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Radioembolization for the treatment of liver tumors general principles.

Abstract

Radioembolization aims to selectively target radiation to all liver tumors while limiting the dose to normal liver parenchyma. The deposition of yttrium-90 ((90)Y) microspheres delivered through the hepatic artery are preferentially implanted within liver tumors in a 3:1 to 20:1 ratio compared with a normal liver. The principles and mode of action of radioembolization are fundamentally different from the conventional embolization of liver tumors through transarterial embolization or chemoembolization. A meticulous work-up, involving computed tomography scanning, contrast-enhanced magnetic resonance imaging, and transfemoral hepatic angiogram, is essential to assess the appropriateness of the patient for treatment. A simulation of the treatment, done with technetium-99m-labeled macroaggregated albumin particles, which approximate the size of microspheres, is used to identify the shunting of microparticles to the lungs or gastrointestinal tract, thus helping to determine patient selection. Whole-liver or unilobar treatment approaches are chosen according to the anatomic distribution of the tumors, concomitant factors affecting liver function, and institutional preferences. Optimal periprocedural care, discharge planning, and follow-up care are essential to assess treatment response and ensure that short-term side effects of radioembolization are adequately managed. The expanding literature on radioembolization shows that this is an effective treatment for the management of both primary and metastatic tumors.

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  • Publisher Full Text
  • Authors

    Kennedy A, Coldwell D, Sangro B, Wasan H, Salem R

    Source

    American journal of clinical oncology 35:1 2012 Feb pg 91-9

    MeSH

    Carcinoma, Hepatocellular
    Cholangiocarcinoma
    Embolization, Therapeutic
    Hepatic Artery
    Humans
    Liver Neoplasms
    Magnetic Resonance Imaging
    Microspheres
    Patient Selection
    Positron-Emission Tomography
    Survival Rate
    Tomography, X-Ray Computed
    Treatment Outcome
    Yttrium Radioisotopes

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    22363944