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Intra-arterial brachytherapy of hepatic malignancies: watch the flow

Nature Reviews Clinical Oncology volume 8, pages 115–120 (2011)Cite this article

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Abstract

Although the liver possesses a dual blood supply, arterial vessels deliver only a small proportion of blood to normal parenchyma, but they deliver the vast majority of blood to primary and secondary cancers of the liver. This anatomical discrepancy is the basis for intra-arterial brachytherapy of liver cancers using radioactive microspheres, termed radio-embolization (RE). Radioactive microspheres implant preferentially in the terminal arterioles of tumors. Although biological models of the flow dynamics and distribution of microspheres are currently in development, there is a need to improve the imaging biomarkers of flow dynamics used to plan RE. Since a direct consequence of RE is vascular disruption and necrosis, we suggest that imaging protocols sensitive to changes in vasculature are highly likely to represent useful early biomarkers for treatment efficacy. We propose dynamic contrast-enhanced CT as the most appropriate imaging modality for studying vascular parameters in clinical trials of RE treatment.

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Figure 1: Macro aggregated albumin scan.
Figure 2: Geometry of microspheres relative to the hepatic arterial system.
Figure 3: Changes in tumor perfusion detected by DCE-CT.
Figure 4: DW-MRI artifacts that make image interpretation difficult.

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Acknowledgements

The concepts presented in this article were developed at the Tryst of Radio-Embolization Brachytherapy Leading Experts (TREBLE) meeting held in Trinity College, Oxford on 26 October 2009. The authors wish to thank the TREBLE participants: Boris Vojnovic, John Primrose, Eli Glatstein, David Berry, Peter Gibbs, Denny Liggitt, David Liu, Marc Peeters and Bruno Sangro. R. A. Sharma is funded by the Higher Education Funding Council for England and the Bobby Moore Fund of Cancer Research UK. R. A. Sharma and B. Jones acknowledge the support of the NIHR Biomedical Research Centre, Oxford, UK.

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Authors and Affiliations

  1. Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

    Bruno Morgan

  2. Mechanical and Aerospace Engineering Department and Biomedical Engineering Department, North Carolina State University, Raleigh, 27695, NC, USA

    Andrew S. Kennedy

  3. Nuclear Medicine Department, Royal Marsden Hospital, Sutton, SM2 5PT, Surrey, UK

    Val Lewington

  4. Cancer Research UK—Medical Research Council Gray Institute for Radiation Oncology and Biology, Old Road Campus Research Building, University of Oxford, Oxford, OX3 7DQ, UK

    Bleddyn Jones & Ricky A. Sharma

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Contributions

B. Morgan, A. S. Kennedy and R. A. Sharma contributed to the data research, discussion, writing and reviewing/editing of the manuscript. V. Lewington and B. Jones contributed to the discussion and writing of the manuscript.

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Correspondence to Ricky A. Sharma.

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Competing interests

A. S. Kennedy declares he receives grant/research support, is on the Speaker's Bureau and is a Consultant for Sirtex Medical. R. A. Sharma declares he receives grant/research support and is on the Speaker's Bureau for Sirtex Medical. The other authors declare no competing interests.

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Morgan, B., Kennedy, A., Lewington, V. et al. Intra-arterial brachytherapy of hepatic malignancies: watch the flow. Nat Rev Clin Oncol 8, 115–120 (2011). https://doi.org/10.1038/nrclinonc.2010.153

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