Improvements in a therapy that targets liver tumours while limiting radiation exposure to healthy surrounding tissue are significantly increasing the survival time of patients with liver cancer, sometimes offering complete remission.
Selective internal radiation therapy (SIRT) involves injecting radioactive microspheres into an artery that supplies the liver. These microspheres lodge in the liver’s capillaries in and around the tumour and deliver radiation that kills the cancer cells.
Prof. Dr. med. Ken Herrmann, the director of nuclear medicine at University Hospital Essen in Germany, emphasises the transformative impact of this localised therapy. More than 1,500 patients at his hospital have been treated with TheraSphere™ glass microspheres containing yttrium-90 (Y-90). Initially used as a last-resort option, the treatment’s efficacy has substantially improved with a more precise, selective approach, moving towards curative intent – treatments with the potential to completely eradicate cancer.
“We are big believers in local therapy,” says Prof. Herrmann. “In the beginning, we really used it as a last-line treatment. But patients did not benefit as much as they do now, where we are more selective, where we almost have curative intent.”
The progression from palliative to potentially curative treatments has been partly due to advancements in therapy optimisation, which allows for highly personalised tumour dosing while sparing healthy tissue. Studies have shown that this personalised dosing, known as dosimetry, can double survival outcomes for patients with primary liver cancer.1
“It’s about finding the optimal balance between delivering an effective radiation dose to destroy cancer cells and minimising radiation exposure to normal liver tissue. This is essential for achieving the desired treatment outcomes, such as tumour shrinkage and control of cancer progression, and to reduce the risk of side effects and toxicity, promoting a better quality of life,” says Dr. Marco Maccauro, director of nuclear medicine at the National Tumour Institute in Milan, where more than 1,000 patients have been treated with TheraSphere therapy planned with personalised dosimetry.
Helping to achieve the effective dosing and shift the use of SIRT towards curative intent is software,such as Simplicit90Y™ 2.8, which helps clinicians plan and target the use of Y‑90 glass microspheres in treating patients.
“The trend towards the dosimetric approach, including Simplicit90Y™, shifted us towards a whole new era of radioembolisation – the personalised treatment approach, the dosimetric considerations,” says Prof. Dr. med. Jens Theysohn, senior interventional radiologist at University Hospital Essen and a colleague of Prof. Herrmann.
In helping to deliver the right dose to the right location, Simplicit90Y™ also provides a standardised workflow for dosimetry that reduces inter-user variability. “Automation features reduce the likelihood of errors and save time for healthcare professionals,” says Dr. Carlo Chiesa, medical physics expert at the National Tumour Institute.
As Prof. Herrmann puts it: “If you have three clinicians who do it, they should have a very similar result.”
Multidisciplinary team collaboration
Dr. Spreafico (IR), Dr. Maccauro (Nuc Med), and Dr. Chiesa (Physic) at the National Tumor Institute in Milan examining a patient case
At both University Hospital Essen and the National Tumour Institute in Milan, this new era of radioembolisation has relied on optimising the management of the most common type of primary liver cancer – hepatocellular carcinoma (HCC) – with a multidisciplinary team (MDT) of hepatologists, oncologists, surgeons and, above all, with the core team of interventional radiologists, nuclear medicine specialists, and medical physicists.
There’s a long history of such collaboration at University Hospital Essen. “The collaboration between gastroenterology, treating HCC in our clinic, and nuclear medicine and radiology was the basis for starting this program here 18 years ago. And I think it also promotes good collaboration today,” Prof. Theysohn says.
The synergy within this multidisciplinary team is complemented by Simplicit90Y, which serves as a common platform for interventional radiology and nuclear medicine. In Milan, Dr. Carlo Spreafico, a senior interventional radiologist at the National Tumour Institute, says Simplicit90Y™ “plays a crucial role” in fostering collaboration.
“The software facilitates communication by providing a platform for shared radiological images and dosimetry data, ensuring that both disciplines can collaboratively analyse and optimise treatment plans based on individual patient characteristics,” Dr. Spreafico says. “This promotes a synergistic approach, where the expertise of interventional radiology and nuclear medicine can be effectively integrated, leading to more personalised and effective SIRT procedures.”
Still, despite the Level-1 clinical evidence of TheraSphere therapy’s efficacy in treating primary liver tumours, challenges persist in making this targeted treatment available to many patients sooner. Prof. Theysohn describes cases where patients aren’t eligible for radioembolisation until they come back two or three months later with tumours “double the size. Then we can decide to do radioembolisation, but our stomach aches a bit because we could have done it earlier.”
EU MDR: Paving the way to wider access to TheraSphere therapy
The new European Medical Device Regulation (MDR) offers promising avenues for overcoming reimbursement challenges. With recent approval, TheraSphere is the only SIRT Y90 product that is CE marked under MDR for the treatment of all hepatic malignancies. This regulatory milestone enhances the flexibility for clinicians in using and prescribing TheraSphere.
Mirada Medical received CE Mark for Simplicit90Y™ 2.8 in September 2023. To learn more about Simplicit90Y™ Personalised Dosimetry software click here.