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Liver Cancer Management with Y90 Glass Microspheres – TheraSphere
Experience and Challenges in HCC
Thomas Lauenstein, MD
Department of Diagnostic and Interventional Radiology and Neuroradiology
University Hospital Essen
Outline
• Indications for Y-90 in HCC
• What are critical vessels ?
• Clinical data on HCC
• Case series
1. Resection
2. Transplantation
3. RF ablation
4. Chemoembolization (TACE)
5. Y-90 (SIRT)
6. Systemic therapy
Therapeutic strategies
Therapeutic strategies
• Multiple / large lesions
• CI for TACE
• Child-A / good Child-B
SIRT for HCC
• with hypervascular tumor• Liver dose without tumor
SIRT
Extrahepatic Tumor Feeders
Extrahepatic Tumor Feeders
Sjoquist et al. Oncologist. 2010;15:830-5
GI shunt
GI shunt
Gastroduodenal Artery
Gastroduodenal Artery
Outline
• Indications for Y-90 in HCC
• What are critical vessels ?
• Clinical data on HCC
• Case series
3mpre
NCI / EASL amendement
Response to treatment / HCC
CT @ 1 month CT @ 3 months
Complete response
4% 3%
Partial response 25% 37%
Stable disease 64% 53%
Progression 7% 6%
Hepatology 2008;47:71-81
Time to progression / Survival
Hepatology 2008;47:71-81
Histopathology
• 1. Physiologic tissue
• 2. Fibrosis (peripheral rim)
• 3. Necrotic tumor Riaz A et al. Radiologic-pathologic correlation of hepatocellular carcinoma treated with
internal radiation using yttrium-90 microspheres. Hepatology., 49:1185-93.
2
1
3
1
23
Outline
• Indications for Y-90 in HCC
• What are critical vessels ?
• Clinical data on HCC
• Case series
Case # 1
Case # 1 – 2nd DSA
Case # 2 - duodenal shunt
Case # 2 – duodenal shunt
Case # 3 – pitfall coiling
Case # 4 – pitfall coiling
Case # 5 – a.v. shunt
Conclusion
• Critical vessels must be identified
• IR has to be familiar with coilembolization
• SPECT/CT is a useful tool to identify additional shunts
• EASL criteria for therapy response
• Sorafenib helpful to reduce lung shunts
Liver Cancer Management with Y90 Glass Microspheres – TheraSphere
Experience and Challenges in HCC
Thomas Lauenstein, MD
Department of Diagnostic and Interventional Radiology and Neuroradiology
University Hospital Essen