University of Rochester Medical Center physicians recently performed upstate New York’s first radioembolization procedure for primary liver cancer. This technique combats the tumor in patients who can not be treated with surgery and are awaiting an organ transplant.
The outpatient procedure, called TheraSphere, involves the insertion of millions of microscopic radioactive glass beads into the vascular system near the tumor. The tiny, glass microspheres, about one-half the diameter of a human hair, attack cancerous cells while minimizing the impact on healthy tissue. This procedure is only available at two other sites in New York and 50 select hospitals in the United States.
“This is another option for patients who are waiting for a curative transplant,” said David Waldman, M.D., Ph.D., chair of Imaging Sciences. Medical Center interventional radiologists and radiation oncologists collaborate to calculate the precise dosage and deliver the microspheres filled with yttrium-90, the radioactive isotope that destroys the cancer.
Inteventional radiologistTakashi Kitanosono, M.D.,and radiation oncologist Alan Katz, M.D., M.P.H., performed the procedure for Thomas Lundgren of Perrysburg, Cattaraugus County. The 61-year-old was diagnosed with hepatocellular carcinoma in March. Physicians at the Veterans Administration Medical Center in Buffalo referred him to Strong Memorial Hospital for evaluation for a liver transplant, the only cure for the disease.
About 22,600 cases of primary liver cancer are diagnosed each year in the United States, according to the American Cancer Society. The most common form of primary liver cancer is hepatocellular carcinoma, which in the U.S. is commonly caused by the hepatitis B or hepatitis C viruses or alcohol abuse. It is the fifth most common form of cancer in the world and is increasing globally due to an increase in the incidence of hepatitis.
This is a microscope's view of the tiny radioactive beads next to a human hair.
Image credit: University of Rochester Medical Center
However, Lundgren’s 7-centimeter tumor was larger than allowable limits for a transplant. Gastrointestinal oncologist Aram Hezel, M.D., of the James P. Wilmot Cancer Center, suggested the new treatment to shrink the tumor and allow for him to be placed on the transplant waiting list.
The Medical Center’s Division of Solid Organ Transplantation includes the only liver transplant program in upstate New York. The transplant team and its four surgeons serves patients from across New York state and northern Pennsylvania. More than 300 patients are on the URMC list waiting for a donor organ to become available. Across the state, more than 1,800 people are waiting.
On average, about a quarter of the people who received a liver transplant at the Medical Center had liver cancer. And, more than a third of the people awaiting transplant have liver cancer or hepatitis C.
The TheraSphere treatment can generally be administered on an outpatient basis and does not usually require an overnight hospital stay.
The procedure involves extensive imaging to determine the exact location of the tumor and the arteries and vessels leading into the cancerous lesion. To direct TheraSphere treatment at tumors in the liver, a physician first makes a small incision in the patient’s leg and places a long, flexible plastic tube (a catheter,) into the femoral artery, the major blood vessel in the leg. Guided by X-ray imaging, the physician then moves the catheter up through the blood vessels to the hepatic artery, which is one of two blood vessels that feed the liver.
The physician guides the catheter into the branch of the hepatic artery that feeds the cancerous tumor in the liver and infuses the microscopic glass beads through the catheter into the blood that supplies the tumor. This is usually performed in a hospital’s radiology suite and patients remain conscious throughout the procedure.
The Wilmot Cancer Center is the Rochester and Finger Lakes region’s leader in cancer care and research. With a team of more than 400 doctors, nurses, scientists and staff, the center is dedicated to providing outstanding patient care and finding cures for cancer.