MDNews - Mid Penn

Professor of Radiolog y, Medicine and Surgery and Director of Interventiona l Oncolog y at the Feinberg School of Medicine of Nor t hwester n Universit y in Chica go, ha s been using radioembolization for 16 yea rs, treating more tha n 1,000 patients with primary liver cancer and more than 1,000 with metastatic cancer that has spread to the liver. Expansion of treatment facilities has a lso inspired a wider focus on Y-90 radioembolization, says William S. Rilling, MD, FSIR , Professor of Radiolog y and Surger y and Vice Chair, Clinica l Operations, in the Department of Radiolog y at the Medica l College of Wisconsin. " The nu mber of t reat ment centers of fer i n g Y-90 ha s expanded throughout the world," Dr. Rilling says. "As people have seen the benefi ts in situations with liver ma lignancy, it is natura l to start thinking of where else we can use this tool. It's not necessarily straightforward to extrapolate, but it's a natura l progression." PROMISING PATIENTS AND SITES Selecting a patient or treatment site that will benefi t from radioembolization relies on a rubric that is much the same no matter the pa r t of the body involved, Dr. Lewa ndowski explains. Loca lly confi ned disease is especia lly amenable to this targeted therapy. " Pat ient s w it h hepat o c el lu l a r c a rci nom a , t he mos t common form of prima r y liver ca ncer, of ten have disease conf ined to the liver," he says. " Locoreg iona l t herapies, such as radioembolization, a re most often the preferred treatment." For met a s t at ic c a nc er s , he explains, the same calculus makes treatment more complex. "While locoregional therapies … often have a role in the treatment of t hese patients, tim ing w it h other treatments — chemotherapy or ot her loc a l t her apie s s uch a s surger y a nd ex ter na l bea m radiation — is mandatory," he says. The nature of the blood supply to the tumor is a lso impor ta nt; h i g h ly v a s c u l a r t u mor s w it h a n isolated blood supply a re considered most a menable to this treatment. With hepatic ca ncer, including metastatic cancers of the liver, the transcatheter intra-arteria l delivery mechanism "ta kes advantage of the dua l blood supply to the liver," Dr. Lewandowski explains. However, that consideration limits possible uses of Y-90 in places other than the liver. " We'd like to be able to do this on lots of tumors outside the liver," Dr. Rilling says, "but the anatomy of the blood supply to other areas is not as isolated and not as straightforward." M e n i n g i o m a s a n d r e n a l c a n c e r o f f e r p r o m i s i n g characteristics for treatment with Y-90, he continues. "In [rena l cancer] the anatomy is not so complex or risky, but in other tumors where it would be interesting to tr y to bring this therapy into play, the anatomy of the blood supply would ma ke things pretty complicated," he says. "To isolate the tumor from norma l tissues is the bottom line." R adioembolization may a lso one day be used to treat noncancerous disease, Dr. Rilling says. "One [nononcolog ic use] is for treating hy persplenism, where people have rea lly big enlargement of the spleen," he says. " Their blood counts will go way down; their platelet counts will go way down. Radioembolization may be a way to reduce the bulk of the spleen. You have less sequestration of blood elements in the spleen. Splenic embolization as done now can be painful and has a signifi cant complication rate. … [T]his could potentia lly be a much more patient-friendly way to do that." ADVANTAGES OF Y-90 RADIOEMBOLIZATION For t he pat ient , ra d ioembol i zat ion w it h Y-9 0 ca n be a convenient treatment with few side e‡ ects. "The therapy is well-tolerated and can be done in … one or two treatment sessions," Dr. Rilling says. "In the liver, for example, if people have bilobar metastases, we ca n do one lobe at a time in two sessions four weeks apa r t. From t he patient perspective, t he t her apy h a s a n endpoi nt , unlike chemotherapy, which may continue for weeks or months at a time." " T h e e v olu t i on of a t r e a t - m e n t f r o m e x p e r i m e n t a l t o s t a nd a rd of c a re dep end s on ev idence prov ided by cli n ica l tria ls," says Dr. Lewa ndowski, who helped write the Society of Interventiona l Radiolog y guide- lines for using Y-90 in metastatic cancers. "Endpoints such as safety and e¢ cacy are most often considered; however, patient qua lity of life is becoming recognized as equa lly important to t hese outcomes. R adioembolization is a n outpatient treatment with proven qua lity-of-life benefi ts over other, similar therapies." ■ " [Radioembolization] really is a very elegant way to deliver high doses of radiation to targets, and that is the beauty of it." WILLIAM S. RILLING, MD, FSIR, PROFESSOR OF RADIOLOGY AND SURGERY AND VICE CHAIR, CLINICAL OPERATIONS, DEPARTMENT OF RADIOLOGY AT THE MEDICAL COLLEGE OF WISCONSIN M D N E W S .C O M /// M D N E W S M I D P E N N ■ 2 017 1 9

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