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Mai Trong Khoa , Tran Dinh Ha, Tran Hai Binh

The Nuclear Medicine and Oncology Center Bach mai Hospital, Vietnam. THE SELECTIVE INTERNAL RADIATION THERAPY FOR HEPATOCELLULAR CARCINOMA WITH Y-90 RESIN MICROSPHERE AT BACH MAI HOSPITAL, HA NOI, VIET NAM. Mai Trong Khoa , Tran Dinh Ha, Tran Hai Binh

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Mai Trong Khoa , Tran Dinh Ha, Tran Hai Binh

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  1. The Nuclear Medicine and Oncology Center Bach mai Hospital, Vietnam THE SELECTIVE INTERNAL RADIATION THERAPY FOR HEPATOCELLULAR CARCINOMA WITH Y-90 RESIN MICROSPHERE AT BACH MAI HOSPITAL, HA NOI, VIET NAM Mai TrongKhoa, Tran Dinh Ha, Tran Hai Binh Pham Minh Thong, Ngo Le Lam, Trinh Ha Chau, et al Bach Mai hospital, Ha noi, Viet nam

  2. BACKGROUND • Hepatocellular carcinoma - HCC • 5th leading cause of cancer in the world • Incidence has risen significantly in developing countries in the past two decades(Increased prevalence of hepatitis B and C) • 1st leading cause of cancer- related deaths in Vietnam (about 22,000 cases each year) • Selective internal radiation therapy with Y-90 is new method, modern, highly effective.

  3. Surgery BACKGROUND • Treatment of HCC Liver transplantation Locoregional Therapy RFA Cryotherapy TACE Targeted therapy: Sorafenib SIRT The prognosis of HCC is not good

  4. SELECTIVE INTERNAL RADIATION THERAPY- SIRT • Selectively targets with very high radiation dose to all tumors (average dose of 280-380 Gy) within the liver, regardless of their cell of origin, number, size or location while at the same time maintaining a low radiation dose to the normal liver tissue (<40 Gy). • Cancer cells are annihilated by dual mechanisms: embolization and irradiation due to emitted ionizing radiation (Beta ray) Microsphere 90Y: Zise: 35µmT1/2: 64,1h; Beta ray: 0,93 Mev Range: 2,5-11mm SIR-Sphere size is small enough to gain entry into tumor nodules but too large to pass through the end capillary bed into the venous circulation

  5. PATIENTS AND METHODS PATIENTS: 60 patients with primary hepatocellular carcinoma (HCC) were subjected to radiotherapy in the Y90 radioactive sputum subset at the Center for Nuclear Medicine and Oncology at Bach Mai Hospital from December 2013 to May 2017.

  6. PATIENTS AND METHODS • METHODOLOGY: Descriptive, prospective • EQUIPMENT AND MACHINERY: • Computerized tomography (DSA), computerized tomography (MSCT) • SPECT, PET / CT • Radiometers, radiation scanners • Tc 99m - MAA (macroagregated albumin): 5-10mCi • Y-90 Micro Spore Grade: 3GBq / 5ml • Tools: lead box, lead container, radioactive drug wire, transmission line ... • Protective guards, glasses, personal radiation dosimeters

  7. PATIENTS AND METHODS • SELECTION CRITERIA: • Age> 18 • Primary liver cancer (HCC) is no longer capable of surgery. Or patient refuse or have surgery cure • Compensated liver function: Child-Pugh A-B7 • Overall good ECOG ≤ 1 • Never used radiotherapy before

  8. PATIENTS AND METHODS • EXCLUSION CRITERIA: • Shunt liver - lung> 20% • The risk of Y-90 particles entering arteries of gastric, intestinal, and pancreatic arteries that can not be pre-controlled by coils • Decompensated cirrhosis; Liver disease • Women are pregnant • Contrasting contrast medium • Condition is too weak, living time is less than 3 months

  9. PROTOCOL SIRT IN BACH MAI HOSPITAL Inject 99mTc MAA to artery – supplying tumor Phase 1 Angiogram SPECT imaging Calculate Y-90 dose Phase 2 Angiogram Inject 90Y PET/CT

  10. Study diagram Patients diagnosed with HCC have radiotherapy indications in selection with 90Y spherical particles Evaluate the clinical characteristics, subclinical pre-treatment Determine the therapeutic dose Selctive internal radiation therapy with Y-90 microsphere Response assessment after 1 month, every 3 month Evaluate side effects

  11. RESULTS AND DISCUSSIONS • Characterization of patients in the study (n=60)

  12. RESULTS AND DISCUSSIONS • Characterization of patients in the study (n=60) SEX RATIO Male/female = 9/1

  13. RESULTS AND DISCUSSIONS • Characterization of patients in the study (n=60) Hepatitis virus infection

  14. RESULTS AND DISCUSSIONS • Characterization of patients in the study (n=60)

  15. RESULTS AND DISCUSSIONS • Characterization of patients in the study (n=60) Liver cancer staging according BCLC pretreatment

  16. RESULTS AND DISCUSSIONS • Compare AFP before and after treatment (n=38) Pretreatment: AFP = 12090.329717.8 ng/mL After 1 month treatment: AFP = 2448.7±6807.7 ng/mL After 3 month: AFP = 1117.1±4277.1 ng/mL After 6 month : AFP = 1081.0±2443.7 ng/mL

  17. RESULTS AND DISCUSSIONS • Compare tumor size before and after treatment (n=54) Pretreatment : 6.9±2.8cm After 1 monthtreatmnet : 5.6±2.1cm After 3 month : 5.1±2.1cm After 6 month : 4.1±1.6cm

  18. RESULTS AND DISCUSSIONS • Response Assessment by mRECIST (n=54)

  19. RESULTS AND DISCUSSIONS • The parameters Y-90 resin microsphere treatment (n=60)

  20. SIRT SUPLY MORE DOSE TO TUMOR THAN EXTERNAL RADIATION EXTERNAL RADIATION INTERNAL RADIATION

  21. RESULTS AND DISCUSSIONS • The side effects after treatment (n=60)

  22. CONCLUSIONS • Radiotherapy in the selection of Y-90 radioactive spherical particles is a new, effective, modern treatment: 35.2% of patients respond fully after 6 months of treatment. • Safe and less serious complications: The most common side effect is vomiting and abdominal pain. • Treatment for advanced stage liver cancers (venous thrombosis) that other methods do not. • Treatment for patients with multiple tumors, can not be operated, patients recurring after surgery and other treatments.

  23. CASE STUDY 1 Female patient, 53 years old, Diagnose : HCC advanced stage (BCLC C)/Hepatitis B Portal vein invasion Liver tumor

  24. CASE STUDY 1 Treatment by Y-90 microsphere with dose: 1.67GBq

  25. CASE STUDY 1 Tuomor size 87x81mm AFP 273 ng/ml Tumor size 59x52mm AFP 7ng/ml

  26. CASE STUDY 2 Female, 59 years old Diagnosis: HCC stage BCLC B/ Hepatitis B- Diabetes mellitus Tumor in lower lobe VIII: 59x55mm

  27. CASE STUDY 2 Treatment by Y-90 microsphere with dose: 0.94GBq

  28. CASE STUDY 2

  29. CASE STUDY 2 After 20 months of treatment: AFP 2.15ng / mL Nodular hepatic nodule should be 13 mm

  30. THANK YOU!

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