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Treatment for Unresectable Tumors

Selective Internal Radiation Therapy Treats Liver Cancer

The University of Virginia Health System is among a few medical centers in the country using radioactive microspheres to deliver radiation therapy to patients with unresectable primary or metastatic liver cancer.

Known as selective internal radiation therapy (SIRT), an intra-arterial catheter advanced through a very small incision at the top of the leg delivers small beads carrying radioactive isotope Yttrium-90 to hepatic artery branches. “It’s a way to deliver very high doses of radiation to the tumor with very little radiation going to surrounding structures or healthy parts of the liver,” says interventional radiologist John Fritz Angle, M.D.

SIRT treatments are delivered with the Artis zeego®, which combines fluoroscopy and CT-type imaging with robotic technology that enables physicians to see the blood supply to the liver in a CT-type image, helping improve accuracy.

The treatment is appropriate for hypervascular liver tumors, Angle says, because the beads are attracted to high-flow areas. The beads release radiation over a two-week period, though most radiation is delivered during the first week, says radiation oncologist Tyvin Rich, M.D. Treatment can be done in one or two sessions, with patients spending one night in the hospital after each session. SIRT can be used in conjunction with chemotherapy and other treatments.

While surgical resection or transplantation provide the best options for curing liver cancer, most patients do not medically qualify for either procedure. A retrospective study by UVA physicians of 20 high-risk primary liver cancer patients undergoing SIRT concluded that the treatment is a low-toxicity alternative for patients without many treatment options. The median survival length for the high-risk patients was 114 days, with one patient having survived 858 days with no recurrence of cancer.

During liver cancer treatment, UVA’s hepatologists help determine options and manage underlying liver problems that frequently co-exist with primary liver cancers. “Our goal is to optimize liver function to facilitate safe and effective treatment of the cancer,” says hepatologist Stephen Caldwell, M.D.

A multidisciplinary team – including radiation oncologists, medical oncologists, medical physicists, hepatologists and interventional radiologists – reviews liver cancer cases weekly to determine whether patients would benefit from SIRT. UVA’s comprehensive treatment options include medical therapy, radiation oncology, surgical resection, other interventional radiology procedures or transplantation. “Without that collaboration, we wouldn’t be able to get as far as we have,” Rich says.

To refer a patient for SIRT, call UVA Physician Direct at 800.552.3723.