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Treatment of Unresectable Primary and Metastatic Liver Cancer with Yttrium-90 Microspheres (TheraSphere®): Assessment of Hepatic Arterial Embolization

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Abstract

In Canada and Europe, yttrium-90 microspheres (TheraSphere®; MDS Nordion, Ottawa, Canada) are a primary treatment option for primary and secondary hepatic malignancies. We present data from 30 patients with hepatocellular carcinoma (HCC) and metastatic liver disease treated with TheraSphere from a single academic institution to evaluate the angiographically evident embolization that follows treatment. Seven interventional radiologists from one treatment center compared pretreatment and posttreatment angiograms. The reviewers were blinded to the timing of the studies. The incidence of postembolization syndrome (PES) was determined as well as objective tumor response rates by the World Health Organization (WHO), Response Evaluation Criteria in Solid Tumors (RECIST), and European Association for the Study of the Liver (EASL) criteria. There were 420 independent angiographic observations that were assessed using the chi-squared statistic. The pretreatment and posttreatment angiograms could not be correctly identified on average more than 43% of the time (p = 0.0004). The postprocedure arterial patency rate was 100%. The objective tumor response rates for all patients were 24%, 31%, and 72% for WHO, RECIST, and EASL criteria, respectively. All of the patients tolerated the procedure without complications and were treated on an outpatient basis, and four patients had evidence of PES. This treatment method does not result in macroscopic embolization of the hepatic arteries, thereby maintaining hepatic tissue perfusion. These data support the principle that the favorable response rates reported with TheraSphere are likely due to radiation and microscopic embolization rather than flow-related macroscopic embolization and ischemia.

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Acknowledgments

We would like to acknowledge the generous assistance of Leslie Herr, Karen Barrett, Angi Courtney, Peggy Gilbertsen and Krystina Sajdak. This work was supported in part by MDS Nordion. RS is a consultant; RDH is an employee of MDS Pharma Services, a contract research organization and subsidiary of MDS Inc. None of the other authors have disclosed a potential conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL, 60611, USA

    Kent Sato, Robert J. Lewandowski, Reed Omary, Howard Chrisman, Scott Resnick, Albert A. Nemcek Jr., Robert Vogelzang & Riad Salem

  2. Department of Radiology, Section of Interventional Radiology, University of Illinois, Chicago, IL, 60612, USA

    James T. Bui

  3. MDS Pharma Services, King of Prussia, PA, and Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL, 60611, USA

    Russell D. Hunter

  4. Department of Hepatology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL, 60611, USA

    Laura Kulik

  5. Department of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL, 60611, USA

    Mary Mulcahy & Riad Salem

  6. Department of Radiology, Section of Interventional Radiology, St. Vincent’s Hospital, Portland, OR, 97225, USA

    David Liu

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  1. Kent Sato
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  2. Robert J. Lewandowski
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Correspondence to Riad Salem.

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Sato, K., Lewandowski, R., Bui, J.T. et al. Treatment of Unresectable Primary and Metastatic Liver Cancer with Yttrium-90 Microspheres (TheraSphere®): Assessment of Hepatic Arterial Embolization. Cardiovasc Intervent Radiol 29, 522–529 (2006). https://doi.org/10.1007/s00270-005-0171-4

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