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Yttrium-90 Microsphere Therapy for Hepatic Malignancy: Devices, Indications, Technical Considerations, and Potential Complications¹

¹ From the Interventional Radiology Section (R.M., D.C.M., S.G., K.A., M.J.W., M.E.H.) and the Departments of Nuclear Medicine (R.N.), Body Imaging (J.S.), and Imaging Physics (W.E.), Division of Diagnostic Imaging, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 325, Houston, TX 77030; Department of Radiology and Nuclear Medicine, University of Texas Hermann Hospital, Houston, Tex (A.C.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (D.M.C.); and Wake Radiation Oncology, Cary, NC (A.S.K.). Presented as an education exhibit at the 2004 RSNA Annual Meeting. Received March 23, 2005; revision requested April 25 and received June 7; accepted June 15. The article discusses an investigational or unlabeled use of a commercial device or pharmaceutical that has not been approved for such purpose by the FDA. The glass microsphere device (TheraSphere; MDS Nordion, Ottawa, Ontario, Canada) has received humanitarian device exemption approval from the FDA for treatment of unresectable hepatocellular carcinoma and can be used only with investigational review board oversight. The resin microsphere device (SIR-Spheres; Sirtex Medical, Lake Forest, Ill) has received premarket approval from the FDA for use in combination with hepatic arterial floxuridine therapy to treat colorectal metastasis to the liver; its use in any other manner for treatment of hepatic neoplastic disease is an off-label application. R.M., A.S.K., and D.M.C. have received honoraria from Sirtex Medical; all remaining authors have no financial relationships to disclose. Address correspondence to R.M. (e-mail: rmurthy{at}di.mdacc.tmc.edu).

Management of hepatic malignancies is a ubiquitous medical problem. Surgical resection of primary or metastatic liver cancer, with or without adjuvant chemotherapy, is the most effective method for enhancing survival; however, hepatic malignancies in the vast majority of patients are unresectable both at initial manifestation and at recurrence. In these patients, palliative cytoreductive therapies may help to retard tumor progression and therefore favorably alter the course of the disease. Since hepatic neoplasms are principally supplied by the hepatic artery, various arterially delivered cytotoxic agents have been developed to achieve these objectives. Recently, the Food and Drug Administration approved the transarterial administration of yttrium-90 microspheres for liver-directed therapy. Effective use of these devices requires knowledge of the accumulated clinical experience and a dedicated multidisciplinary effort to ensure optimal outcomes and avoid therapy-specific life-threatening complications.

© RSNA, 2005

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