Yttrium-90

Ytttrium - 90 | Interventional radiologists at Memorial Hospital are treating liver cancer patients with yttrium-90 (Y-90) radioembolization, an outpatient procedure that targets tumors with a high dose of radiation while sparing healthy liver tissue.

For patients with Hepatocellular Carcinoma (HCC) or liver tumors from metastatic colorectal carcinoma, Y-90 radioembolization is “an exciting form of therapy that’s very well tolerated by the patient and can prolong the time to progression and survival,” says Dr. Steven Wegert, one of two radiologists at Radiology & Imaging Consultants, P.C., trained to do the procedure at Memorial.

While it is considered palliative and not a cure, recent studies suggest the procedure is very effective compared with chemoembolization. It causes less pain to the patient, has a low toxicity profile and low complication rate, and can downstage a patient to allow resection or transplant.

“One of the benefits of yttrium - 90 is that it does not preclude future therapy,” Dr. Wegert says. If a n HCC patient is awaiting a transplant, yttrium-90 treatment can halt progression of the disease. For a patient with metastatic colorectal cancer, “yttrium-90 offers an excellent alternative if there has been no response with conventional first and second-line therapy,” he says.

A multidisciplinary team Memorial, including interventional radiologists in the RIC group, evaluates patients to determine suitability for the procedure. Two weeks prior to performing radioembolization, an angiogram is taken to map the patient’s blood supply, identify vessels that communicate from the liver to the gut, and block them with coils.

During the procedure, the radiologist implants microspheres containing the radioactive isotope yttrium-90 through a tiny catheter inserted from the groin into the liver. A smaller catheter is then advanced to the artery supplying the liver tumor, targeting it directly. The tiny spheres lodge at the periphery of the lesion, where growth occurs, causing cell damage and death, and tumor shrinkage. Other areas of the liver are spared. This can even be done in patients who have a blockage of the portal vein.

Adverse events after treatment may include fatigue, which can be managed with steroids; mild pain or discomfort; fever; and night sweats related to tumor necrosis. A CT scan one month post-procedure is performed to assess response to treatment.

Yttrium-90 radioembolization “is an excellent tool in the armamentarium of those fighting liver cancer,” Dr. Wegert says.

Radiology & Imaging Consultants is a multi-specialty radiology group based in Colorado Springs. Its board certified radiologists specialize in minimally invasive therapies, pediatric radiology, digital mammography, musculoskeletal imaging, neuroradiology, PET, CT and MRI scans.

Written for Medical Voyce by Steven Wegert, MD, Radiology Imaging Consultants

References

Gulec S et al. “Safety and efficacy of Y-90 microsphere treatment in patients with primary and metastatic liver cancer: The tumor selectivity of the treatment as a function of tumor to liver flow ratio.” J Transl Med. 2007; 5:15

Kennedy A et al. Resin 909Y-Microsphere Brachytherapy for Unresectable Colorectal Liver Metastases: Modern USA Experience. Int J Radiat Oncol Biol Phys 2006; 65:412-425

Sharma R et al. FOXFIRE: A Phase III Clinical Trial of Chemo-radioembolisation as First-line Treatment of Liver Metastases in Patients with Colorectal Cancer. Clinical Oncol 2008; 20:261-263

van Hazel G et al. Treatment of Fluorouracil-Refractory Patients With Liver Metastases From Colorectal Cancer by Using Yttrium-90 Resin Microspheres Plus Concomitant
Irinotecan Chemotherapy. J Clinical Oncol 2009; 27