1. Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC
Thomas Lauenstein, MD
Department of Diagnostic and Interventional Radiology and Neuroradiology
University Hospital Essen

2. Outline Indications for Y-90 in HCC What are critical vessels ?
Clinical data on HCC
Case series

4. Therapeutic strategies
Resection
Transplantation
RF ablation
Chemoembolization (TACE)
Y-90 (SIRT)
Systemic therapy

5. Therapeutic strategies

6. SIRT for HCC Multiple / large lesions CI for TACE
Child-A / good Child-B

7. SIRT

8. SIRT
Liver dose without tumor
with hypervascular tumor

9. What are critical vessels?
Extrahepatic tumor feeder
(gastrointestinal) shunts arising from the hepatic arteries

10. Extrahepatic Tumor Feeders

11. Extrahepatic Tumor Feeders

12. GI shunt Sjoquist et al. Oncologist. 2010;15:830-5
Pretreatment hepatic arteriogram illustrating the accessory right gastric artery (large arrow) branching off the left hepatic artery, with coils in place in the gastroduodenal artery (short arrow).
Sjoquist et al. Oncologist. 2010;15:830-5

13. GI shunt

14. Gastroduodenal Artery

15. Gastroduodenal Artery

16. Cystic Artery

17. Coiling Cystic Artery

18. Outline Indications for Y-90 in HCC What are critical vessels ?
Clinical data on HCC
Case series

19. NCI / EASL amendement
pre 3m

20. Response to treatment / HCC
1 month
3 months
Complete response 4% 3%
Partial response
25%
37%
Stable disease
64%
53%
Progression 7% 6%
Hepatology 2008;47:71-81

21. Time to progression / Survival
Hepatology 2008;47:71-81

22. Histopathology 1. Physiologic tissue 2. Fibrosis (peripheral rim)3 2 3
1. Physiologic tissue
Randständige Mehranreicherung: Leukozyteneinwanderung, reaktive Vorgänge, Fibrose, nicht gleichzusetzen mit vitalen Tumorzellen
2. Fibrosis (peripheral rim)
3. Necrotic tumor
Riaz A et al. Radiologic-pathologic correlation of hepatocellular carcinoma treated with
internal radiation using yttrium-90 microspheres. Hepatology., 49:

23. Outline Indications for Y-90 in HCC What are critical vessels ?
Clinical data on HCC
Case series

24. Case # 1
akkaya

25. Case # 1 – 2nd DSA
akkaya

26. Case # 2 - duodenal shunt
akkaya

27. Case # 2 – duodenal shunt
akkaya

28. Case # 3 – pitfall coiling
akkaya

29. Case # 4 – pitfall coiling
akkaya

30. Case # 5 – a.v. shunt
akkaya

31. Conclusion Critical vessels must be identified
IR has to be familiar with coilembolization
SPECT/CT is a useful tool to identify additional shunts
EASL criteria for therapy response
Sorafenib helpful to reduce lung shunts

32. Liver Cancer Management with Y90 Glass Microspheres – TheraSphere Experience and Challenges in HCC
Thomas Lauenstein, MD
Department of Diagnostic and Interventional Radiology and Neuroradiology
University Hospital Essen