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Yttrium 90 Microspheres for the Treatment of Hepatocellular Carcinoma

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Book cover Multidisciplinary Treatment of Hepatocellular Carcinoma

Part of the book series: Recent Results in Cancer Research ((RECENTCANCER,volume 190))

Abstract

Yttrium-90 microspheres are radioactive particles which are increasingly being employed for treating patients with unresectable hepatocellular carcinoma (HCC). The procedure is called radioembolization. It involves the injection of micron-sized embolic particles loaded with a radioisotope by use of transarterial techniques. Because of the sensitivity of liver parenchyma and relative insensitivity of tumor, external radiation has played a limited role in treating HCC. 90Y administered via arterial route directs the highly concentrated radiation to the tumor while healthy liver parenchyma is relatively spared due to its preferential blood supply from portal venous blood. This technique has proven useful for the majority of patients with HCC as most of them present in advanced stage, beyond potentially curative options (resection/liver transplantation). 90Y microspheres can be used in downstaging large tumors to bring within transplantable criteria, in patients with portal venous thrombosis due to tumor invasion and as palliative therapy. There are two available devices for 90Y administration; TheraSphere® (glass based) and SIR-Spheres® (resin based). The procedure is performed on an outpatient basis. The incidence of complications is comparatively less and may include nausea, fatigue, abdominal pain, hepatic dysfunction, biliary injury, fibrosis, radiation pneumonitis, GI ulcers, and vascular injury; however, these can be avoided by meticulous pretreatment assessment, careful patient selection, and adequate dosimetry. This article explores the technical and clinical aspects of 90Y radioembolization with keeping emphasis on patient selection, uses, and complications.

Riad Salem is supported in part by NIH grant CA126809.

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Conflict of Interest

Riad Salem is advisor to MDS Nordion and Sirtex Medical. None of the other authors have any conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA

    Khairuddin Memon, Robert J. Lewandowski, Ahsun Riaz & Riad Salem

  2. Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA

    Riad Salem

  3. Department of Radiology, Interventional Oncology, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA

    Riad Salem

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  1. Khairuddin Memon
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  2. Robert J. Lewandowski
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Correspondence to Riad Salem .

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  1. M.D. Anderson Cancer Center, Dept. Surgical Oncology, University of Texas, Holcombe Blvd. 1515, Houston, 77030, Texas, USA

    Jean-Nicolas Vauthey

  2. , Dept. of Surgical Oncology, MD Anderson Cancer Center, Holcombe Boulevard, Unit 444 1515, Houston, 77030, USA

    Antoine Brouquet

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Memon, K., Lewandowski, R.J., Riaz, A., Salem, R. (2013). Yttrium 90 Microspheres for the Treatment of Hepatocellular Carcinoma. In: Vauthey, JN., Brouquet, A. (eds) Multidisciplinary Treatment of Hepatocellular Carcinoma. Recent Results in Cancer Research, vol 190. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-16037-0_14

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