Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC
description
Transcript of Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC
![Page 1: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/1.jpg)
Liver Cancer Management with Y90 Glass Microspheres – TheraSphere
Experience and Challenges in HCC
Thomas Lauenstein, MD
Department of Diagnostic and Interventional Radiology and NeuroradiologyUniversity Hospital Essen
![Page 2: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/2.jpg)
Outline
• Indications for Y-90 in HCC
• What are critical vessels ?
• Clinical data on HCC
• Case series
![Page 3: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/3.jpg)
![Page 4: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/4.jpg)
1. Resection2. Transplantation3. RF ablation4. Chemoembolization (TACE)5. Y-90 (SIRT) 6. Systemic therapy
Therapeutic strategies
![Page 5: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/5.jpg)
Therapeutic strategies
![Page 6: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/6.jpg)
• Multiple / large lesions• CI for TACE• Child-A / good Child-B
SIRT for HCC
![Page 7: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/7.jpg)
• with hypervascular tumor• Liver dose without tumor
SIRT
![Page 8: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/8.jpg)
Extrahepatic Tumor Feeders
![Page 9: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/9.jpg)
Extrahepatic Tumor Feeders
![Page 10: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/10.jpg)
Sjoquist et al. Oncologist. 2010;15:830-5
GI shunt
![Page 11: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/11.jpg)
GI shunt
![Page 12: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/12.jpg)
Gastroduodenal Artery
![Page 13: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/13.jpg)
Gastroduodenal Artery
![Page 14: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/14.jpg)
Outline
• Indications for Y-90 in HCC
• What are critical vessels ?
• Clinical data on HCC
• Case series
![Page 15: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/15.jpg)
3mpre
NCI / EASL amendement
![Page 16: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/16.jpg)
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
![Page 17: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/17.jpg)
Time to progression / Survival
Hepatology 2008;47:71-81
![Page 18: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/18.jpg)
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
![Page 19: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/19.jpg)
Outline
• Indications for Y-90 in HCC
• What are critical vessels ?
• Clinical data on HCC
• Case series
![Page 20: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/20.jpg)
Case # 1
![Page 21: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/21.jpg)
Case # 1 – 2nd DSA
![Page 22: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/22.jpg)
Case # 2 - duodenal shunt
![Page 23: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/23.jpg)
Case # 2 – duodenal shunt
![Page 24: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/24.jpg)
Case # 3 – pitfall coiling
![Page 25: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/25.jpg)
Case # 4 – pitfall coiling
![Page 26: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/26.jpg)
Case # 5 – a.v. shunt
![Page 27: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/27.jpg)
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
![Page 28: Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC](https://reader035.fdocuments.in/reader035/viewer/2022062323/568165c3550346895dd8ccc1/html5/thumbnails/28.jpg)
Liver Cancer Management with Y90 Glass Microspheres – TheraSphere
Experience and Challenges in HCC
Thomas Lauenstein, MD
Department of Diagnostic and Interventional Radiology and NeuroradiologyUniversity Hospital Essen