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
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