Hope for unresectable liver tumors

Largest Study to Date Confirms Effectiveness of Radioembolization for Unresectable Liver Tumors
02-26-2007

CARY – Radioembolization is considered a safe and effective treatment for patients with liver tumors that cannot be surgically removed and can be safely applied to a wider group of patients, according to the results of the largest-ever study of patients treated. The study and recommendations by an international consensus panel were presented at the 18th Annual International Congress on Anti Cancer Treatment (ICACT) in Paris, France on Thursday, February 8, 2007.

Results of the study using resin 90Y-microspheres for unresectable liver cancer, involving 680 treatments in 515 patients, spread over 16 collaborating centers in the US and Europe, confirmed the efficacy and safety of the technique, according to Andrew Kennedy, MD, radiation oncologist and co-medical director, Wake Radiology Oncology Services, lead investigator of the study and conference presenter.

“This the first time that any group has reviewed such a large cohort of patients who had received radioembolization using resin 90Y-microspheres, and it’s reassuring to see that this is a well-tolerated therapy with low overall toxicity.”

Dr. Kennedy reintroduced the use of microsphere therapy in the US. The treatment places radiation-filled microscopic spheres into the liver, destroying cancerous cells, while preserving adjacent healthy tissue. The microspheres deliver a continuous radiation dosage over 14 days. Patients who have not had success with chemotherapy or are not able to have surgery are candidates for the therapy.

Patients represented in the study were primarily colorectal cancer patients (310 patients; 46 percent), followed by carcinoid (84 patients; 12 percent), hepatocellular carcinoma (79 patients; 12 percent) and other cancer patients who had spread to their liver. The majority of them had failed other treatments, including either systemic chemotherapy or prior treatment to the liver consisting of surgery, radiofrequency ablation (RFA), trans-arterial chemoembolisation (TACE) or radiation therapy with one or more interventions.

The study looked at risk of toxicity and found that there was no relationship between tumor type and toxicity. Tumor response data were available for 74 percent of the treatments. Despite the failure of prior therapies, the majority of patients treated with microsphere as salvage therapy responded favorably in 54 percent of the cases. Approximately seven percent of the patients achieved stability in their disease and only 1.3 percent showed progression of their disease in the first 90 days after radioembolization.

The study was presented, along with consensus treatment guidelines, by the Radioembolization Brachytherapy Oncology Consortium (REBOC). This independent group was formed in 2006 to address the need for standardization since the indications, techniques, multimodality treatment approaches and dosimetry (amount, rate and distribution of radiation for treatment) vary among centers using microsphere therapy with liver cancer patients. REBOC includes an international membership from interventional radiology and surgical oncology. Consensus guidelines were developed in collaboration with scientific organizations including the American College of Radiation Oncology (ACRO), American Brachytherapy Society (ABS), Society of Interventional Radiologists (SIR), Society of Nuclear Medicine SNM), Cardiovascular and Interventional Radiological Society of Europe (CIRSE) and selected users. Fourteen recommendations on using radioembolization using microspheres are now endorsed by REBOC.

“The goal is to now make this treatment more accessible for patients all over the world,” Dr. Kennedy, a founding member of REBOC, explained. “These guidelines and endorsement from REBOC give physicians added assurance that microsphere therapy is a safe and effective treatment for their patients with unresectable liver cancer.”

The full recommendations from REBOC are noted in the current issue of the International Journal of Radiation Oncology *Biology * Physics and are expected to be published in upcoming months.

While in Europe, Dr. Kennedy also spoke to fellow physicians and medical practitioners on the use of microspheres in liver cancer treatment at the University of Mainz, Berlin, Germany; the University of Navarro, Pamplona, Spain; and the University of Stuttgart, Stuttgart, Germany.

About Wake Radiology Oncology Services
Wake Radiology Oncology Services is the Triangle’s first freestanding, full-service, outpatient radiation therapy center. Its state-of-the-art facility combines the newest technology in three-dimensional radiation therapy with the expertise of highly trained professionals to provide thorough, quality care for each patient. For more information about Wake Radiology Oncology Services, please visit the website at www.wakeoncology.com.