Liver cancer

1.4.1 Liver cancer

Patients with primary or metastatic tumours were treated by radio-embolization via a
catheter [59,69] or direct injection of beads into the tumour, with a needle [21,70].
Most studies describe administration of microspheres to patients via a catheter,
whereby the tip was placed in the hepatic artery. The spheres eventually lodge in the
microvasculature of the liver and tumour, remaining until the complete decay of the
radioisotope. Lung shunting and tumour-to-normal liver ratio was determined after
infusion of 99mTc-labeled macroaggregated albumin, and microspheres were
subsequently administered to patients [71,72]. Tumour-to-normal liver ratio was
approximately 3-5 [12,22,56,73]. In some studies the blood flow within the liver was
temporarily redirected in favour of the tumour by a bolus infusion of a
vasoconstrictor, and the spheres were then embolized into the arterial circulation [69].
While external beam radiation causes radiation hepatitis at doses above 30-35 Gy [74]
the liver can tolerate up to 80-150 Gy, using internal radionuclide therapy [12,69,72].
Increased longevity, pain relief, tumour response and total clinical improvement are
frequently reported [12,24,37,70].