Hepatocellular caricinoma: Issues with Radioembolization
Hepatocellular carcinoma (HCC) is caused by liver cirrhosis, viral hepatitis (80% HBsAg positive, 10% anti-HCV positive), chronic liver disease, and afaltoxin B1. Small HCC is rarely seen, and abdominal pain with RUQ mass is the most common finding, with friction rub or bruit over liver, bloody ascites, and rarely jaundice. In addition, an anemia, leukocytosis, elevated levels of AFP / ALP / 5-nucleotidase, etc. can be confirmed by the test results.
Abdominal ultrasonography (U / S) and α-fetoprotein are used as a screening test to diagnose hepatocellular carcinoma. Tumor markers such as α-FP and PIVKA Ⅱ are available. If abnormal findings are detected in the U / S, CT can be taken and MRI and PET-CT can be used for more accurate confirmation. Biopsy is not a frequent diagnostic method
Radical therapy of hepatocellular carcinoma is performed at the early stage of diagnosis, including surgical resection, liver transplantation and local ablation therapy. Transarterial chemoembolization (TACE), radioembolization, hormonal treatments, immunotherapy, antiproliferative agents and molecular target therapy.
Radioembolization is a method of injecting radioisotope-loaded microspheres into the hepatic artery supplying the tumor, and yttrium-90 is currently being used most actively for the treatment of liver tumors. After injection into the hepatic artery, the blood vessels are distributed into the microvessels, where the beta rays emitted from the yttrium-90 are localized to radiation therapy.
To determine the distribution and variation of blood vessels before the procedure and to measure percentage lung shunting, angiography is performed before the procedure. In particular, to prevent the occurrence of radiation pneumonia, the lung shunt must be measured before the procedure. Measurement of Shunting The use of 99mTc macoaggregated albumin (MAA) and radioembolization can not be performed if the amount is greater than 20%. It is important to understand the distribution and variation of the blood vessels before the procedure, and if it is believed that there is a risk of infusion or reflux into the blood vessels other than the part to be treated during the procedure, It is good practice.
The advantage of this procedure is that there is less post-embolization syndrome after the procedure, fewer procedures compared to TACE, and a mean tissue penetration depth of 2.5 mm, which may reduce local recurrence. Disadvantages include expensive materials, complex pre-test, and relatively severe side effects when embolized into the hepatic artery.
All response rates (AR) were 29-88% in the Theraphere preparation, 75-100% in the SIR-spheres, and 0% and 0-9% in the complete response rate, respectively. Median survival of Yttrium-90 treatment was 7.1-21 months for treatment and 9.4-24 months for liver cancer.
Abdominal ultrasonography (U / S) and α-fetoprotein are used as a screening test to diagnose hepatocellular carcinoma. Tumor markers such as α-FP and PIVKA Ⅱ are available. If abnormal findings are detected in the U / S, CT can be taken and MRI and PET-CT can be used for more accurate confirmation. Biopsy is not a frequent diagnostic method
Radical therapy of hepatocellular carcinoma is performed at the early stage of diagnosis, including surgical resection, liver transplantation and local ablation therapy. Transarterial chemoembolization (TACE), radioembolization, hormonal treatments, immunotherapy, antiproliferative agents and molecular target therapy.
Radioembolization is a method of injecting radioisotope-loaded microspheres into the hepatic artery supplying the tumor, and yttrium-90 is currently being used most actively for the treatment of liver tumors. After injection into the hepatic artery, the blood vessels are distributed into the microvessels, where the beta rays emitted from the yttrium-90 are localized to radiation therapy.
To determine the distribution and variation of blood vessels before the procedure and to measure percentage lung shunting, angiography is performed before the procedure. In particular, to prevent the occurrence of radiation pneumonia, the lung shunt must be measured before the procedure. Measurement of Shunting The use of 99mTc macoaggregated albumin (MAA) and radioembolization can not be performed if the amount is greater than 20%. It is important to understand the distribution and variation of the blood vessels before the procedure, and if it is believed that there is a risk of infusion or reflux into the blood vessels other than the part to be treated during the procedure, It is good practice.
The advantage of this procedure is that there is less post-embolization syndrome after the procedure, fewer procedures compared to TACE, and a mean tissue penetration depth of 2.5 mm, which may reduce local recurrence. Disadvantages include expensive materials, complex pre-test, and relatively severe side effects when embolized into the hepatic artery.
All response rates (AR) were 29-88% in the Theraphere preparation, 75-100% in the SIR-spheres, and 0% and 0-9% in the complete response rate, respectively. Median survival of Yttrium-90 treatment was 7.1-21 months for treatment and 9.4-24 months for liver cancer.
