Interventional applications to liver tumors

Interventional radiological applications used in the treatment of liver cancers help high-dose radiation to directly affect the tumor without damaging peripheral organs and tissues.

Surgical, medical and radiological interventions engage an important place in the treatment of cancer. Studies conducted in these areas are aimed at ensuring that patients achieve the highest treatment rate with the fewest side effects. One of them is Yttrium-90  Microsphere treatment applied to liver tumors. The method, that is based on the principle of directly delivering high doses of radiation to the tumor in the liver with the help of a catheter instead of classical radiotherapy treatment, also reduces prevalence of a number of possible side effects. We learned about this treatment from Interventional Radiology specialists at Memorial Şişli Hospital.

What is the importance of interventional radiology applications in cancer treatments?

Types of interventional radiological applications in the treatment of cancer and their effectiveness have been increasing with developing technology in recent years. Major ones of these treatment include radiofrequency (RF) and microwave (MW) ablation treatments that are defined as burning tumor with a needle inserted into the tumor under the guidance of imaging, and chemoembolization and radioembolization (Yttrium-90 ) in which high dose chemotherapeutic medications or radioactive isotope-induced medications are administered both to block the veins for the purpose of disconnecting the feeding of the tumor by reaching the tumor from blood veins via angiographic techniques and to ruin them at the same time. These methods, which can provide complete treatment for small tumors at an early stage, can be used to slow down and stop the spread of the tumor, or to reduce the tumor in the patients whom other treatments cannot be applied due to the fact that it is at an advanced stage.

How does Yttrium-90  treatment differ from others at the stage of liver cancer.

Radioembolization or selective internal radiation therapy (SIRT) refers that a tumor in the liver is reached through artery and high dose radiation which cannot be administered externally is given by injecting Yttrium-90  radioisotope loaded with microspheres, and that thus, live of tumor is eliminated. Treatment of Yttrium-90  is carried out in two stages. In the first stage, patient's liver arteries is determined in detail; if there are veins connected to gastrointestinal tract, they are blocked. Then, test medication imitating actual Y90 radioactive drug is injected into the liver; and preparatory angiography is completed, in which main treatment is tested. The patient does not need to be hospitalized for preparatory angiography. When it is understood that the structure of the liver veins is suitable for this treatment at the end of the operation, appropriate treatment dose for the patient is calculated by nuclear medicine physician, and main treatment day is determined. Usually, about 7-10 days after preparatory angiography, the second stage treatment is given into the liver again angiographically.

What diseases are treated with this method?

Currently, it is used to treat liver tumors. These diseases include tumors originating from the liver or metastases of tumors of large intestine, breast, stomach, and similar tumors.

Who is suitable for the treatment of Yttrium-90?

The group of patients suitable for the treatment consists of patients whose current tumoral diseases are limited to the liver and who do not have a significant tumor focus outside the liver. In addition, the patient's suitability for treatment is evaluated in preparatory angiography performed.

Who is involved in the treatment team?

Interventional Radiology and Nuclear Medicine specialists are applying this treatment together. Preparation of the radioisotope dose is performed by the Department of Nuclear Medicine, and angiographic operations are also performed by Interventional Radiology.

How is it performed?

The treatment is performed by entering through inguinal artery, similar to other angiographic procedures. Although there is not much suffer or pain during the operation, the anesthetist intravenously gives the patient relaxative medications called intravenous sedation.

Is it necessary to repeat it?

Total dose of radiation that can be administered into the liver is limited. These limits can be repeated in limited way, providing that they are not exceeded.

Is this treatment also a kind of radiotherapy?

Yes, but in classical radiotherapy applied externally, certain doses cannot be exceeded due to skin burns, and damage to peripheral organs and tissues. In the treatment of Yttrium-90 , intra-tumor doses that are too high to be given externally can be achieved.

How long do patients need to stay in the hospital?

Diseases called liver cancer are divided into two main groups. The first group includes cancers that originate from the liver's own tissue, and that source is this organ. In the second group, there are the cases that the source is outside of the liver, but the organ is retained due to splashes and spread from the outside. In this group, there may be many different tumors such as breast, intestine, stomach, pancreas and similar. Number of the patients is more than in the first group. Treatment is being successfully carried out in both groups of patients. The answer does not match the question. On the day of treatment, hospitalization is required for 1 day. The patient may be discharged the next day.

Risks are minimized.

Most of the patients treated with Yttrium-90  have complaints such as weakness, mild fever that last about a week. If radioisotope-loaded microspheres intravenously administered into the liver escape out of the liver and into gastrointestinal veins, it can cause the development of ulcer in these areas. The specialist, who states that connection veins detected between liver veins and stomach-intestine in preparatory angio are closed deliberately as a precaution, tell that "Thus, it is approved that there is no leakage towards out of the liver via given tests dose. In very rare cases, liver failure may occur due to radiation given. In order to prevent this not to happen, upper limits of radiation dose designated for the liver must be strictly followed.”. . .

Prepared by the Medical Editorial Board. Our health library contents have been prepared for informational purposes only and with the scientific content on the registration date. For all your questions, concerns, diagnosis or treatment about your health, please consult your doctor or health institution.