Radioembolization for liver cancer treatment

Radioembolization is an exclusive embolization method performed using catheter angiography and microspheres loaded with radioactive material (Yttrium 90). These microspheres are directly given into the cancerous tissue via vessels and radiation energy kills cancer tissue.

Which cancer types are treated with radioembolization?

Radioembolization is used to treat liver cancers. It can be applied in primary cancers (HCC and cholangiocarcinoma) originating from the liver itself or in secondary cancers (metastasis) which spread from another region like colon, breast, neuroendocrine tumors, etc. to the liver. It is a first-line treatment method in primary liver cancers, which are not eligible for surgery. It is usually performed in metastatic cases with limited or no response to systemic chemotherapy or even as an adjunct to systemic chemotherapy. It can be performed in scenarios when chemoembolization may not be suitable or hazardous, e.g. portal vein thrombosis, larger tumors, salvage therapy, etc. Moreover, it can be conducted as a bridge to surgery, and sometimes makes patients suitable for surgery or transplantation.

What are the advantages of radioembolization ?

It is a locoregional treatment which means it is applied directly to the cancerous tissue. Therefore, treatment with internal radiation is very effective almost for every type of liver cancers.  It is quite efficient and safe even in situations when other forms of embolization may not be suitable or hazardous, for e.g. portal vein thrombosis, larger tumors, salvage therapy, etc. It does not harm other organs, and its greatest advantage is that it does not cause systemic side effects. It can be performed as an outpatient procedure without the need of painkillers or other medications. Up to 70-95% of patients with different types of liver cancer respond positively to this treatment method.

How is radioembolization performed?

Radioembolization treatment is performed by a specially trained Interventional Radiologist having specialized in this field and with international qualifications (such as CIRSE).There are two steps taken 7-10 days apart for radioembolization. On the first step, a thorough angiography is done to map the vessels, and a nuclear medicine tracer is injected through the catheter to calculate effective treatment dose without a harmful extratumoral deposit. This first step may be considered as a simulation of therapy. On the second step, angiography is performed to administer Yttrium 90 for optimal radioembolization treatment. Angiography and nuclear medicine scans take about 2-3 hours each. The patient may be discharged 4-6 hours after the procedures. So, at most one-day hospital stay is enough. Some patients are discharged on the same day without hospitalization.

Radioembolization is a treatment, not a cure. Scientific studies have proven its efficacy. It has been shown that it extends the lifespan as well as increasing the quality of life. When compared with the best supportive treatment, it is emphasized that radioembolization therapy is superior. The final clinical outcome is closely related to the stage of the disease and general condition of the patient.