JOLIET – In what may sound like a futuristic scenario, a local cancer patient just received a shot of millions of tiny, perfectly round glass spheres, about one-third the size of a human hair and impregnated with radioactive yttrium-90.
The tiny beads immediately attached directly to little arteries in his liver, right next to a colony of deadly cancer cells. During the next 10 days, the radiation did two important jobs: It cut off the oxygen-carrying blood supply to the tumor and killed the cancer cells with high-levels of beta radiation.
The procedure, called radioembolization, was a first for Presence Saint Joseph Medical Center in Joliet and a first for the Joliet area as a whole. According to interventional radiologist Joshua Tepper, who led the team that performed the procedure, of the six hospitals registered in Illinois to perform radioembolization, four are university medical hospitals and two are community hospitals, including Presence.
Tepper trained at Northwestern University, which is a leading facility for instruction of the procedure.
“It’s been very exciting,” Tepper said. “A lot of our patients want to stay in the area when they’re being treated.”
So far, radioembolization is just for liver cancer, whether the tumor originated in the liver or metastasized from another organ. The liver is difficult to treat, Tepper said, especially with traditional radiation therapy, as its tissue is fairly dense. So when a high enough dose of external beam radiation is administered, it can significantly damage healthy liver cells.
According to the American Cancer Society, other treatments for liver cancer include radiofrequency ablation, surgery, liver transplant and chemotherapy, although the latter is not very effective with that type of cancer. Treatments other than transplants will not usually cure liver cancer; they typically can prolong life and reduce pain.
This makes radioembolization a good weapon in the arsenal, Tepper said, one with fewer side-effects than chemotherapy or chemoembolization. When to use it depends on the patient and the type of liver cancer he or she has.
Some patients will be treated with other types of procedures or surgeries first, followed by radioembolization. For those with certain kinds of primary liver cancer – such as those caused by hepatitis – radioembolization is the first line of treatment, Tepper said.
So far, Tepper said, radioembolization is just being used to treat liver cancer. The treatment doesn’t cure the cancer but it can prolong life and reduce pain. It does come with risks, include radiation hepatitis and liver failure.
“It’s a little challenging,” he said of the procedure, “but it’s worth it to push the boundaries of what we can do in a community hospital setting.”
Tepper’s patient was diagnosed with colorectal cancer in 2009, which had spread to the liver. Several courses of chemotherapy put the colorectal cancer in remission, but the liver cancer had worsened, Tepper said. The patient’s oncologist referred him to Tepper, and the procedure was performed July 17.
Much prep work was done before the radioembolization, Tepper said. Two weeks before the procedure, the patient had an angiogram, where the blood vessels serving the tumor were precisely mapped. Where and how much yttrium-90 would be injected is different for each patient, Tepper said.
The procedure itself involved several staff members: Tepper, a nuclear medical physicist, a special interventional radiology nurse, a radiology technologist and a nuclear medical technologist.
Despite the complicated preparatory work and the number of staff, the procedure lasted only about 25 minutes. A small flexible tube was inserted into the hepatic artery and the radioactive microspheres were injected to the exact site of the tumor. The spheres permanently lodge in and block the blood vessels. The radiation in them emits strong beta rays that kill the tumor cells.
The radiation only travels about two millimeters, Tepper said, so minimizing destruction to healthy tissue. The half-life of the isotope is short – only 64 hours – so the spheres emit radiation for only about 10 days.
The patient went home two hours after the procedure.
“It went really well,” Tepper said. “He did have the expected nausea and weakness and a little loss of appetite, but the side effects were fewer than he would have had with some other treatments.”
Liver cancer by the numbers
• Estimate of the number of cases of primary liver cancer that will be diagnosed this year: 33,190 (24,600 in men and 8,590 in women)
• Estimate of the number of people who will die from liver cancer this year: 23,000 (15,870 men and 7,130 women)
• Lifetime risk of getting primary liver cancer: For men, 1 in 81. For women, 1 in 196.
• Average age of liver cancer diagnosis: 63
• Prevalence of liver cancer: The fifth most common primary cancer and the second most frequent metastatic site for all cancers.
Source: American Cancer Society, www.cancer.org