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:
Liver cancers can be treated by surgery, radiation, chemotherapy, as well as minimally-invasive, non-surgical interventions directed to the liver. At VIP, we have expertise in non-surgical, liver-directed therapies for liver cancers. These minimally-invasive therapies include yttrium-90 radioembolization, chemoembolization, bland embolization, and liver ablation. We have high-functioning relationships with numerous oncologists, surgeons, and radiation oncologists to make certain your care is efficient and well-communicated through regular discussions and tumor boards. Drs. Dowell and Flanders have a particular interest and exceptional experience in liver-directed therapy and have presented and published extensively on these techniques. VIP is the first outpatient facility in Indiana to provide these local regional therapies in an outpatient clinic model.
We are currently the only outpatient clinic in Indiana capable of performing Y90 radioembolization. Radioembolization is a procedure to block or disrupt the blood flow to the liver tumors by delivering thousands of nearly microscopic beads impregnated with yttrium-90 (namely Y90).
A Y90 treatment is a form of targeted radiation therapy used to treat liver cancer tumors. Following an initial clinic consultation and review of all diagnostic CT or MR images, the interventional radiologist initially performs an angiogram to determine if a patient is a candidate. This “mapping” procedure is done outpatient under moderate sedation to determine each patient’s unique anatomy by advancing a small catheter in the liver arteries under x-ray guidance as well as delivering a diagnostic tracer called MAA (technician-labeled macroaggregated albumin) to the liver. The subsequent diagnostic images obtained after the MAA is delivered help determine if a patient is a candidate for Y90 radioembolization and the calculated Y90 dose to deliver on treatment day.
On a separate Y90 treatment day, the supplied dose of microscopic radioactive spheres are delivered by a small catheter under x-ray guidance in a similar procedure again by a small needle stick under moderate sedation. Once the beads are delivered, they emit radiation for a period of about a month, killing the tumors from the inside. Both procedures take approximately 1 hour each. Patients go home a few hours following the procedure.
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.
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 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.
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