Radioembolization is a treatment method used in patients with liver cancer who cannot be operated on. It is an application that ensures the death of cancer cells by applying both radiation therapy and embolization simultaneously in the area where liver cancer is located.
Who Applies Radioembolization? Who Makes the Treatment Decision?
Radioembolization is performed by interventional radiologists. He is the person who plans all the technical details regarding the procedure during the application of the treatment.
However, the treatment decision is often made by the joint council decision of Oncology, Nuclear Medicine, Radiation Oncology, General Surgery, Radiology and other branches related to the treatment.
Oncology plays a central role in many issues such as patient selection, treatment algorithm, patient follow-up, evaluation of treatment, and additional treatments. Many other branches provide additional contributions to the application and execution of treatment.
In Which Situations Is Radioembolization Used?
It is used in the liver's own (primary) tumors (hepatocellular cancer, HCC) is also effective in tumors that spread (metastasize, secondary) to the liver (metastases of cancers such as colon, breast, lung, kidney, etc.). Radioembolization treatment is not a method that provides cure, but this treatment method;
What is the Radioembolization Process?
Radioembolization is a two-stage process. Both stages are performed in the angiography room, accompanied by an angiography device.
In the first stage, just like heart and brain angiographies, an angiograph for the liver is used to visualize the liver vessels by entering the groin veins before the procedure. Operation i is performed. In this way, the location, size and vascularity of the cancer focus located in the liver are determined. It is learned which vessels feed the cancer focus within the liver. In addition, in this first stage angiography, a substance called Technetium combined with special proteins is injected into the vessels that feed the patient's cancer tissue. At the end of the procedure, a special imaging device in the Nuclear Medicine unit determines whether the given technetium substance actually adheres to the cancerous tissue or whether it distributes to other organs in the body. Patients who pass the first stage are taken to the second stage angiography.
In the second stage, the vascular structures of the cancerous tissue in the liver are reached with the same angiographic method. Then, some special micro catheters (plastic tubes) and micro wires are entered into the veins that feed the cancer focus, and a special mixture containing radioactive material (yttrium-90, Y90) and occlusive particles (embolising substance) is injected into these veins. is done. In this way, a double effect is achieved by injecting both radioactive material and vascular-occlusive particles into the cancer tissue at the same time. While the radioactive substance causes cancer cells to die by irradiating the cancer focus, on the other hand, the blood supply of cancer cells is stopped with vascular-clogging particles. With this double effect, the metabolism of cancer cells is slowed down (the patient's symptoms decrease), their growth is prevented, and their spread is controlled.
How Does Radioembolization Work?
While the radioactive substance called yttrium-90 (Y-90, yttrium 90) causes tumor death in the cancer focus through radiation, the same effect is given to the patient. With the vascular-occlusive microspheres administered at the same time, the nutrition and blood flow of the cancerous tissue is stopped. With the double effect, a significant decrease in the metabolism of the cancerous tissue and death of cancer cells occur.
What is the Patient Preparation for Radioembolization?
If possible, patients should consult an oncologist or gastroenterologist or It must be followed by the internal medicine department. Specify above In patients who will be treated with the joint decision of the council, the size of the cancer focus, its metabolism, its extent, and whether it has spread to other organs should be monitored with imaging methods such as Ultrasonography, Tomography, MRI, PET/CT before the procedure.
The patient must undergo the same angiography before the treatment procedure. It is prepared as if preparing for the process. A few blood tests are performed to determine whether the patient is ready for angiography and interventional procedures. The procedure should be performed on an empty stomach. Before the procedure, it is questioned whether the patient is allergic to the vascular dyeing agent (contrast material) to be used in angiography.
What is done after radioembolization?
The patient rarely has abdominal pain after the procedure. You may feel nauseated and sometimes vomiting may occur. This is considered a sign that the treatment is effective. Because the radioactive substance emits radiation and the blood flow of the cancerous tissue is rapidly cut off, there will be serious edema and tension in the liver. This is a mechanism that explains abdominal pain, nausea and vomiting. Preventive and relieving drug treatments for these symptoms are given to patients during and immediately after the procedure.
After the procedure, patients are generally followed for 1 day (for patients who do not mind leaving the hospital). Since the procedure is an angiography procedure, patients are treated during the follow-up period. They are monitored for the groin area that is located.
After discharge, they are examined at regular intervals (for example, after 3 months, 6 months and 1 year), if possible with a PET/CT device. In this way, the first PET/CT scan is compared with the PET/CT scans after the treatment. The response to treatment is evaluated comparatively in terms of the size, metabolism and extent of the cancerous tissue.
Rarely, patients may need to undergo radioembolization a second time or repeatedly.
How to Monitor the Effectiveness of Radioembolization Treatment. Can it be done?
Most of the time, the effectiveness of the treatment can be monitored on an imaging basis by imaging with PET/CT. The clinical scoring of the patient and the clinical performance monitoring of the physician who follows the patient are also important in terms of monitoring the benefit the patient receives.
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