Yttrium-90 microspheres for the treatment of hepatocellular carcinoma
Section snippets
Patients selected
Data from 80 patients were included in the analysis. The centers providing data were The Toronto General Hospital (n = 17), the University of Pittsburgh Medical Center Starzl Transplant Institute (n = 51), the Hospital of the University of Pennsylvania (n = 7), and Johns Hopkins University Hospital (n = 5). Patients were treated under 2 fixed-dose protocols. The Toronto Protocol, using a nominal fixed dose of 100 Gy, began enrolling patients in March 1992 and ended enrollment in March 1996.18
Study population
The study population is characterized in Table 1, Table 2, Table 3, Table 4. The population was predominantly older, white, and male, and 35 patients (44%) had bilobar disease. Fifty-six (70%) patients had documented cirrhosis, 10 (13%) had ascites, and 13 (16%) had >50% of their liver replaced by tumor. The serum bilirubin level was increased in 13 (16%) patients, and 72 (90%) were characterized as having Child-Pugh class A liver disease. HCC staging resulted in 54 (68%) patients being
Discussion
Most patients diagnosed with unresectable HCC succumb to liver failure as a result of advancing cirrhosis or tumor progression.29 Because tumor burden in the liver is a major threat to patient survival and well-being and because systemic chemotherapy is ineffective, local liver-directed therapies have been developed to reduce tumor burden, providing palliation and the potential for increased survival. Decreasing tumor burden unintentionally results in compromised liver function through
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2019, Applied Clay ScienceCitation Excerpt :In recent decades, several efforts have been undertaken to develop Y-90 delivery carriers for specific tumor targeting (Cosimelli et al., 2010; Hendlisz et al., 2010; Kennedy and Salem, 2010; Wang et al., 2010). Ceramic microspheres consisted of 17Y2O3–19Al2O3–64SiO2 have been explored as a radio-therapeutic agent for the treatment of cancer, where Y-90 with a half-life of 64.1 h was found to be an effective way of treating large solid tumors (Ehrhardt and Day, 1987; Erbe and Day, 1993; Geschwind et al., 2004). However, in this approach, Y-90 microspheres with a size of 20–30 μm were directly infused near hepatic malignancy through a catheter in order to kill the cancer cells with the β-rays emitted from the radioisotope, indicating that they could not be delivered directly to the target, cancer tissues, without applying a surgical catheterization procedure (Geschwind et al., 2004; Kennedy and Salem, 2010).
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Supported in part by MDS Nordion, Ottawa, Ontario, Canada.