radioembolizationNYC Surgical Associates offers a new outpatient procedure for the treatment of primary liver cancer, unresectable colorectal liver metastases, and other metastatic disease. The procedure, Radioembolization or Selective Internal Radiation Therapy (SIRT), provides targeted radiation to unresectable liver tumors.

Radioembolization may be an option for patients who have primary or metastatic liver cancer that cannot be treated by surgical resection or ablation or have stopped responding to chemotherapy. Radioembolization may also be used in conjunction with chemotherapy to treat liver cancer.

Radioembolization, performed as an outpatient procedure by our endovascular surgeons, requires the placement of a microcatheter that is positioned in the artery supplying blood to the tumor. Millions of spheres of the radioactive isotope yttrium-90 microspheres are implanted in the microvascular arterial supply of the tumor where they become trapped, killing tumor cells and sparing the surrounding healthy liver tissue. With a half-life of approximately 2.7 days, most therapeutic radiation (94%) is delivered in 11 days, with almost no radiation remaining after one month.

The procedure takes between 60 and 90 minutes, and patients are usually able to go home four to six hours after the procedure.

Physicians, your patient may be eligible for Radioembolization if he/she has:

  • Primary liver cancer, colorectal cancer with unresectable liver metastases, other liver metastases
  • Bilirubin of <2.0
  • Less than 70% tumor involvement of liver
  • ECOG performance score <2

Below are some frequently asked questions to help you understand the procedure.

What are SIR-Spheres microspheres?

SIR-Spheres microspheres are microscopic polymer beads that contain the radioactive isotope Y-90 and emit beta radiation to kill cancer cells. Due to their small size, (~average size 32 microns) they travel easily through the bloodstream directly to the liver. The microspheres become lodged in the tumor vasculature and kill the cancer cells. SIR-Spheres microspheres are considered a safe and effective method of using radiation to treat liver cancer and are often used in conjunction with chemotherapy. SIR-Spheres microspheres are manufactured by Sirtex, which is headquartered in Australia and has U.S. operations in Woburn, Mass.

What do SIR-Spheres microspheres treat?

SIR-Spheres microspheres are used to treat primary liver cancer, metastatic liver cancer and colorectal cancer.

What are Theraspheres?

Theraspheres are small glass beads that contain radioactive yttrium-90 which is used primarily to treat hepatocellular carcinoma (primary liver cancer). Theraspheres are approved by the US FDA under a Humanitarian Device Exemption.

Can you describe the radioembolization procedure?

Radioembolization treatment is performed as an outpatient procedure by endovascular surgeons and requires the placement of a transfemoral microcatheter. Using the liver’s unique vascular supply, millions of tiny resin microspheres charged with yttrium-90 (beta radiation) are released to the liver circulation. The radioactive microspheres selectively implant in the microvascular supply of the tumor where they become trapped. The microspheres emit beta radiation for a period of about two weeks. The procedure can be done concurrently with chemotherapy or as monotherapy (without chemotherapy).

How effective is the treatment?

Clinical studies have shown radioembolization increases the time-to-disease progression and overall survival without adversely affecting the patient’s quality of life. In clinical studies, radiomicrospheres have been combined with modern chemotherapy or administered as a monotherapy during a chemotherapy holiday.

Where is the procedure performed?

The procedure is performed typically at our in-office surgical suites or in the hospital, depending on the procedure needed.

How is radioembolization different from other treatments?

The targeted nature of SIR-Spheres microspheres therapy enables doctors to deliver up to 40 times more radiation to the liver tumors than would be possible using conventional radiotherapy, while sparing the surrounding healthy liver parenchyma.

How common is this procedure?

Radioembolization is currently being offered at more than 500 medical centers around the world, including more than 200 centers in the United States.

Other than treating the cancer, what are the benefits to the patients?

Besides offering patients an effective treatment option to control the advancement of their liver cancer, microspheres therapy also helps patients maintain a good quality of life. The procedure is performed as an outpatient service which minimizes the time spent at the hospital.

What are the side effects?

Some side effects following a radioembolization procedure can be minor, making patients feel uncomfortable, but a small number can be serious. Many patients experience abdominal pain or tightness in their abdomen, nausea and loss of appetite which normally subsides within a week. Many patients also develop a mild fever that may last for up to a week and fatigue that may last for several weeks. As a precaution, specific medications are prescribed to control these symptoms.

What are the potential complications?

In rare instances, there is the possibility that a small number of microspheres may inadvertently reach other organs in the body, such as the gall bladder, stomach, intestine, or pancreas. If the radiomicrospheres reach these organs, they may cause inflammation of the gallbladder (cholecystitis), stomach (gastritis) or intestine (duodenitis). These complications are rare, but if they do occur they require additional medical treatment.

Do patients have to take special precautions?

There are some simple precautions that patients need to take during the first 24 hours following the radioembolization procedure. These precautions include: thorough hand washing after using the toilet; cleaning up any spills of body fluids such as blood, urine, or stools and disposing of them in the toilet. Otherwise, patients can resume normal contact with family members.

Does insurance cover the procedure?

Under the terms of the Medicare Prescription Drug Improvement and Modernization Act (MMA) of 2003, Medicare, for the most part, reimburses hospitals for the cost of outpatient treatment with radioembolization. Many private payers have realized the efficacy of radioembolization and as a result have issued positive coverage policies for treatment.