- New radiation segmentectomy (RS) treatment shows promise in targeting site of liver cancer while sparing much of the surrounding normal tissue
- Current standard treatment options for early liver cancer such as surgery, liver transplantation and radiofrequency ablation are expensive and associated with potential complications. In addition many patients are unsuitable for these procedures due to other comorbidities
segmentectomy treatment selectively destroys liver tumor tissue while sparing
the adjacent normal tissue. It could become a potential curative option for
early stage liver cancer patients according to recent study conducted at the Department of
Radiology at the North-western University Feinberg School of Medicine in
The findings of the study appear online in the journal Radiology
Details of StudyThe study was led by senior author Riad Salem, M.D., chief of vascular interventional radiology and his team in the Department of Radiology at the Northwestern University Feinberg School of Medicine in Chicago
Dr. Salem and his team assessed long-term outcomes in 70 early-stage HCC patients who underwent RS between 2003 and 2016. They analyzed the patients' responses to treatment based on two commonly employed sets of criteria.
- As per one criteria, 90 percent of patients demonstrated positive response to the therapy, with 59 percent showing complete response.
- Based on the second set of criteria, 71 percent achieved positive response, with 16 percent achieving a complete response.
- RS destroyed the target tumor, decreased the time for disease progression and improved patient survival at rates comparable to surgery, radiofrequency ablation, and
- transplantation in early-stage HCC patients.
- Nearly 75 percent of patients had no cancer progression in the target tumor for five years after treatment
- Average overall survival was 6.7 years, and one-, three-, and five-year survival chances were 98 percent, 66 percent and 57 percent, respectively.
- One-, three-, and five-year overall survival probability in patients with a baseline tumor size of 3 centimeters or less was 100 percent, 82 percent and 75 percent respectively.
About Radiation SegmentectomyRadiation segmentectomy (RS) is a minimally invasive procedure using the radioisotope yttrium-90 (Y90) to destroy tumors. The isotope embedded into tiny beads is delivered via a catheter into a blood vessel in the liver. They then reach the site of the tumor, where they come to rest and deliver their radiation effect on the tumor site leaving much of the adjacent healthy tissue unaffected.
The name of the procedure derives from the fact that the liver is into a number of segments for clinical purposes by surgeons . Using an imaging procedure called cone beam CT, interventional radiologists are able to obtain a detailed view of the complex liver vasculature segment wise and can concentrate on delivery of the Y90 to the relevant or affected segment.
"Cone beam CT has revolutionized our ability to perform segmental injections isolated to very small tumors, sparing the majority of normal tissue," said study senior author Riad Salem, M.D., chief of vascular interventional radiology in the Department of Radiology at the Northwestern University Feinberg School of Medicine in Chicago. "Before cone beam CT, we had the ability to focus radiation, but not with this level of accuracy."
Advantages of Radiation Segmentectomy Over Current Standard Treatments
- RS can be done on an outpatient basis, is minimally invasive and associated with lesser complications and adverse effects on the patient.
- RS has been found to be superior to transarterial chemoembolization, another minimally invasive method in which anti-tumor drugs are injected into the liver's main artery under radiological guidance and reach microvessels supplying the tumor.
- Other procedures including transarterial chemoembolization requiring hospitalization.
About Liver CancerLiver or hepatocellular cancer is the most common (90%) form of primary liver cancer. The incidence has been found to be on the rise in many developed nations and is likely to continue increasing. Most patients have associated underlying chronic liver disease.
Surgery, liver transplantation and radiofrequency or ethanol injection ablation are standard therapies for early-stage disease. With these treatments, five year survival rates range from 50 to 70%.
Ongoing and Future PlansThe research team continue to follow the patients from the original study group with a view to find ways to optimize the liver cancer treatment and improve outcome.
"We want to see these outcomes validated in patients over the longer term," Dr. Salem said. "We also want to minimize the time from clinic visit to treatment, and fine-tune dosimetry so that we can find the optimal dose that will kill the tumor. In the right patient setting, RS can be considered curative."
In conclusion, radiation segmentectomy offers several advantages over current standard therapies for early stage liver cancer and could potentially change the management of liver cancer.