liver cancer management with y90 glass microspheres – therasphere experience and challenges in hcc

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

Outline

• Indications for Y-90 in HCC

• What are critical vessels ?

• Clinical data on HCC

• Case series

1. Resection2. Transplantation3. RF ablation4. 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 NeuroradiologyUniversity Hospital Essen