Current Role of Selective Internal Radiation with Yttrium-90 in Liver Tumors

Abstract

An expert panel met to review the evidence for selective internal radiation therapy (SIRT) using yttrium-90 microspheres in hepatocellular carcinoma and metastases from colorectal cancer and neuroendocrine tumors. There is now convincing evidence for the safety and efficacy of SIRT in these situations albeit mostly from retrospective cohort studies. There are a number of ongoing prospective randomized controlled clinical trials investigating the role of SIRT in liver tumors; however, data from these trials are still several years away (although the SIRFLOX study has been recently published). In this evolving environment, published evidence and the authors' experience were used to summarize the current and potential role of SIRT in the management of hepatocellular carcinoma of intermediate or advanced stage and in liver-dominant metastatic colorectal cancer and metastatic neuroendocrine tumors.

Enhancing Nanoparticle Accumulation and Retention in Desmoplastic Tumors via Vascular Disruption for Internal Radiation Therapy

“…In a large, stroma-rich tumor model, it may be better to use an isotope with a more cytotoxic, higher energy beta emission that can reach farther away from the source, especially considering the heterogeneous and high stromal delivery of nanoparticles and the fact that treatment with CA4P may further induce regions of higher and lower nanoparticle density. 177 Lu was therefore compared to 90 Yttrium ( 90 Y), a clinically used radioisotope 22, 23 which has a max beta energy of 2.28 MeV and a half-life of 2.67 days. Figure 7A compares the relative decay of 177 Lu and 90 Y over a period of seven days, while Figure 7B compares the previously calculated dose kernels for point sources of the two isotopes in units of absorbed dose (nanogray per decay per h over a given surface area) 24, 25.…”

Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China (2017 Edition)

“…Radioactive particle implantation is an effective local method for the treatment of liver cancer; this treatment includes Y-90 microsphere treatment [109, 110], iodine-131 monoclonal antibody [111], radioactive lipiodol [112], and iodine-125 seed implantation. Radioactive particles that continuously emit low-energy X-rays, γ-rays, or β-rays can maximize the destruction of tumor cells by continuous low-dose radiation after being implanted into tumor tissues or tumor-invaded body canals (portal vein, inferior vena cava, or biliary tract).…”

Hong Kong Consensus Statements for the Management of Unresectable Hepatocellular Carcinoma

“…A recent publication from a Singaporean expert group is generally representative of other guidelines for use of Y-90 TARE to treat HCC. Y-90 TARE is an option as a bridging therapy in patients with early HCC awaiting transplant, in intermediate HCC patients who have failed conventional TACE, or in advanced HCC with vascular invasion [51]. A metaanalysis of 10 studies comparing Y-90 TARE and TACE, including 2 RCTs, concluded these 2 treatments have similar effects in terms of survival, response rate and safety profile, although tumor progression is delayed after TARE [52].…”