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Neuroendocrine tumours
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Sairah R Khan, Kathryn L Wallitt, Adil Al-Nahhas, Tara D Barwick
First-line treatment of NETs remains surgical resection of the primary tumour plus resection of any regional lymph node metastases, followed by ‘cold’ somatostatin analogue therapy plus/minus chemotherapy in the presence of highly proliferating disease. Locoregional approaches for liver-only or liver-predominant disease are also available with transarterial chemoembolization (TACE) and selective internal radiation therapy (SIRT), the latter involving the delivery of Yttrium-90 labelled microspheres to hepatic tumours directly via the hepatic artery. PRRT has been reserved as a treatment for patients with positive expression of SSTR2 and inoperable or metastasized, well-differentiated disease who have progressed on somatostatin analogue and/or systemic therapy.
Liver and biliary system, pancreas and spleen
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
In contrast to normal liver tissue, tumours in the liver receive their blood supply predominantly from the hepatic artery. Any treatment delivered through the hepatic artery will have a proportionately bigger effect on liver tumours than normal surrounding liver. This is the basis of the liver-directed therapies transarterial chemoembolisation (TACE) and selective internal radiation therapy (SIRT) for treating liver tumours. TACE delivers chemotherapy drugs loaded into special microspheres in high doses to liver tumours. SIRT delivers high-dose radiation to liver tumours using yttrium microspheres. In both procedures, the microspheres are delivered into the hepatic artery either selectively to the arteries supplying the tumour or non-selectively to an entire lobe or the whole liver. Care needs to be taken to ensure the microspheres are not delivered into branches of the hepatic artery that do not supply the liver in order to prevent potentially serious side-effects from these treatments. Radiofrequency and cryoablation techniques can be used to treat individual tumours in the liver, including metastases, without recourse to surgery.
Liver Transplantation for Neuroendocrine Tumors
Published in Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner, Endocrine Surgery, 2017
Nir Lubezky, Parissa Tabrizian, Myron E. Schwartz, Sander Florman
Selective internal radiation therapy (SIRT), or transarterial radioembolization, using Y90-labeled microspheres, is a novel treatment modality for liver cancer. The technique involves the intra-arterial injection of Y90-labeled microspheres through the hepatic artery. Two types of Y90-labeled microspheres are commercially available: SIRspheres (resin spheres) and TheraSpheres (glass spheres). Both types of microspheres gain entry to the tumor after injection to the artery, but will not pass through the capillary bed to the venous circulation, thus becoming trapped in the tumor. As described above, the tumors derive most of their blood supply from the artery; therefore, arterial injection of the spheres results in their accumulation within the tumor at a much higher concentration than in adjacent liver tissue, and exposure of the tumor to a high dose of local radiation, while sparing the normal liver. This technique has been used successfully for various hepatic malignancies, including NET metastases [77–80]. Small series of selective hepatic arterial administration of radionuclide-labeled somatostatin analogs have also been reported, in patients with large somatostatin receptor-positive tumors, with clinical and radiological response [81, 82].
Role of immune checkpoint inhibitors in metastatic uveal melanoma: a single-center retrospective cohort study
Published in Acta Oncologica, 2023
Lize Vanaken, F.J. Sherida H. Woei-A-Jin, Rita Van Ginderdeuren, Christophe M. Deroose, Annouschka Laenen, Guy Missotten, Dietmar R. Thal, Oliver Bechter, Patrick Schöffski, Paul Clement
Treatments were categorized as ICI, other systemic treatments, local treatments or best supportive care (BSC) (i.e., no anti-cancer treatment). Since ICI was introduced in our hospital as treatment for MUM on August 1st, 2010, we refer to the period before this date as the pre-ICI era and the period afterwards as the ICI era. All patients were observed until data cutoff on August 1st, 2022. The category ‘other systemic treatments’ included chemotherapy, tyrosine kinase inhibitors and Tebentafusp. Local treatments included LDT and local therapies such as surgery and external beam radiotherapy for oligometastatic disease. In our center, the selective internal radiation therapy (SIRT) procedure consisted of injection of radioactive 90Yttrium microspheres in the common/right/left hepatic artery or smaller branches (tumoricidal dose >100 Gy). For trans-arterial embolization small particles without chemotherapeutic impregnation were used. High dose melphalan was used for isolated hepatic perfusion. Combination of ipilimulab and nivolumab followed by nivolumab monotherapy was counted as one treatment line unless interrupted by local therapies. Consecutive treatments with different classes of ICI upon disease progression were counted as separate treatment lines.
A systematic literature review and network meta-analysis of first-line treatments for unresectable hepatocellular carcinoma based on data from randomized controlled trials
Published in Expert Review of Anticancer Therapy, 2021
Richard F. Pollock, Victoria K. Brennan, Suki Shergill, Fabien Colaone
In patients with good liver function, and without extrahepatic metastases (EHM) or contraindications to hepatic embolization, locoregional treatment using selective internal radiation therapy (SIRT) is another treatment option. SIRT preferentially targets liver tumors over the normal liver parenchyma, utilizing the relatively high microvascular density in the tumor and the supply of tumoral blood from the hepatic artery, as opposed to the hepatic portal vein for normal liver tissue. Relative to systemic therapies and TACE, SIRT has the advantage of being a one-off treatment with a well-characterized safety and efficacy profile; SIRT with SIR-Spheres Y-90 resin microspheres has been studied, alone and in combination with sorafenib, in three randomized controlled trials (RCTs) enrolling a total of 1,243 patients with unresectable HCC (SARAH, SIRveNIB, and SORAMIC) [7–9]. Current guidelines from the European Society for Medical Oncology recommend SIRT in patients with HCC in Barcelona Clinic Liver Cancer (BCLC) stage B after TACE failure or refractoriness, and in patients with HCC in BCLC C where no systemic therapy is feasible [3]. SIRT may also be used in patients with early (BCLC stage A) HCC, potentially with the objective of downstaging the tumor for resection or liver transplantation, or ‘bridging’ the patient to transplant [10,11].
A cost-utility analysis of SIR-Spheres Y-90 resin microspheres versus best supportive care in the treatment of unresectable metastatic colorectal cancer refractory to chemotherapy in the UK
Published in Journal of Medical Economics, 2020
V. K. Brennan, F. Colaone, S. Shergill, R. F. Pollock
For patients refractory to third-line therapy or ineligible for current third-line treatments, no other systemic therapy options are currently available and disease management may therefore be restricted to best supportive care (BSC), which is associated with median survival of 4–6 months.20 However, in patients with liver-only or liver-dominant metastases, selective internal radiation therapy (SIRT) with SIR-Spheres Y-90 resin microspheres represents another potential treatment option. SIRT is recommended in the European Society for Medical Oncology (ESMO) 2016 Guidelines for patients who are refractory or intolerant to chemotherapy (category B recommendation for SIR-Spheres Y-90 resin microspheres) and in the National Comprehensive Cancer Network (NCCN) Guidelines v2.2018 (category 2A recommendation for “arterially directed catheter therapy, and in particular yttrium-90 microsphere selective internal radiation”) in this indication.21,22 In the UK, the National Institute for Health and Care Excellence (NICE) 2020 interventional procedures guidance on the use of SIRT in patients with mCRC recommended that SIRT could be used in patients who cannot tolerate chemotherapy or have liver metastases refractory to chemotherapy, with special arrangements for clinical governance, consent, and audit or research.23