Summary

Infusion of microspheres to treat liver cancer tumors offers a major breakthrough in the treatment of liver cancer, especially for patients who have not had success with chemotherapy.

Dr. Andrew Kennedy, a former research oncologist at the University of Maryland, has played the lead role in developing the procedure. He is also training other hospital teams in the US to perform the procedure.  Dr. Kennedy’s protocol for this procedure became the model approved and used by the FDA.

Dr. Kennedy was hired in the fall of 2002 as director of radiation oncology services at Wake Radiology, the Triangle’s largest radiology practice and one of the foremost radiology practices in the United States.

Infusion of microspheres will be performed at WakeMed, where Dr. Kennedy will be working with Wake Radiology’s interventional radiology, nuclear medicine, and diagnostic teams to perform the procedure.

Infusion of microspheres to treat liver cancer became available through Wake Radiology Oncology beginning in June 2003.

Medical Application

For treatment of liver cancer tumors -- both primary liver cancer and metatastic colorectal cancer that has spread to the liver.

This procedure has traditionally been used in cases where chemotherapy has been ineffective, but soon may become available to liver cancer patients in conjunction with chemotherapy.

Description of the Procedure

Treatment involves delivery of very small beads of glass that have been implanted with Yttrium 90. The beads, which are called microspheres, are minuscule in size and so small it would take three side by side to equal the width of a human hair. At the same time, the beads are too large to escape from the confines of the liver.

The procedure uses two brands of microspheres:

• Theraspheres®, which are made by MDS Nordion, and
• SIR –Spheres®, which are made by SirTex Medical.

The microspheres, which have been irradiated in a nuclear reactor, are delivered by catheter through the hepatic artery to the arterial section of the liver. The hepatic artery is the major artery supplying blood to the liver. The section of the liver fed by the hepatic artery is, essentially, the input side of the liver, and the section most exposed to cancer causing agents.

A catheter is used to deliver the microspheres, which become permanently implanted in the tumor and stay there slowly releasing radiation over a period of about 14 days.  The radiation in each bead is quite powerful, but does not have a wide range of exposure. In fact, the distance the radiation travels from each bead is very short. This helps to reduce radiation exposure to the healthy sections of the liver.

The procedure is conducted at WakeMed.

Results

In colon cancer, implantation of microspheres successfully destroys most of the tumors, and has helped many patients live more than 11 months longer than expected. In the majority of cases, implantation of the microspheres successfully halts growth of the tumor for a period of time, usually many months.  In carcinoid tumors, some patients have had all of the tumors eradicated.  This therapy has had success in a variety of tumor types, including lung, breast, sarcoma, colon, hepatocellular, ocular melanoma, to name a few.

History of the Procedure

Infusion of microspheres to treat liver cancer was originally tested in the 1960’s in the United States, but without much success. A similar procedure was tested in Australia in the 1980’s, with better success but there were still many problems related to the procedure. Early in the 1990’s, the University of Michigan tested infusion of microspheres using TheraSpheres® on 22 patients. Those tests showed great promise, but refinement and development of the procedure was still needed. In the late-1990’s, Dr. Kennedy led a team at the University of Maryland that refined the procedure, and the protocols he set are now those approved by the FDA for this procedure. Although the procedure is only recommended to liver cancer patients for whom surgery and chemotherapy have not been effective, Dr. Kennedy anticipates that soon the procedure will be available as a first course of therapy in conjunction with chemotherapy after national trials are conducted in 2003-4.

A few liver cancer facts

1. 100,000 people each year with colorectal cancer will get spread of their cancer to the liver cancer.
2. Hepatitis B and C are both growing at alarming rates and are also major causes of liver cancer.
3. For many of the estimated 20,000 cases of liver cancer this year, chemotherapy, surgery and transplant will not be an option.
4. For many, a liver transplant is the only option.
5. Meanwhile, the demand for liver transplants is growing with the spread of Hepatitis B and C. Liver failure from hepatitis C is one of the major reasons for liver transplants in the US.
6. Approximately 4 million Americans are infected with hepatitis C.

This information is provided by Wake Radiology Oncology's Doctors, Nurses, and Technologists.  It was added to this site on November 12, 2003 and last updated on March 13, 2006.