Liver Directed Therapy

Transarterial Loco-Regional Treatment
of Liver Tumors

The liver is unique among other organs because of its dual blood supply. The liver is supplied by the hepatic artery as well as the portal vein. Liver tumors are supplied by the hepatic artery predominantly. Liver therapy can be delivered thru the artery (transarterial) directing treatment to the tumor while sparing the normal liver. The most common treatment involves injecting microspheres into the artery to deliver either radiation (yttrium-90) or chemotherapy to the tumor.

The Microspheres (tiny little BB’s)

Yttrium-90

Beta particles are high-energy, high-speed electrons or positrons emitted by certain types of radioactive nuclei, such as Yttrium-90 (Y90). This type of radiation travels only a few millimeters away from the source before hitting its target. Y90 microspheres injected into the hepatic artery accumulate within the tumor and concentrate radiation inside it.

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Drug eluding beads (TACE)

Microspheres can be loaded with doxorubicin or irinotecan depending on the type of tumor being treated. Injected inside the tumor they release the drug slowly over 24 hours. This treatment is known as Transarterial Chemoembolization or TACE.

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Why use this treatment option?

Curing cancer requires removing or destroying all of the tumor and is why surgical resection is generally the most effective treatment. Liver cancers in particular fall in this category. It is also true that the liver presents unique challenges to the surgeon because of its crucial role in body function and its complex anatomy which can make surgery difficult to accomplish safely. If a patient is not a candidate for surgical removal of his/her cancer then other therapeutic options are available.

Chemotherapy & Radiation Therapy

For most tumors if the lesions can’t be removed or ablated because of their size, location or number then systemic chemotherapy and radiation therapy become the mainstays of therapy. However, the liver doesn’t readily tolerate traditional radiation therapy and some liver tumors are not responsive to chemotherapy. Local liver directed therapy can be very effective in these cases.

Loco-Regional Liver Therapy

TACE and yttrium-90 treatments can be used individually or in combination to treat a variety of primary liver cell tumors and metastatic disease. These liver directed therapies are used in patients who cannot benefit from surgical resection or ablation. Many of these patients will already have had chemotherapy or radiation treatments before being referred for loco-regional therapy.

This Is Why

Even though Liver Directed Therapies are not, in of themselves, considered to be primary curative treatments they can be quite effective in palliating disease and prolonging high-quality life. Alone, or in combination with other treatments, some patients can be “down-staged” to a point where curative surgery may be possible. And, in liver failure patients, these treatments serve as a bridge to transplantation controlling liver cancer until a new organ becomes available.

More about Yttrium-90 and TACE

Yttrium-90

Also known as Y90 therapy or formally as Complex Interstitial Brachytherapy it is a radiation therapy used to target liver tumors. Millions of tiny yttrium-90 microspheres (“radioactive BB’s”) are delivered to the blood vessels supplying the tumor(s) in the liver. These microspheres follow the blood flow and accumulate in the abnormally vascular liver tumors at a much higher density than in the normal liver tissue. The yttrium-90 microspheres then deliver their radiation to the local tissue around them.

This internal radiation technique makes it possible to safely treat liver many tumors without injuring the normal liver in the process.

Transarterial Chemoembolization

Also known as TACE it is a minimally invasive procedure performed targeting the liver tumor(s) blood supply. Thousands of drug-eluting beads (“poison BB’s”) are delivered to the blood vessels in the liver that supply the liver tumor. The tiny little beads block the nourishing blood flow to the tumor while releasing locally high concentrations of chemotherapy.

This treatment affects the tumor directly while the patient avoids the usual chemotherapy side-effects like hair loss.