What Is Liver Cancer?
Patients may have either primary cancer in the liver or cancer that has spread (metastasized) to the liver from other organs. Liver-directed therapy may be an option for patients with the following cancers:
Colon Cancer | Neuroendocrine Tumor | Hepatocellular Carcinoma (HCC) | Cholangiocarcinoma | Pancreatic Cancer | Esophageal Cancer | Uterine Carcinoma | Melanoma | Ovarian Cancer | Sarcoma
How Is It Treated?
Liver cancers can be treated by surgery, radiation, or chemotherapy, as well as minimally-invasive, non-surgical interventions directed to the liver. VIP’s expertise in non-surgical therapies for liver cancers include yttrium-90 radioembolization, chemoembolization, bland embolization, and liver ablation. Our long-term and ongoing relationships with numerous oncologists, surgeons, and radiation oncologists in the region assure that your care is efficient and well-communicated with all parties. Drs. Dowell and Flanders have presented and published extensively about liver-directed therapy and techniques. VIP is the first outpatient facility in Indiana to provide these local regional therapies.
YTTRIUM-90 Radioembolization Procedure
We are currently the only outpatient clinic in Indiana capable of performing Y90 radioembolization, a form of targeted radiation therapy for liver cancer that involves delivering thousands of nearly microscopic beads impregnated with yttrium-90 (Y90) to block or disrupt blood flow to the tumors.
Following an initial consultation and review of diagnostic images, the interventional radiologist performs an angiogram to determine if the patient is a candidate. This “mapping” procedure is done as an outpatient under moderate sedation. A small catheter is advanced into the liver arteries under X-ray guidance, and a diagnostic tracer (technetium-labeled macroaggregated albumin, or MAA) is delivered to the liver. Subsequent diagnostic images after MAA delivery help determine if the patient is eligible for Y90 radioembolization and calculate the Y90 dose.
On a separate treatment day, the prescribed dose of microscopic radioactive Y90 spheres is delivered through a small catheter under X-ray guidance and moderate sedation. Once delivered, the spheres emit radiation for about a month, killing the tumors from the inside. Both the mapping and treatment procedures take approximately one hour each, and patients go home a few hours after the procedure.
Chemoembolization
Embolization procedures are arterial procedures performed by advancing a catheter under x-ray guidance to the vessels supplying a tumor and small particles are administered to block or disrupt the blood supply to starve and ultimately kill the tumor. A transarterial chemoembolization (TACE) treatment is an embolization procedure targeted to treat liver cancer tumors by delivering chemotherapy directly or via drug eluting beads to deliver the chemotherapy over time. Following an initial clinic consult and review of all diagnostic CT and MR imaging, the interventional radiologist advances a small catheter to the supplying liver arteries and the microscopic beads are embedded in the liver cancer tumors and the small arteries blocked to starve the tumors of their blood supply. The procedure takes approximately 1 hour and patients are discharged home a couple hours after the procedure. Success rates vary widely depending on the type of cancer treated and the type of embolization performed.
Bland Embolization
Embolization procedures are arterial procedures performed by advancing a catheter under x-ray guidance to the vessels supplying a tumor and small particles are administered to block or disrupt the blood supply to starve and ultimately kill the tumor. A bland embolization procedure is one in which bland microscopic particles, without chemotherapy or radiation, are delivered to the tumors to block the blood supply to the tumors. The procedure takes approximately 1 hour and patients are discharged home a couple hours after the procedure. Success rates vary widely depending on the type of cancer treated and the type of embolization performed.
Follow Up
Follow up imaging is obtained 1-3 months after an embolization procedure by either a multiphase CT or MRI of the liver with and without contrast. Patients are seen in clinic to review imaging and to discuss next steps, including if additional treatments are needed. Follow up is every three months with any additional treatment dependent upon the imaging response.
If you have liver cancer or metastatic cancer to the liver and would like to be evaluated for potential liver directed therapies, please book an appointment.