Liver Radioembolization Doubles Survival Time

Palliative Y90 treatment may get earlier application

Patients with primary hepatocellular cancers who receive Y90 liver embolization therapy can see life expectancy stretch from 7 to 8 months to 2 to 3 years.

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With this procedure, radioactive (Y90) resin or glass-based particles are delivered by catheter and provide a continuing radiation dose for approximately three and a half weeks to targeted tissues. The results typically are documented via imaging three and six months out. It can benefit patients whose disease is in the liver, or liver dominant disease in which the liver may have responded well to chemotherapy but the liver metastasis is still progressing.

Cholangiocarcinoma is sometimes intrahepatic and also responds well to radioembolization, says Gordon McLennan, MD, Cleveland Clinic Department of Interventional Radiology and Bioengineering. In rare cases, radioembolization also can help breast cancer metastasis to the liver. For instance, if other metastases throughout the body respond to chemotherapy, but a liver tumor does not.

“Unfortunately, most of the time patients with metastatic breast cancer have fairly widespread cancer elsewhere if it has metastasized to the liver. Occasionally, the disease is well controlled elsewhere but in the liver it is progressing,” says Abraham Levitin, MD, Clinical Director, Interventional Radiology.

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New Rad Applications

Radioembolization is FDA approved for the treatment of colorectal cancer with liver-dominant metastasis. It’s typically given as a third-line palliative treatment following first and second-line chemotherapy. Now, Cleveland Clinic is participating in study of the value of radioembolization earlier in the treatment cycle, in conjunction with second-line chemotherapy.

Cleveland Clinic is also evaluating another particle type, TheraSphere®, in which are small glass spheres made radioactive in a nuclear reactor, for hepatocellular and colorectal cancers. The TheraSphere® device is currently designated a Humanitarian Use Device by the FDA for patients with primary liver cancer.

Oncology Partnership a Must

“When we treat patients with oncologic disease of the liver, it is critical that there be a team approach because there are some really good chemotherapies and what we do in interventional oncology can’t be viewed in isolation of the overall medical oncology,” says Dr. McLennan.

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Cleveland Clinic‘s  interventional radiology team consults  with radiation oncologists, medical oncologist, hepatologists and liver surgeons to discuss the best comprehensive course of care – radioembolization is one tool on the spectrum, from resection and transplantation to chemotherapies, chemo embolization, ablation and radiation oncology, as well as clinical trial participation.  Interventional radiologists also work closely with referring oncologists to time radioembolization during a chemo holiday and immediately start up chemo therapy following the procedure.

“With oncologists working with us on combined treatment, sometimes we can downstage a patient. That’s a typical scenario that comes up with cancer patients just beyond the criteria for liver transplant or resection,” says Dr. Levitin.

Alok Khorana, MD, Cleveland Clinic Department of Solid Tumor Oncology, adds, “With its potential high impact on survival, radioembolization is a tool that we factor into the overall cancer care plan when the liver is involved. Interventional Radiology works well with oncologists to coordinate the timing of the procedure with chemotherapy treatment.”