MDNews - Cleveland-Akron-Canton

Small Particle Technology for Liver Disease When surgery is not an option for patients with cancer of the liver, Akron General Medical Center now offers selective internal radiation therapy utilizing novel small particle technology. The goals are to control the disease locally and extend patient survival. ���The small particle technology we use at Akron General Medical Center is called SIR-Spheres,��� says Dr. Isaacs, a board-certified interventional radiologist who completed his fellowship training at Cleveland Clinic. ���SIR-Spheres are glass beads 32 microns in size (about one-third the width of a human hair) that contain beta radiation emitting yttrium with a half-life of 60 hours. They���re used only in the liver for primary hepatic cellular carcinoma and some metastatic disease to the liver, and usually after conventional therapy has failed.��� He explains that the liver has a dual blood supply: the portal vein which supplies 80% of the liver���s blood, and the hepatic artery which supplies the rest. Liver tumors obtain all of their blood supply from the hepatic artery, offering an ideal method of delivering radiation to the tumor ��� through the bloodstream. ���The particles are injected via catheter through the hepatic artery into the tumor itself where they lodge and emit radiation,��� says Dr. Isaacs, who points out that the actual infusion takes about 15 minutes. ���Most of the radiation is delivered by the particles within 14 days, and most of it is gone after 30 days.��� To determine a patient���s candidacy for SIR-Sphere treatment, Dr. Isaacs obtains a CT scan or MRI to estimate what percentage of the patient���s liver is involved with the tumor and determine whether the treatment can be done. A patient whose entire liver is involved is not a good candidate. However, a patient with isolated involvement in both the right and left lobes may be eligible for the treatment, since one lobe at a time can be treated. ���The CT and MRI help us determine if there will be enough hepatic reserve after treatment. They also help us estimate how many beads or how much y90 is needed to effectively treat the tumor,��� he says. A treatment ���test run��� is then done a week or two before the scheduled IMAGE COURTESY OF DR. DAVID ISAACS and the masses ��� was produced using the Pathfinder software,��� Dr. Lowe explains. ���From that, the resection plane was planned.��� With a preoperative plan in place, Dr. Lowe was able to track during surgery where he was and where he was going by identifying points on the anatomy with the image in front of him. As a result, he was able to navigate around, with sufficient margin, the metastasis without resecting the right portal vein. And what would have been a 60% resection of the patient���s liver ended up being a 20% resection. Dr. Lowe saved 40% more of the patient���s liver. ���So the benefit of this system to the surgeon is better precision which translates into less trauma and less blood loss for the patient, and hopefully better outcomes,��� says Dr. Lowe. He predicts that use of this system will eventually be expanded to other organs, most likely the pancreas. He feels the real future of the technology, however, is in its integration into robotic and laparoscopic surgery systems. ���You can imagine situations where you���re sitting at a screen manipulating the surgical instruments, having both the visualization of the patient���s anatomy along with a 3-D image that���s guiding your resection in a very specific way,��� he says. Selective angiogram of the hepatic artery during radiomicrosphere intra-arterial therapy in a patient with a metastatic neuroendocrine tumor. Note the coils from prior nontarget branch embolization. infusion. This involves a planning angiogram of the hepatic arterial vasculature and an embolization of the gastroduodenal artery and the right gastric artery. Once this is done, a macro aggregated albumin (MAA) study is completed to ensure there are no significant levels of radiation shunting from the liver to the lungs. Dr. Isaacs explains that while this treatment is not necessarily curative, it can stop tumor progression and shrink tumors significantly. It can also help prolong the patient���s life by one to two years. ���It���s a viable option for isolated disease when conventional therapy has failed,��� says Dr. Isaacs. For more information, contact Dr. Kevin Lowe at (330) 344-4800 or Dr. David Isaacs at (330) 344-6450 or (330) 344-6248 or visit www.agmc.org. ��� JANUARY- FEBRUARY 2013 ��� MDNEWS.COM ��� MD News Cleveland/Akron/Canton | 27

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