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Radionuclide Therapy of Tumors of the Liver and Biliary Tract

Nuclear Oncology

  • 136 Accesses

Abstract

The liver represents a frequent site for both primary cancer and metastatic disease, In these circumstances, liver-directed therapies as cytoreduction via surgery or in situ ablative techniques may influence the natural history of the disease progression and improve clinical outcomes.

Radioembolization (RE) is a selective internal radiotherapy technique in which 131I-lipiodol or 90Y microspheres are infused through the hepatic arteries. It is based on the fact that primary and secondary hepatic tumors are vascularized mostly by arterial blood flow whereas the normal liver perfusion is mostly from the portal network. This enables high radiation doses to be delivered, sparing the surrounding non-malignant liver parenchyma.

Although there are some clinical evidences that RE may play an important role in the management of hepatocellular carcinoma of intermediate or advanced stage and in liver-dominant metastatic colorectal cancer and metastatic neuroendocrine tumors, further randomised clinical trials are mandatory to better assess the potential beneficial and harmful outcomes of trans-arterial radioembolisation either as a monotherapy or in combination with other systemic or locoregional therapies.

In this chapter we discuss some technical aspects, patient selection, current clinical evidence, and future directions of radioembolisation for primary and secondary liver cancer.

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Abbreviations

[18F]FDG:

2-Deoxy-2-[18F]fluoro-d-glucose

5-FU:

5-Fluorouracil, a chemotherapy agent

68Ga-DOTANOC:

68Ga-DOTA-1-Nal3-octreotide

99mTc-HSA:

99mTc-human serum albumin

99mTc-MAA:

99mTc-macroaggregated albumin

99mTcO4 − :

99mTc-pertechnetate

AFP:

Alpha-fetoprotein, a circulating serum marker of hepatocellular carcinoma (and of testicular germ-cell cancer as well)

Bq:

Becquerel unit

BSA:

Body surface area

CA 19–9:

Carbohydrate antigen 19–9, a tumor-associated serum marker

ce-CT:

Contrast-enhanced x-ray computed tomography

CI:

Confidence interval

CR:

Complete response

CRC:

Colorectal cancer

CT:

X-ray computed tomography

DEB:

Drug-eluting bead

DOTA:

1,4,7,10-Tetraazacyclododecane-1,4,7,10-tetraacetic acid

EASL:

European Association for the Study of the Liver

ECOG:

Eastern Cooperative Oncology Group

eV:

Electron volt

GBq:

Giga-Becquerel (109 Becquerel)

Gy:

Gray unit (ionizing radiation dose in the International System of Units, corresponding to the absorption of one joule of radiation energy per kilogram of matter)

HCC:

Hepatocellular carcinoma

HDD:

4-Hexadecyl 2,2,9,9-tetramethyl-4,7-diaza-1,10-decanethiol, a chelating agent

ICC:

Intrahepatic cholangiocarcinoma

IRE:

Irreversible electroporation

keV:

Kiloelectron volt (103 eV)

LSF:

Lung shunt fraction

MBq:

Mega-Becquerel (106 Becquerel)

MeV:

Megaelectron volt (106 eV)

MIP:

Maximum intensity projection

MIRD:

Medical Internal Radiation Dose

MR:

Magnetic resonance

MRI:

Magnetic resonance imaging

NET:

Neuroendocrine tumor

PET:

Positron emission tomography

PET/CT:

Positron emission tomography/computed tomography

PFS:

Progression-free survival

PR:

Partial response

PVT:

Portal vein thrombosis

RE:

Radioembolization

RECIST:

Response evaluation criteria in solid tumors

RFA:

Radiofrequency ablation

RILD:

Radiation-induced liver diseases

ROI:

Region of interest

SD:

Stable disease

SIRT:

Selective internal radiation therapy

SPECT/CT:

Single-photon emission computed tomography/computed tomography

SUV:

Standardized uptake value

SUVmax :

Standardized uptake value at point of maximum

TACE:

Transcatheter arterial chemoembolization

TARE:

Transarterial radioemobilization

VIPoma:

Neuroendocrine tumor producing vasoactive intestinal peptide

WHO:

World Health Organization

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Authors and Affiliations

  1. Regional Center of Nuclear Medicine, University of Pisa, Via Roma 57, 56126, Pisa, Italy

    Giuseppe Boni, Federica Guidoccio, Duccio Volterrani & Giuliano Mariani

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  1. Giuseppe Boni
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  2. Federica Guidoccio
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  3. Duccio Volterrani
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  4. Giuliano Mariani
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Correspondence to Giuseppe Boni .

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  1. Attending Emeritus, Memorial Sloan-Kettering Cancer Center Dept. Radiology, New York, New York, USA

    H. William Strauss

  2. Professor Emeritus, University of Pisa, Pisa, Italy

    Giuliano Mariani

  3. Associate Professor and Director of Nuclear Medicine, University of Pisa, Pisa, Italy

    Duccio Volterrani

  4. Attending Physician, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    Steven M. Larson

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Boni, G., Guidoccio, F., Volterrani, D., Mariani, G. (2016). Radionuclide Therapy of Tumors of the Liver and Biliary Tract. In: Strauss, H., Mariani, G., Volterrani, D., Larson, S. (eds) Nuclear Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-26067-9_51-1

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  1. Latest

    Radionuclide Therapy of Tumors of the Liver and Biliary Tract
    Published:
    05 April 2022

    DOI: https://doi.org/10.1007/978-3-319-26067-9_51-2

  2. Original

    Radionuclide Therapy of Tumors of the Liver and Biliary Tract
    Published:
    05 October 2016

    DOI: https://doi.org/10.1007/978-3-319-26067-9_51-1

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