous studies some of
HCC, treated with
90
Y microspheres, 19 of 34 patients with UNOS stage T3 these adverse events were reported as severe, and few of them have
disease and available pre- and post-treatment imaging were successfully been life-threatening or fatal. Clinical adverse events have been
downstaged to T2. When analyzed as a cohort, the 34 patients had a classified into hepatic (hyperbilirubinemia, ascites, increased
aminotransferases, alkaline phosphatase, prothrombin time,
encephalopathy, liver failure), gastrointestinal (gastric/duodenal ulcer,
A major contributor to the improved
nausea, cholecystitis), hematological (lymphopenia), pulmonary (pleural
effusion and aspiration pneumonia), renal (hepatorenal syndrome),
quality of life of patients receiving
90
Y
circulatory (edema, hypotension, hypertension), infectious (spontaneous
microsphere radioembolization is the
bacterial peritonitis), and others (allergic reaction, hyponatremia,
fatigue, malaise, fall).
6,51,53,56
Kulik et al. reported that 9% of patients had
absence of an embolic effect to the
vague abdominal pain. In this cohort of patients there were no
hepatic artery distribution.
significant complications or mortalities at either treatment center
secondary to the technical aspects of radioembolization; nevertheless,
there was one death in the follow-up period that was possibly attributed
significant decrease in tumor size (p<0.0001). The median pre-treatment to treatment. Geschwind et al. studied an 80-patient cohort and
tumor size was 5.6cm and the median post-treatment tumor size was reported that 22 patients (28%) had at least one hepatic event, four
4.3cm. The median reduction in tumor size for all 34 patients was 49%. patients (5%) had at least one gastrointestinal event, and 10 patients
The authors report one patient who underwent right hepatectomy 40 (13%) had at least one pain event associated with
90
Y microsphere
days following treatment; 11 of 34 patients were downstaged to RFA and treatment. Of the 80 patients, only eight had life-threatening events and
68 US ONCOLOGY
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