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| |  Recommendations Support Key Role of Radioembolization in Treatment of Unresectable Liver Tumors CARY, NC -- February 12, 2007 -- The transition of radioembolisation using 90Y-microspheres from a promising new approach to a recognized treatment option for unresectable liver tumours took a significant step forward with the presentation of consensus guidelines by the Radioembolization Brachytherapy Oncology Consortium (REBOC). This independent expert group was established in 2006 in order to address the need for standardization since the indications, techniques, multimodality treatment approaches and dosimetry vary considerably between centers. REBOC includes international membership from interventional radiology, nuclear medicine, radiation oncology, medical oncology and surgical oncology, and their consensus guidelines were developed in collaboration with scientific organizations including the American College of Radiation Oncology (ACRO), American Brachytherapy Society (ABS), Society of Interventional Radiologists (SIR), Society of Nuclear Medicine (SNM), and Cardiovascular and Interventional Radiological Society of Europe (CIRSE) as well as selected users. Fourteen recommendations on radioembolisation using 90Y-microspheres for hepatic malignancies were presented at ICACT by Dr Subir Nag on behalf of REBOC. "Sufficient evidence now exists to support the safety and effectiveness of 90Y-microspheres therapy in selected patients that have unresectable primary or metastatic hepatic disease with a liver-dominant tumor burden and a life expectancy greater than three months," said Dr Subir Nag, formerly of Ohio State University, Columbus, Ohio, now chief of brachytherapy for Kaiser Permanente in California and Chair of REBOC. "A multidisciplinary team approach combining the expertise and skill of various specialties is essential for the management of patients with primary and metastatic liver cancers, but the pre-treatment investigations use existing technology such as CT or MR imaging, serum chemistry and tumor markers, with 18FDG-PET employed as a useful adjunct." Absolute contraindications to 90Y-microsphere treatment include pre-treatment 99mTc MAA scan demonstrating the potential of excessive (>30Gy) radiation exposure to the lung or flow to the gastrointestinal tract that cannot be corrected by interventional techniques. Relative contraindications to 90Y-microsphere treatment include limited hepatic reserve, irreversibly elevated bilirubin levels, compromised portal vein (unless selective or super-selective RE can be performed), and prior radiation therapy involving the liver. REBOC also recommended that the body surface area (BSA) formula should be the method of choice for calculating the prescribed activity for resin 90Y-microspheres. "The REBOC consensus guidelines will now make it much easier for centers who wish to establish and offer a radioembolization service," said Dr Nag. "They will also provide a clear signal and guidance to all physicians treating patients with unresectable liver tumors that they should consider referring patients for this important treatment modality as part of their overall care package." The full recommendations from REBOC are currently in press in the International Journal of Radiation Oncology * Biology * Physics and are expected to be published in the forthcoming months.
SOURCE: Wake Radiology
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