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Radioembolization of hepatic tumors
#MMPMID24982766
Kennedy A
J Gastrointest Oncol
2014[Jun]; 5
(3
): 178-89
PMID24982766
show ga
Unresectable primary and metastatic liver tumors are a leading cause of cancer
mortality and morbidity. This remains a challenging and key task for every
oncologist despite significant advances that have been made with selective
targeted systemic agents and in technology advances with radiotherapy delivery.
Radioembolization (RE) is a technique of permanently implanting microspheres
containing Yttrium-90 ((90)Y), a beta-emitting isotope with a treatment range of
2 mm, into hepatic tumors. This form of brachytherapy utilizes the unique dual
vascular anatomy of the liver to preferentially deliver radioactive particles via
the hepatic artery to tumor, sparing normal liver parenchyma. The main treatment
inclusion criteria are patients with solid tumors, compensated liver functions,
life expectancy of at least three months, and ECOG performance status 0-2.
Benefit of RE has been proven in patients that have low-to-moderate extrahepatic
disease burden, prior liver radiotherapy, heavy prior chemotherapy and biologic
agent exposure, and history of hepatic surgery or ablation. Most of the clinical
evidence is reported in metastatic colorectal, and neuroendocrine tumors (NET),
and primary hepatocellular cancer. A growing body of data supports the use of RE
in hepatic metastatic breast cancer, intrahepatic cholangiocarinoma, and many
other metastatic tumor types. Side effects are typically mild constitutional and
GI issues limited to the first 7-14 days post treatment, with only 6% grade 3
toxicity reported in large series. Potentially serious or fatal radiation induced
liver disease is extremely rare, reported in only 1% or fewer in major series of
both metastatic and primary tumors treated with RE. Currently, high priority
prospective clinical trials are testing RE combined with chemotherapy in first
line therapy for colorectal hepatic metastases, and combined with sorafenib for
hepatocellular carcinomas (HCCs). Fortunately, this beneficial and now widely
available therapy is being increasingly incorporated into the standard therapy
algorithms of multidisciplinary GI cancer teams worldwide. This form of
radiotherapy differs significantly from daily external beam radiotherapy in many
ways, particularly in dose rate, dosimetric coverage and duration of radiation
delivery, side effects, and patient selection factors. A wealth of experience
using RE in solid tumors exists and ongoing major prospective clinical trials
will soon clarify the role of RE in the management of metastatic colorectal liver
metastases.
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