Understanding Radioembolization for Liver Cancer: A Patient’s Guide

Introduction and Terminology

Radioembolization is an advanced and targeted treatment method for liver cancer. It involves the use of tiny radioactive beads, also known as microspheres, to precisely deliver radiation directly to the cancer cells in the liver. The procedure, also known as selective internal radiation therapy (SIRT) or transarterial radioembolization (TARE), is effective in treating both primary liver cancer and liver metastases. The procedure is minimally invasive and typically performed by an Interventional Radiologist.

In the USA, Radioembolization has seen growing utilization over the last decade, with thousands of patients benefiting from this approach each year. This increase is attributed to the continuous refinement of the technique, the effectiveness of the procedure, and the suitability for patients who cannot undergo surgery or whose cancer is not responsive to chemotherapy.

Indications for Radioembolization

Radioembolization is considered a viable treatment option for various liver cancer scenarios. The procedure is typically indicated for:

• Patients with primary liver cancer (hepatocellular carcinoma or cholangiocarcinoma) that cannot be surgically removed due to the tumor’s size, location, or the patient’s overall health condition.
• Patients with liver metastases (cancer that has spread to the liver from another part of the body) when other treatment options such as surgery or systemic chemotherapy are not effective or suitable.
• Patients with inoperable liver tumors who require a bridge to liver transplantation or downstaging of tumors.
• Patients who have failed previous systemic therapies or those who cannot tolerate the side effects of systemic treatments.

Radioembolization can be used alone or in combination with other treatments like chemotherapy, depending on the specific circumstances of the patient and the cancer. However, it’s important to note that the procedure might not be suitable for everyone. Factors such as liver function, overall health, and the extent of the disease play a critical role in determining the eligibility for Radioembolization.

Pre-Op Preparation

Preparing for your Radioembolization procedure involves several steps to ensure a successful outcome and minimize potential complications.

• Generally, you will be asked to fast for several hours before the procedure.
• Adjustments may need to be made to your current medications, particularly those affecting blood clotting like aspirin or warfarin.
• Pre-operative labs or imaging may be required to assess your liver function and visualize the tumors.
• Pre-clearance authorization from your insurance may also be necessary.
• Considering your transportation home after the procedure, as you might not be able to drive yourself, is essential.
• Finally, you may need to arrange for work or school notes to allow for your recovery time.

Please note that these are general instructions and your doctor may have specific guidelines based on your health status. Always consult your doctor for personalized pre-operative instructions and to discuss any medications you’re currently taking that might need to be stopped before the procedure and when to resume them afterward.

If you are looking for a reliable medical team to assist with pre-operative clearances and ordering of pre-op labs and imaging, our telemedicine primary care practice can offer this service. Don’t hesitate to get in touch with us for all your pre-operative needs.

Procedure Technique for Radioembolization

Radioembolization is a complex, yet minimally invasive procedure that requires careful planning and execution by a specialized medical team, typically led by an Interventional Radiologist. Although medical procedures can seem overwhelming, understanding the process can alleviate some of the stress. The following is a simplified, step-by-step walkthrough of the Radioembolization process.

1. Pre-procedure Planning

The procedure begins with extensive planning, including mapping your liver’s blood vessels via angiography. This imaging test involves injecting a contrast dye into your blood vessels to make them visible on X-rays. This allows the doctor to visualize the liver’s anatomy and plan for the selective delivery of the microspheres.

2. Particle Mapping

Afterward, the doctor performs a test called a ‘particle mapping’ or a ‘nuclear medicine scan’. Here, harmless radioactive particles are injected to mimic the microspheres’ path. These particles are then tracked using special imaging techniques to ensure they are targeted at the tumors and not elsewhere in the body.

3. Preparing for the Radioembolization

Once the mapping is complete, the treatment day is scheduled. On the day of treatment, the doctor will administer a local anesthetic to numb the area where the catheter will be inserted – typically, this is in the groin.

4. Catheter Placement

Next, the doctor will make a small incision in your skin and insert a thin, flexible tube called a catheter into a large blood vessel. Using live X-ray guidance, the doctor guides the catheter through your blood vessels and into the hepatic artery, which supplies blood to your liver.

5. Delivery of Radioactive Beads

Once the catheter is in the correct position, the doctor will inject millions of tiny radioactive beads (microspheres) through the catheter and into the liver’s blood vessels. These beads deliver high-dose radiation directly to the cancer cells while sparing healthy liver tissue. This process can take between one to three hours, depending on the complexity of your liver’s blood vessels.

6. Completion of the Procedure

After the radioactive beads have been delivered, the catheter is carefully removed, and the incision is closed with a bandage – no stitches are needed. This marks the completion of the Radioembolization procedure. At this point, you’ll be moved to a recovery area where you’ll be closely monitored for a few hours before being discharged home.

