Innovative treatments for liver cancer available
MUSC doctors are the first in the state to provide two innovative treatments
for liver cancer that cannot be treated surgically.
Liver tumors are on the rise, according to Renan
Uflacker, M.D., an MUSC interventional radiologist. The primary causes
are an epidemic of Hepatitis C and high rates of alcoholism, both of which
lead to chronic liver disease or cirrhosis, a condition predisposing patients
to liver cancer. In addition, many patients have other types of cancer that
spread to the liver.
The MUSC interventional radiology team, in conjunction with the oncology service,
provide the two new forms of therapy, using X-ray guidance of a catheter to
bring treatment directly to the cancer cells in the liver. One treatment directs
tiny radioactive spheres to the liver, and the other delivers drug eluting
beads. Both treatments are designed for patients whose liver cancer is not
amenable to surgical treatment.
The radiation treatment—selective internal radiation therapy (SIRT)—involves
placing radioactive spheres (SIR Spheres) directly into the hepatic artery
that feeds the liver. These spheres travel through smaller arteries into the
tumor. The spheres contain a radioactive element, yttrium-90. Because liver
tumors derive most of their blood supply from the hepatic artery while healthy
liver tissue is fed predominantly by the portal vein, injecting the SIR-Spheres
into the hepatic artery delivers them preferentially to the tumor. In order
to deliver the SIR-Spheres, a catheter is placed in the femoral artery of
the upper thigh and threaded through the aorta to the hepatic artery, which
carries them to the tumor where they become lodged and deliver their dose
of radiation over a period of approximately two weeks.
SIRT selectively irradiates the tumor and therefore has the ability to deliver
more potent doses of radiation directly to the cancer cells over a longer
period of time than other available treatments. The radioactivity damages
cancer cells with less effect on healthy liver tissue. While depositing the
radioactive spheres, Uflacker also embolizes, or blocks, the blood supply
to the tumor. The embolization procedure is not new, but combining it with
the radioactive spheres provides a powerful weapon against the tumor.
“This is a unique method of delivering radiation,” said David
Marshall, M.D., an MUSC radiation oncologist. He said it is a good choice
for many patients for whom surgery is not an option. It is generally well
tolerated and patients can go home the same day after the single procedure.
This is in contrast to external beam radiation where the patients must come
back for daily treatment for several weeks in order receive the same amount
of radiation. There also can be more side effects with the external beam radiation.
Marshall said the treatment is relatively new so studies on long-term survival
are sparse. But, he said, one trial which looked at comparing a combination
of SIR-Spheres with chemotherapy versus chemotherapy alone, showed the addition
of the radioactive spheres to the chemotherapy resulted in marked improvement
in patient survival.
The second treatment procedure is very new and being used by very few centers
in the country. It utilizes a similar delivery system to administer doxorubicin,
a highly effective, but toxic anticancer drug. The drug is contained within
small beads that are injected through X-ray guidance into the hepatic artery
that feeds the tumor. The beads provide a controlled release of a high concentration
of the drug to the tumor, and minimize systemic side effects associated with
the drug.
Frank Brescia, M.D., an MUSC oncologist, feels the drug eluting beads provide
advantage particularly to the patient with primary liver cancer. He said that
chemotherapy has been universally disappointing in these patients who are
beyond surgery or transplant. “We look to other modalities of local
treatment,” he said. “Often there is only liver involvement as
well as liver function abnormalities, making general chemotherapy treatment
difficult because the drugs have to be metabolized in the liver and toxicity
may be severe.”
The Catalyst Online
March 17, 2006
Catalyst Online is available at www.musc.edu/catalyst, published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island papers at 849-1778, ext. 201.