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THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING

Rivista di Medicina Nucleare e Imaging Molecolare


A Journal on Nuclear Medicine and Molecular Imaging
Affiliated to the Society of Radiopharmaceutical Sciences and to the International Research Group of Immunoscintigraphy
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REVIEW  TREATMENT OF HCC AND LIVER METASTASES BY MEANS OF RADIONUCLIDE THERAPY


The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2009 June;53(3):317-24

lingua: Inglese

Yttrium-90 labelled resin microspheres for treatment of primary and secondary malignant liver tumors

Van De Wiele C. 1, Defreyne L. 2, Peeters M. 3, Lambert B. 1

1 Department of Nuclear Medicine University Hospital Ghent, Ghent, Belgium
2 Division of Interventional Radiology Department of Radiology University Hospital Ghent, Ghent, Belgium
3 Division of Hepatogastroenterology Department of Internal Medicine University Hospital Ghent, Ghent Belgium


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Neither regional nor systemic chemotherapy significantly improve survival in the majority of patients presenting with liver metastases and their median survival is short. While the incidence of hepatocellular (HCC) is increasingly worldwide, the various treatment approaches that hve been developped to treat non-resectable HCC have had minimal or moderate impact on overall survival. SIR-Spheres (SIRS) are commercially available 90Y-labelled resin microspheres that when selectively injected via the hepatic artery will become trapped in the tumor caplliary bed and will selectively deliver radiation to the tumor whilst sparing normal tissue. In this manuscript, the available literature on the use of SIRS in the clinic is summarized. First, available, predominantly phase I and II studies, on SIRS treatment performed in patients suffering from liver metastases as well as in patients suffering from multinodular asymptomatic unresectable HCC with a well preserved liver function have consistently reported a favourable safety profile for SIRS therapy; only a limited number of patients develop gastrointestinal ulceration or bleeding. Second, most of the studies also reported a high reponse rate to SIRS treatment resulting in increased life expectancy; median survival rates proved consistently higher when compared to historical controls. Finally, in two randomized controlled phase III trials, benefits were demonstrated for SIRS combined with chemotherapy when compared to the chemo-arm alone in patients suffering from colorectal liver metastasis. However, since these reports, novel, potentially more effective chemotherapeutics have been introduced for treating colorectal liver metastasis and the clinical value of 90Y-Sirspheres when compared to these novel chemotherapeutics warrants confirmation and validation.

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