Novel Interventional Radiology Treatment With Microspheres Shows Promise for Liver Cancer Patients

More Than Three-fourths of Hepatocellular Carcinoma Patients Can't Have
Surgery; Intra-arterial Yttrium-90 Gives Patients More Time, Offers Minimally
Invasive Treatment

TAMPA, Fla., March 16 /PRNewswire-USNewswire/ -- An interventional radiology
treatment-the use of intra-arterial yttrium-90 microspheres for liver cancer
(also known as hepatocellular carcinoma)-shows promise in prolonging life for
many patients with this devastating condition, according to researchers at the
Society of Interventional Radiology's 35th Annual Scientific Meeting in
Tampa, Fla.

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"This is encouraging news for liver cancer patients, especially those who also
have blockage in the portal vein. While patients aren't cured, their lives are
being extended and their quality of life is improving with yttrium-90
microsphere treatment," said Riad Salem, M.D., MBA, director of
interventional oncology at the Robert H. Lurie Comprehensive Cancer Center at
Northwestern Memorial Hospital in Chicago, Ill. "This unique interventional
radiology treatment, which combines the radioactive isotope Y-90 into
microspheres that deliver radiation directly to a tumor, is a particularly
elegant way to give patients a cancer treatment that doesn't harm the healthy
cells. Patients don't feel sick or have many of the side effects that happen
with standard cancer treatments," added Salem, an interventional radiologist
and professor of radiology, medicine and surgery at Northwestern University
in Chicago, Ill. In a 291-patient study, patients with Child-Pugh A disease,
with or without portal vein thrombosis (blood clot), benefited the most from
Y-90 treatment, said Salem, with some patients surviving more than 20 months.
Child-Pugh A patients with branch portal vein thrombosis survived nearly 17
months. "These are early promising results. This information can be used to
design future Y-90 trials and to describe Y-90 as a potential treatment
option to liver cancer patients," he added.

About 18,500 cases of primary liver cancer are diagnosed each year; the most
common form is hepatocellular carcinoma, a tumor that begins in the main cells
of the liver (hepatocytes). Primary liver cancer is twice as common in men as
in women and occurs most frequently in those who have a form of liver disease
called cirrhosis. Cirrhosis occurs when the liver becomes diseased and
develops scarring, usually over a period of years. The liver attempts to
repair or regenerate itself; this process can lead to the formation of tumors.
In the United States, the most common causes of cirrhosis are alcohol abuse
and chronic infection with the liver virus hepatitis B or C. Many patients
with liver cancer have impaired liver function due to underlying cirrhosis
and/or the tumors themselves. They are then at increased risk for liver
toxicity from any liver cancer treatment. In the United States, approximately
50-60 percent of patients with primary liver cancer die of tumor progression
and 40-50 percent die from advancing cirrhosis and subsequent liver failure.

Liver cancer treatment options are limited, said Salem. Although surgical
removal of liver tumors offers the best chance for a cure, it is not possible
for more than three-fourths of primary liver cancer patients. Liver tumors are
often inoperable because the tumor may be too large or have grown into major
blood vessels or other vital structures. Sometimes many small tumors are
spread throughout the liver, making surgery too risky or impractical.
Historically, chemotherapy drugs and external radiation therapy have been
ineffective at curing inoperable liver cancer. Additionally, due to the
compromised liver function of liver cancer patients, physicians must be
careful that cancer treatments do not cause additional liver damage and
toxicity, which could lead to death.

"For these patients, minimally invasive treatments offer them an option that
can give them more time," said Salem. Tumors need a blood supply, which they
actively generate, to feed themselves and grow. As vascular experts,
interventional radiologists are uniquely skilled in using the vascular system
to deliver targeted treatments via catheter throughout the body, he added. In
treating cancer patients, interventional radiologists can attack the cancer
tumor from inside the body without medicating or affecting other parts of the
body. Y-90 treatment adds to interventional radiology's nonsurgical advances
for liver cancer, such as delivering chemotherapy directly to the affected
organ (chemoembolization), killing the tumor with heat (radiofrequency
ablation) or freezing the tumor (cryoablation) to treat cancer locally.

