US Gastroenterology & Hepatology Review, 2006;(2):48-50
Longer version of article from Reference Section:
The understanding of radiation effect on tissue and the principles of dosimetry and fractionation have led to the acceptance and adoption of radiation as a standard treatment option for various cancers. Delivered in staged and fractionated aliquots, radiation will break nucleic strands, resulting in cellular death.
In general, radiation therapies are delivered using external techniques (external beam, intensity-modulated therapy). Despite the ability to concentrate radiation to very small and focused targets, these techniques continue to be limited by non-target radiation. With the development of 'internal radiation' delivered via the transarterial route, radioembolization using yttrium-90 (90Y) microspheres has the ability to avoid many of the limitations of external techniques. This article briefly discusses the current state of this technology.
Radiation therapy uses high-energy penetrating radiation to disrupt cellular DNA. Unfortunately, nontarget radiation also causes injury to normal tissue. In order to compensate for this, radiation treatments are fractionated and administered at regular intervals, thereby giving sufficient time for normal tissue to heal.
Until recently, no therapy has capitalized on one particular characteristic of malignant tissue: hypervascularity. Given the differential flow between tumor and normal tissue, the advantages of a transarterial approach for radiation delivery become apparent. This is the basis and mode of action of radioembolization with 90Y.
During the past ten years, numerous studies involving large phase II cohorts and randomized trials using 90Y microspheres have provided confirmatory evidence of the safety and efficacy for the treatment of primary and metastatic liver disease.8,13,14,17–27 New applications for 90Y therapy in selective lobar/segmental infusion with the intent of preserving functional liver reserve, and downstaging to resection, radiofrequency ablation (RFA), and liver transplantation are also being explored.1–6
There are two radioembolic devices commercially available.TheraSphere® (glass microsphere) was approved in 1999 by the US Food and Drug Administration (FDA) for the treatment of unresectable hepatocellular carcinoma (HCC) in patients (with or without portal vein thrombosis) who can have appropriately positioned hepatic arterial catheters.7 SIR-Sphere® (resin microsphere) was FDA-approved in 2002 for the treatment of colorectal metastases in conjunction with intrahepatic fluorodeoxyuridine (FUDR).8 Both devices are approved for the treatment of liver neoplasia in Europe.TheraSphere is also approved for the treatment of liver neoplasia in Canada, while SIR-Sphere has a broad approval for use in India and Australia, as well as several other countries in the Far East.
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