Innovative Treatment Offers New Hope

The American Cancer Society estimates that nearly 19,000 new cases of primary liver cancer will be diagnosed in the US in 2004 and that more than 14,000 will die from the disease. Unlike most other cancers, the number of liver cancers is rising.

The Radiology and Radiation Oncology departments at EJGH have joined forces to offer a new treatment for patients with primary and metastatic liver cancer. It offers not only a new therapy option, but also a less invasive procedure with fewer side effects.

This cutting edge procedure, called Yttrium Microsphere Embolization, uses tiny particles injected directly into the blood supply of a liver tumor. The particles, or microspheres, are impregnated with a radioactive compound that delivers radiation to malignant cells while reducing damage to surrounding healthy tissue compared to other forms of radiation therapy. In addition, the microspheres block blood flow to the tumor, starving it of the nutrients it needs to grow.

Before a patient undergoes Yttrium Microsphere Embolization, an arteriogram is performed. This radiologic exam uses an injected dye to visualize the blood vessels surrounding the tumor. The results of the arteriogram are used to determine if the patient is a good candidate, and to provide a map of the vessels that will be used to deliver the microspheres.

The procedure is performed by an interventional radiologist via a catheter inserted through an artery. The catheter is guided through the body and into the liver through the hepatic artery, the main vessel carrying blood into the liver. From the hepatic artery, the microspheres are injected and travel with the normal flow of blood to reach the capillaries that supply the cancer.

The procedure is being used for patients whose tumors cannot be removed surgically or have not responded to other treatments. Liver cancer is difficult to treat because liver tumors have unpredictable growth patterns and symptoms often appear only when the cancer is in advanced stages. Also, many patients diagnosed with liver cancer have Hepatitis B, Hepatitis C, or cirrhosis. These conditions make surgery difficult because patients may have very little healthy liver tissue left.

Because it is minimally invasive, it presents fewer risks, such as infection and complications from anesthesia, than traditional open surgery. Most patients who undergo Yttrium Microsphere Embolization can return home on the day of their procedure.

Study Explores New Diagnostic Technique for Breast Cancer

Radiology Medical Director Mary Beth Lobrano, M.D., is leading a study into the use of Positron Emission Mammography (PEM) to determine whether an abnormality revealed by mammogram or ultrasound is cancerous tumor or a benign lesion. If found to be effective, these scans could be used to help plan treatment and to detect other, smaller tumors that were not detected through other types of imaging.

PEM uses a high-resolution PET scan to diagnose breast cancer when a mammogram or ultrasound indicates an abnormality. Dr. Lobrano stresses that this is not a replacement for mammograms, but a diagnostic tool to be used in conjunction with routine screenings. Currently, insurance companies will only pay for PEM scans if the patient has a known history of breast cancer that has been proven by biopsy. One of the goals of the current study is to demonstrate the usefulness of PEM so that insurance companies will consider reimbursement for a broader range of patients.

“Hopefully, more patients will be able to benefit from this very cutting edge technology,” says Dr. Lobrano.

The study began at EJGH with 28 patients and yielded very promising results. In fact, in three of the patients, PEM was able to detect cancers that were not seen when other imaging tests were performed. The study was then expanded to include institutions throughout the country, including Wake Forest University, Johns Hopkins Medical Institutions and Georgetown University. Dr. Lobrano is the principle investigator in the multi-center study. Other investigators from EJGH are William Stein, M.D., oncology, Joseph Uddo, M.D., surgery, and Carol Anne Luttrell, M.D., radiology.