Abstract
Primary and secondary liver cancer have longtime been characterized by an overall poor prognosis since the majority of patients are not candidates for surgical resection with curative intent, systemic chemotherapy alone has rarely resulted in long-term survival, and the role of conventional external beam radiation therapy has traditionally been limited due to the relative sensitivity of the liver parenchyma to radiation. Therefore, a host of new treatment options have been developed and clinically introduced, including radioembolization techniques, which are the main topic of this paper. In these locoregional treatments liver malignancies are passively targeted because, unlike the normal liver, the blood supply of intrahepatic tumors is almost uniquely derived from the hepatic artery. These internal radiation techniques consist of injecting either yttrium-90 (90Y) microspheres, or iodine-131 (131I) or rhenium-188 (188Re) labeled lipiodol into the hepatic artery. Radioactive lipiodol is used exclusively for treatment of primary liver cancer, whereas 90Y microsphere therapy is applied for treatment of both primary and metastatic liver cancers. Favorable clinical results have been achieved, particularly when 90Y microspheres were used in conjunction with systemic chemotherapy. The main advantages of radiolabeled lipiodol treatment are that it is relatively inexpensive (especially 188Re-HDD-lipiodol) and that the administration procedure is somewhat less complex than that of the microspheres. Holmium-166 (166Ho) loaded poly(L-lactic acid) microspheres have also been developed and are about to be clinically introduced. Since 166Ho is a combined beta-gamma emitter and highly paramagnetic as well, it allows for both (quantitative) scintigraphic and magnetic resonance imaging.
Keywords: Colorectal liver metastases, hepatocellular carcinoma, microspheres, lipiodol, iodine-131, yttrium-90, rhenium-188, holmium-166
Anti-Cancer Agents in Medicinal Chemistry
Title: Radionuclide Liver Cancer Therapies: From Concept to Current Clinical Status
Volume: 7 Issue: 4
Author(s): Maarten A.D. Vente, Monique G.G. Hobbelink, Alfred D. van het Schip, Bernard A. Zonnenberg and Johannes F.W. Nijsen
Affiliation:
Keywords: Colorectal liver metastases, hepatocellular carcinoma, microspheres, lipiodol, iodine-131, yttrium-90, rhenium-188, holmium-166
Abstract: Primary and secondary liver cancer have longtime been characterized by an overall poor prognosis since the majority of patients are not candidates for surgical resection with curative intent, systemic chemotherapy alone has rarely resulted in long-term survival, and the role of conventional external beam radiation therapy has traditionally been limited due to the relative sensitivity of the liver parenchyma to radiation. Therefore, a host of new treatment options have been developed and clinically introduced, including radioembolization techniques, which are the main topic of this paper. In these locoregional treatments liver malignancies are passively targeted because, unlike the normal liver, the blood supply of intrahepatic tumors is almost uniquely derived from the hepatic artery. These internal radiation techniques consist of injecting either yttrium-90 (90Y) microspheres, or iodine-131 (131I) or rhenium-188 (188Re) labeled lipiodol into the hepatic artery. Radioactive lipiodol is used exclusively for treatment of primary liver cancer, whereas 90Y microsphere therapy is applied for treatment of both primary and metastatic liver cancers. Favorable clinical results have been achieved, particularly when 90Y microspheres were used in conjunction with systemic chemotherapy. The main advantages of radiolabeled lipiodol treatment are that it is relatively inexpensive (especially 188Re-HDD-lipiodol) and that the administration procedure is somewhat less complex than that of the microspheres. Holmium-166 (166Ho) loaded poly(L-lactic acid) microspheres have also been developed and are about to be clinically introduced. Since 166Ho is a combined beta-gamma emitter and highly paramagnetic as well, it allows for both (quantitative) scintigraphic and magnetic resonance imaging.
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Maarten A.D. Vente , Monique G.G. Hobbelink , Alfred D. van het Schip , Bernard A. Zonnenberg and Johannes F.W. Nijsen , Radionuclide Liver Cancer Therapies: From Concept to Current Clinical Status, Anti-Cancer Agents in Medicinal Chemistry 2007; 7 (4) . https://dx.doi.org/10.2174/187152007781058569
DOI https://dx.doi.org/10.2174/187152007781058569 |
Print ISSN 1871-5206 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-5992 |
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