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Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC

Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC. Thomas Lauenstein, MD Department of Diagnostic and Interventional Radiology and Neuroradiology University Hospital Essen. Outline. Indications for Y-90 in HCC What are critical vessels ?

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Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC

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  1. Liver Cancer Management with Y90 Glass Microspheres – TheraSphereExperience and Challenges in HCC Thomas Lauenstein, MD Department of Diagnostic and Interventional Radiology and Neuroradiology University Hospital Essen

  2. Outline • Indications for Y-90 in HCC • What are critical vessels ? • Clinical data on HCC • Case series

  3. Therapeutic strategies • Resection • Transplantation • RF ablation • Chemoembolization(TACE) • Y-90 (SIRT) • Systemic therapy

  4. Therapeutic strategies

  5. SIRT for HCC Multiple / large lesions CI for TACE Child-A / good Child-B

  6. SIRT Liver dose without tumor with hypervascular tumor

  7. Extrahepatic Tumor Feeders

  8. Extrahepatic Tumor Feeders

  9. GI shunt Sjoquist et al. Oncologist. 2010;15:830-5

  10. GI shunt

  11. Gastroduodenal Artery

  12. Gastroduodenal Artery

  13. Outline • Indications for Y-90 in HCC • What are critical vessels ? • Clinical data on HCC • Case series

  14. NCI / EASL amendement pre 3m

  15. Response to treatment / HCC Hepatology 2008;47:71-81

  16. Time to progression / Survival Hepatology 2008;47:71-81

  17. Histopathology 1 1 2 3 2 3 1. Physiologic tissue 2. Fibrosis (peripheral rim) 3. Necrotic tumor Riaz A et al. Radiologic-pathologic correlation of hepatocellular carcinoma treated with internal radiation using yttrium-90 microspheres. Hepatology., 49:1185-93.

  18. Outline • Indications for Y-90 in HCC • What are critical vessels ? • Clinical data on HCC • Case series

  19. Case # 1

  20. Case # 1 – 2nd DSA

  21. Case # 2 - duodenal shunt

  22. Case # 2 – duodenal shunt

  23. Case # 3 – pitfall coiling

  24. Case # 4 – pitfall coiling

  25. Case # 5 – a.v. shunt

  26. Conclusion Critical vessels must be identified IR has to be familiar with coilembolization SPECT/CT is a useful tool to identify additional shunts EASL criteria for therapy response Sorafenib helpful to reduce lung shunts

  27. Liver Cancer Management with Y90 Glass Microspheres – TheraSphereExperience and Challenges in HCC Thomas Lauenstein, MD Department of Diagnostic and Interventional Radiology and Neuroradiology University Hospital Essen

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