Minimally Invasive Treatment Method for Liver Tumors.

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The treatment focuses on delivering radiation directly into the tumor using tiny radioactive particles injected into the hepatic arteries supplying blood to the tumor.

This treatment is suitable for primary liver tumors such as hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma, and for treating liver metastases (e.g., colorectal cancer, neuroendocrine tumors, breast cancer). This treatment involves two catheterization procedures:
a preparatory catheterization and a therapeutic catheterization.
 

Before deciding on the feasibility of the treatment, the patient undergoes a series of preliminary tests such as CT, MRI, or PET-CT to assess the size, location, and number of metastases.
The treatment is suitable for patients whose major or entire metastatic burden is in the liver.

Patients with poor liver function, ascites, portal vein obstruction,
or lung disease cannot receive this treatment.
 

First Catheterization (Preparatory Catheterization):

An interventional radiologist inserts a catheter through the femoral artery in the groin or the radial artery in the forearm and guides it through the arterial system until the catheter reaches the hepatic artery.
The procedure is performed under fluoroscopic imaging guidance to ensure maximum accuracy.
 

Several angiograms of different parts of the liver are taken to map the blood supply to the tumor.
Then, MAA (Macroaggregated Albumin) is injected.
This material consists of small albumin particles labeled with a radioactive isotope,
usually Technetium-99m (Tc-99m).
The purpose of using this material is to map the blood flow to the tumor and ensure that the radioactive microspheres will reach the targeted area during treatment and not adjacent organs.
Another goal is to assess the pulmonary risk; if there is a leakage of labeled material into the lung of above 20%, the option of radioembolization will be ruled out to prevent lung damage.
 

Second Catheterization (Therapeutic Catheterization):

An interventional radiologist inserts a catheter through the femoral artery in the groin or the radial artery in the forearm and guides it through the arterial system until the catheter reaches the hepatic artery.
The catheter is positioned near the target treatment site according to the findings from the preparatory catheterization.
Radioactive microspheres containing the isotope Yttrium-90 (Y-90) are injected through the catheter directly into the hepatic arteries leading to the tumor. The microspheres release into the small blood vessels supplying the tumor, radiating from within, leading to the destruction of cancer cells.
 

The radiation used in radioembolization is beta radiation. Beta radiation from Y-90 creates breaks in the DNA of cancer cells, leading to their death. This radiation has a short range (an average of 2.5 mm in soft tissue, maximum 11 mm), allowing it to primarily affect tumor cells in the close vicinity of the injected radioactive particles, with minimal damage to the surrounding healthy tissues.
 

Advantages of the Treatment
 

1. Targeted Treatment

   • Radiation is delivered directly to the tumor, reducing damage to surrounding healthy tissues
      

   • High concentration of radiation in the tumor leads to effective destruction of cancer cells
      

2. Minimal Invasiveness

   • The procedure is minimally invasive and allows for a shorter recovery time compared to traditional surgeries
      

   • Fewer systemic side effects compared to systemic chemotherapy
      

3. Option for Non-Surgical Patients

   • Suitable for patients who cannot undergo open surgery due to poor health or other risk factors
     
      

Disadvantages and Risks
 

1. Side Effects

   • Pain, nausea, fatigue, and symptoms similar to radiation syndrome
      

   • Risk of liver damage, fibrosis, and radioactive pneumonitis
      

2. Not Suitable for All Patients

   • Radioembolization is not suitable for patients with poor liver function or a high risk of damage to other organs due to radiation
      

3. Frequent Monitoring and Imaging

   • Frequent monitoring and imaging are required to ensure the treatment was successful and to check if     additional treatments are needed