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Radioembolization (Yttrium-90 Microspheres) for Metastatic Hepatic Malignancies

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Therapeutic Nuclear Medicine

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

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Abstract

Radioembolization is the process of permanently implanting radioactive microspheres into hepatic malignant tumors using the hepatic arterial system for delivery. The most common therapeutic radioisotope used in this form of brachytherapy (placing radioactive sources into or next to a tumor) is yttrium-90 (90Y). Since the earliest attempts to implant liver tumors, the technique has been surprisingly similar—a catheter is situated into a branch of the hepatic artery, and microspheres (25–35 micron diameter) containing 90Y preferentially flow to tumors as opposed to normal liver. The microspheres are small enough to penetrate into the tumors but too large to pass out of the hepatic capillary beds, and so they permanently reside in the tumor. The most common cancers treated with 90Y microspheres are primary hepatocellular carcinoma, and metastatic tumors from primary colorectal, neuroendocrine, pancreas, and breast carcinomas. The toxicity profile is highly favorable for this outpatient procedure with fewer than 2% serious adverse events (gastric ulceration 1–2%, radiation-induced liver failure 0.8%). Overall response rates are 30–75% (RECIST) based on tumor type, and in colorectal cancers, there is a proven survival improvement with 90Y in patients whose chemotherapy agents are no longer inducing a response. The use of radioembolization continues to rapidly grow for a variety of patient subgroups which now include first line therapy in neuroendocrine and colorectal tumor types.

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Authors and Affiliations

  1. FACRO Co-Medical Director, Wake Radiology Oncology, 300 Ashville Ave Suite 110, Cary, NC, 27518, USA

    Andrew S. Kennedy

  2. Department of Biomedical Engineering, Department of Mechanical and Aeronautical Engineering, North Carolina State University, Raleigh, NC, USA

    Andrew S. Kennedy

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  1. Andrew S. Kennedy
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Correspondence to Andrew S. Kennedy .

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Editors and Affiliations

  1. THERANOSTICS Center for Molecular, Radiotherapy and Molecular Imaging, ENETS Center of Excellence, Bad Berka, Germany

    Richard P. Baum

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© 2012 Springer-Verlag Berlin Heidelberg

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Kennedy, A.S. (2012). Radioembolization (Yttrium-90 Microspheres) for Metastatic Hepatic Malignancies. In: Baum, R. (eds) Therapeutic Nuclear Medicine. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2012_727

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  • DOI: https://doi.org/10.1007/174_2012_727

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-36718-5

  • Online ISBN: 978-3-540-36719-2

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