Radioembolization’s role in liver cancer treatment
By Brian Sodoma
Dr. Andrew Price has a wealth of knowledge and more than a few high-tech tools at his disposal. But the Director of Interventional Radiology at Banner MD Anderson Cancer Center in Gilbert, says finding the best time during a treatment course to use those tools is a burning question in his field today.
Price is a radioembolization expert, a minimally-invasive, catheter-based treatment where millions of tiny spheres coated with radioactive isotopes known as yttrium-90 (Y-90) are delivered directly into the arteries of liver tumors. This technology delivers high doses of radiation while minimizing the impact on surrounding liver tissue. The treatment has been proven safe and effective through the years, but questions are surfacing as to the best time to administer it — before, after or during chemotherapy.
Today, Y-90 is most commonly used after several rounds of unsuccessful chemotherapy, a stage referred to as “salvage treatment.” There is a growing sense in the medical community that if Y-90, sometimes also referred to as SIRT (Selective Internal Radiation Therapy), was performed earlier in the course of treatment, patients could enjoy better outcomes like decreased tumor size and better survival rates.
Two international studies, SIRFLOX and FOXFIRE, are currently weighing whether radioembolization in combination with chemotherapy is more effective than chemotherapy alone as a first line treatment option for patients with metastatic colorectal cancer to the liver. SIRFLOX is enrolling patients from Australia, New Zealand, Europe, the Middle East and North America, while FOXFIRE is focusing on patients in the United Kingdom.
Even without final results from these large clinical trials, Price is finding that more and more patients with colorectal liver metastases are asking to have Y-90 performed earlier.
“We’re not involved in that research formally, but we see many well-educated patients who are specifically requesting radioembolization earlier in their treatment course,” he says. “This is an outpatient procedure that is really well tolerated and proven to be really quite effective.”
In a few situations, Price has seen how some patients try Y-90 first, as they are skeptical of even trying chemotherapy at all. The encouraging results then bring a sense of hope, and these patients seem more open to expanding their treatment options to include chemotherapy.
“Often times when you are first diagnosed (with a liver metastasis), you feel pessimistic about the future. But this treatment, while not providing a cure, can prolong survival with minimal downtime, improve quality of life, and restore a sense of hope,” Price says.