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Review
. 2017 Apr;8(2):266-278.
doi: 10.21037/jgo.2016.11.08.

Selective internal radiation therapy with SIR-Spheres in hepatocellular carcinoma and cholangiocarcinoma

Eric A Wang  1 , Scott R Broadwell  1 , Ross J Bellavia  1 , Jeff P Stein  1
Affiliations
Review

Selective internal radiation therapy with SIR-Spheres in hepatocellular carcinoma and cholangiocarcinoma

Eric A Wang et al. J Gastrointest Oncol. 2017 Apr.

Abstract

Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) often present at stages where patients have limited treatment options. Use of selective internal radiation therapy (SIRT) with yttrium-90 (Y-90) resin microspheres has progressed as data increasingly speak to its utility in patients with both intermediate and late stage disease in these cancers. In anticipation of the pending completion of several prospective randomized controlled multicenter studies exploring the use of Y-90 resin microspheres in primary liver cancers, this article outlines mechanisms involved in SIRT administration and reviews key efficacy and safety data that are currently available in the literature involving use of this therapy in both HCC and ICC.

Keywords: Hepatocellular carcinoma (HCC); SIR-Spheres; intrahepatic cholangiocarcinoma (ICC); radioembolization; yttrium-90 resin microspheres.

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Conflict of interest statement

Conflicts of Interest: EA Wang is a training proctor for Sirtex Medical. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
SIRT delivery of Y-90 microspheres to primary hepatic tumors. Illustration of multifocal bi-lobar HCC with selective catheterization of the right hepatic artery for SIRT treatment. SIRT, selective internal radiation therapy; HCC, hepatocellular carcinoma.
Figure 2
Figure 2
66-y/o male with 10 cm unresectable HCC, BCLC stage C, that has invaded the inferior vena cava. (A) CT prior to Y-90 resin administration; (B) angiogram on day of Y-90 resin treatment; (C) CT following three Y-90 resin treatments that occurred in January, March, and July of 2010; small area of radiation necrosis at prior site of 10 cm tumor observed. Patient’s baseline AFP was 143,987 ng/mL and decreased to 113,200; 43,295; and 9.5 after the 1st, 2nd and 3rd Y-90 resin treatments, respectively. As of February 2016 the patient’s AFP is 13.2. HCC, hepatocellular carcinoma; BCLC, Barcelona clinic liver cancer; AFP, alpha-fetoprotein.
Figure 3
Figure 3
62 y/o female with 12 cm unresectable, infiltrative ICC, >50% liver involvement. (A) CT prior to Y-90 resin administration; (B) angiogram on day of Y-90 resin treatment. Patient received right lobe SIRT on 11/2012, 12/2012, 8/2013 and 8/2014. She received left lobe medial segment SIRT on 12/2014; (C) CT 3+ years after initial Y-90 resin treatment. Radiation necrosis in prior site of 12 cm ICC. Compensatory hypertrophy left lobe. ICC, intrahepatic cholangiocarcinoma.
Figure 4
Figure 4
Y-90 resin safety in HCC and ICC. HCC, hepatocellular carcinoma; ICC, intrahepatic cholangiocarcinoma.
See this image and copyright information in PMC

References

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