Combining the radioactive isotope Y-90 into microspheres to deliver
radiation directly to a tumor allows for a higher, local dose of radiation to
be used-without subjecting healthy tissue in the body to the radiation. Each
microsphere is about the size of five red blood cells in width. These beads
are injected through a catheter from the groin into the liver artery supplying
the tumor. The beads become lodged within the tumor vessels where they exert
their local radiation that causes cell death. Y-90 radiates from within and,
since it is administered via the hepatic artery, it can be viewed as
"internal" radiation, said Salem. Y-90 treatment is approved by the Food and
Drug Administration for the treatment of unresectable hepatocellular
carcinoma.

In the study, 291 patients with hepatocellular carcinoma were treated with
intra-arterial yttrium-90 microspheres as part of a single-center prospective
study. Researchers administered 526 (average, 1.8) Y-90 treatments.
Researchers reviewed 1,250 scans to assess response and time-to-progression (a
surrogate marker that might imply-but does not prove-improved survival).
Survival by stage was assessed. Overall time-to-progression was 7.9 months,
said Salem. In other words, it took a median 7.9 months for the tumors to
regrow after treatment. In oncologic standards for this disease, this is a
very promising finding, said Salem. Survival times differed by the cancer
staging system used: Child-Pugh A (17.2 months) and Child-Pugh B (7.7 months)
and by Barcelona Clinic Liver Cancer staging (A, 26.9 months; B, 17.2 months).
Researchers used baseline age; sex; performance status; presence of portal
hypertension; tumor distribution; levels of bilirubin, albumin and
alpha-fetoprotein; and World Health Organization/European Association for the
Study of the Liver response rates to predict survival. Toxicities included
fatigue (57 percent), transient pain (23 percent), nausea/vomiting (20
percent) and exhibited grade 3/4 bilirubin toxicity (5 percent).

More information about the Society of Interventional Radiology, interventional
radiologists and minimally invasive treatments for liver cancer can be found
online at www.SIRweb.org.

Abstract 34: "Yttrium-90 Radioembolization for Hepatocellular Carcinoma:
Comprehensive Analysis of Long-term Outcomes in 291 Patients," A. Riaz, R.J.
Lewandowski, R. Gupta, R.K. Ryu, K.T. Sato, R.A. Omary and R. Salem, all
at Northwestern University, Chicago, Ill., SIR 35th Annual Scientific
Meeting March 13-18, 2010, Tampa, Fla. This abstract can be found at
www.SIRmeeting.org.

About the Society of Interventional Radiology

Interventional radiologists are physicians who specialize in minimally
invasive, targeted treatments. They offer the most in-depth knowledge of the
least invasive treatments available coupled with diagnostic and clinical
experience across all specialties. They use X-ray, MRI and other imaging to
advance a catheter in the body, such as in an artery, to treat at the source
of the disease internally. As the inventors of angioplasty and the
catheter-delivered stent, which were first used in the legs to treat
peripheral arterial disease, interventional radiologists pioneered minimally
invasive modern medicine. Today, interventional oncology is a growing
specialty area of interventional radiology. Interventional radiologists can
deliver treatments for cancer directly to the tumor without significant side
effects or damage to nearby normal tissue.

Many conditions that once required surgery can be treated less invasively by
interventional radiologists. Interventional radiology treatments offer less
risk, less pain and less recovery time compared to open surgery. Visit
www.SIRweb.org.

The Society of Interventional Radiology is holding its 35th Annual Scientific
Meeting March 13-18 in Tampa, Fla. The theme of the meeting is "IR
Innovation," celebrating the remarkable inventiveness of SIR members and
highlighting the contribution made to both creating the field of
interventional radiology and to improving patient care.

SOURCE Society of Interventional Radiology

Maryann Verrillo, (703) 460-5572, Diane Shnitzler, (703) 460-5582; March
11-12, Lisa Tadje, (212) 453-2137; March 11-12, Don Murphy, (212) 453-2462;
March 11-12, Neil Hochman, (212) 453-2067; March 13-18, Tampa Press Room,
(813) 276-6905, (813) 276-6906 or (813) 276-6912, comm@SIRweb.org