Keep in mind that while this description provides a general outline of what to expect, your experience may vary slightly based on your specific medical condition and the practices of your healthcare team. It’s also important to remember that while the procedure itself usually takes a few hours, the entire process, from the initial planning stage to the completion of the procedure, can span several weeks.

Radioembolization is a powerful tool in the fight against liver cancer, and understanding how it works can give you a sense of control over your treatment. While this is a complex procedure, it’s important to remember that your healthcare team is there to guide you every step of the way. Be sure to ask them any questions you may have and to discuss any concerns about the procedure.

Duration of Radioembolization

The actual Radioembolization procedure typically takes between one to three hours. However, please note that the entire process, including pre-procedure imaging and post-procedure observation, can span several hours in total.

Post-Op Recovery from Radioembolization

After your Radioembolization procedure, you’ll be closely observed in a recovery area for a few hours before being discharged. Initially, you may experience mild fatigue and discomfort, which are common and usually subside within a few days.

Follow-up appointments will be scheduled to monitor your recovery and evaluate the treatment’s effectiveness. The first follow-up is usually one week after the procedure, and subsequent appointments are generally at one-month intervals.

There is typically no need for physical therapy following Radioembolization. However, lifestyle changes like maintaining a healthy diet, staying hydrated, and avoiding strenuous activities can aid your recovery.

Most patients can return to work within a week, but this can vary depending on your job nature and how quickly your body recovers. Full recovery, marked by your liver function returning to its pre-procedure state, typically takes a few weeks to months.

Should you need work or school notes, our telemedicine practice can provide same-day appointments until 9 pm on weekdays and 5 pm on weekends to cater to your needs.

Effectiveness of Radioembolization

Radioembolization has been demonstrated to be an effective treatment for liver cancer. It works by delivering high doses of radiation directly to the cancer cells while sparing healthy liver tissue, thus potentially shrinking tumors, alleviating symptoms, and improving quality of life.

Several studies have shown that Radioembolization can help control tumor growth in over 70-90% of cases. In some cases, it can also help make inoperable tumors suitable for surgery by reducing their size. It is particularly effective in treating liver cancer that has not spread to other organs.

However, the effectiveness of Radioembolization can vary based on several factors. It tends to be more effective in patients with smaller, localized tumors and good overall liver function. Conversely, patients with large tumors, significant liver damage, or cancer spread to other parts of the body may see less benefit.

While Radioembolization is a powerful tool in managing liver cancer, it’s not a cure. It’s most often used as part of a broader treatment strategy, which may include other treatments such as chemotherapy or surgery.

It’s important to discuss with your healthcare team your specific circumstances and what you can expect from this treatment. The goal of Radioembolization is not just to control the cancer, but also to help you maintain the best possible quality of life throughout your cancer journey.

Adverse Events with Radioembolization

Like any medical procedure, Radioembolization can come with potential adverse events. These include:

• Post-embolization syndrome (20-70%): This refers to a combination of symptoms including fever, pain, nausea, and fatigue that occur after the procedure. These symptoms are typically mild and manageable with medications.
• Radiation hepatitis (2-4%): This is inflammation of the liver caused by radiation exposure. Symptoms may include jaundice (yellowing of the skin and eyes), dark urine, and abdominal pain.
• Gastrointestinal ulcers (5-10%): Rarely, some microspheres may inadvertently reach the stomach or duodenum, leading to ulcers. These are generally treated with medications and rarely require surgery.
• Radiation pneumonitis (<1%): In some cases, the microspheres can reach the lungs, causing inflammation, shortness of breath, and coughing.

The overall mortality rate from the procedure is typically low, around 1-2%, but can be higher in patients with significant underlying health conditions.

Alternatives to Radioembolization

While Radioembolization is a valuable tool in treating liver cancer, it’s not the only option available. Surgical resection, liver transplantation, ablation therapies, and systemic treatments such as chemotherapy or targeted therapies are all viable alternatives depending on the disease’s stage and the patient’s overall health.

Lifestyle modifications, such as maintaining a healthy diet, reducing alcohol intake, and managing underlying conditions like hepatitis or diabetes, can also play a role in managing liver cancer.

Experimental or Emerging Technologies

Medical science is continually evolving, and researchers are exploring new treatment options for liver cancer. Some of these experimental technologies include immunotherapy, which uses the body’s immune system to fight cancer, and targeted therapy, which attacks specific characteristics of cancer cells. Another promising area is gene therapy, which involves modifying the genes inside your body’s cells to fight cancer.

Conclusion

Radioembolization is an effective and minimally invasive treatment option for liver cancer. While it comes with potential adverse events, the benefits of controlling tumor growth and improving patient quality of life are significant. However, it’s not the only treatment option, and emerging technologies show promise for the future. Understanding your treatment options and potential outcomes is crucial in making informed decisions about your healthcare.

Brief Legal Disclaimer: This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.