- 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 Study
The 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
‘Radiation segmentectomy (RS) treatment is a minimally invasive procedure that employs the radioisotope yttrium-90 (Y90) to destroy tumors.’
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,
- 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.
"The results show that we are able to impart curative outcomes to
these patients," Dr. Salem said. "Our numbers with radiation
segmentectomy match or outperform those of other curative
treatments in terms of tumor control, survival rate and
About Radiation Segmentectomy
Radiation 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
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
Advantages of Radiation Segmentectomy Over Current Standard
- 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
About Liver Cancer
Liver or hepatocellular cancer
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 Plans
The 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
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