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Radiation traveling in microspheres hits liver cancer where surgery can't

Michelle Phillips came to Stanford Hospital with all other options exhausted. In 2002, the Sunnyvale mother of two had been diagnosed with a very rare, and malignant, brain tumor. Two surgeries and radiation treatments removed it, but five years later, new tumors appeared in her liver and lungs: thirty in her liver alone. Inoperable, her physicians told her. And they didn't have any other recommendations.

After long hours of research, Philips and her husband found (.pdf) Stanford’s Daniel Sze, MD, PhD, an interventional radiologist. Sze and his colleagues had made Stanford among a few dozen U.S. hospitals offering patients like Philips a very new form of treatment: microscopic, radiation-loaded spheres sent through the bloodstream to the arteries that feed tumors.

Now, in a new paper in the Journal of Vascular and Interventional Radiology, Sze and his team share the results of their work with 201 patients treated this way between 2004 and 2010.  In two separate studies, the team looked at how to deliver the microspheres most effectively. In some patients, tumors had recruited blood vessels from outside the liver to feed them. The Stanford group wanted to see what would happen if they closed off those vessels first before delivering the microspheres. In a second group of patients, the physicians blocked off extra arteries found in almost half the population and used the liver's own network of vessels to deliver the microspheres.

"Results of these two new studies may be beneficial to patients with liver tumors that cannot be surgically removed," Sze said in a release (.pdf). "These studies address methods to modify the blood vessels of the liver in order to maximize delivery of tumor-killing material to the targets and to make treatment simpler and safer."

In a commentary accompanying the paper, Riad Salem, MD,  director of interventional oncology at Northwestern University, put the work into a broader context:

Blood supply to tumors can be complex and can present challenges for interventional radiologists. This research advances the field and provides information that is immediately applicable to all interventional radiologists when treating their cancer patients. Such research allows interventional radiologists to tailor treatments to help even the sickest patients achieve a better quality of life. By embolizing small, less important vessels to the tumors, one main arterial channel was created that could treat the entire area in a technically simple and practical way.

The methodology, he added, might also be used to deliver chemotherapy in a way that would lessen the impact it has now, sent throughout the body instead of directly to a tumor. As outlined in the release, though, multicenter studies of this approach are still needed.



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