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Radioembolization (Yttrium-90 Microspheres) for Metastatic Hepatic Malignancies

  • Andrew S. Kennedy
Chapter
Part of the Medical Radiology book series (MEDRAD)

Abstract

Radioembolization is the process of permanently implanting radioactive microspheres into hepatic malignant tumors using the hepatic arterial system for delivery. The most common therapeutic radioisotope used in this form of brachytherapy (placing radioactive sources into or next to a tumor) is yttrium-90 (90Y). Since the earliest attempts to implant liver tumors, the technique has been surprisingly similar—a catheter is situated into a branch of the hepatic artery, and microspheres (25–35 micron diameter) containing 90Y preferentially flow to tumors as opposed to normal liver. The microspheres are small enough to penetrate into the tumors but too large to pass out of the hepatic capillary beds, and so they permanently reside in the tumor. The most common cancers treated with 90Y microspheres are primary hepatocellular carcinoma, and metastatic tumors from primary colorectal, neuroendocrine, pancreas, and breast carcinomas. The toxicity profile is highly favorable for this outpatient procedure with fewer than 2% serious adverse events (gastric ulceration 1–2%, radiation-induced liver failure 0.8%). Overall response rates are 30–75% (RECIST) based on tumor type, and in colorectal cancers, there is a proven survival improvement with 90Y in patients whose chemotherapy agents are no longer inducing a response. The use of radioembolization continues to rapidly grow for a variety of patient subgroups which now include first line therapy in neuroendocrine and colorectal tumor types.

Keywords

Liver Metastasis Median Overall Survival Eastern Cooperative Oncology Group Unresectable Liver Metastasis Substantial Clinical Benefit 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.FACRO Co-Medical DirectorWake Radiology OncologyCaryUSA
  2. 2.Department of Biomedical Engineering, Department of Mechanical and Aeronautical EngineeringNorth Carolina State UniversityRaleighUSA

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