Practical Radioembolization: Y90 at CIO 2019

Friday, October 11, 2019 (Miami, FL) — The first day of the Symposium on Clinical Interventional Oncology (CIO) explored radioembolization using Y90 in detail.

Ripal T. Gandhi, MD, of the Miami Cardiac & Vascular Institute, moderated the session. A highlight was Dr. Gandhi’s presentation on avoiding Y90-related toxicities and complications. In addition, he offered valuable advice and tips for mitigating complications should they occur.

Benefits of radioembolization compared to chemoembolization were emphasized by Robert J. Lewandowski, MD, Professor of Radiology, Medicine (Hematology and Oncology) and Surgery at Feinberg School of Medicine at Northwestern University. He discussed evidence that there appears to be a longer time to progression when using radioembolization, in addition to a reduction in toxicity. An additional reported benefit was an increase in quality of life among hepatocellular carcinoma (HCC) patients treated with radioembolization. Evolving concepts in this treatment area include extra-hepatic perfusion, treatment of multi-focal disease, and radiation lobectomy. The learning curve associated with disruption in workflow when launching a same-day radioembolization program was addressed.

David Liu, MD, FRCPC, FSIR, Vancouver Imaging, Clinical Professor, University of British Columbia, discussed dosimetry in Y90 and the myriad treatments to consider, including hypovascular, radiation segmentectomy, radiation lobectomy, RapidSphere (Varian Medical Systems) exploration, and deformable dose mapping. He offered guidance for the interventional oncologist on how to approach the decision-making process to select the best treatment approach for each patient. An app developed by Dr. Liu, the Dosimetry and Activity Visualizer for Yttrium-90 Radioembolization (DAVYR), can be downloaded for free.

Dr. Liu also presented on the management of patients with portal vein thrombosis in HCC. While the overall prognosis is poor, in select patients with good liver function, radioactive seed localization (RSL) technique results in significant improvement in survival.

The question of whether unresectable patients could eventually be made resectable using Y90 radiation lobectomy was addressed by Siddharth A. Padia, MD, Associate Professor, Interventional Radiology at the David Geffen School of Medicine at UCLA. He presented important segmentectomy techniques to use to achieve sustained tumor response and noted that survival will ultimately be determined by cancer, cirrhosis, and comorbidities.

Brian J. Shiro, MD, of the Miami Cardiac & Vascular Institute and Florida International University, discussed the management of high lung shunts and the use of selective internal radiation therapy (SIRT). Contraindications tor SIRT include unavoidable hepaticoenteric communications and high hepatopulmonary shunts. Methods for identifying and reducing HPS were detailed, with the emphasis on dose reduction as the initial attempt.

The final presentation was from Riad Salem, MD, MBA, Northwestern University Feinbert School of Medicine, who discussed “Streamlining Y-90: Is it Possible to Eliminate the Tc-MAA study?”

About the Symposium on Clinical Interventional Oncology (CIO)

Renowned for its originality, practicality, and focus on improving patient care, CIO, an HMP event, highlights the most viable and sought-after treatments in the rapidly expanding field of interventional oncology. CIO is led by course directors Ripal Gandhi, MD; Ziv Haskal, MD; Constantino Peña, MD; Daniel Sze, MD; and Alda Tam, MD. The program contains a mix of didactic lectures, case presentations and debates between experts, hands-on workshops, and pre-recorded cases woven together with audience interactivity through polling and question and answer sessions. For more information, visit theiomeeting.com.

About HMP 

HMP is the force behind Healthcare Made Practical – and is a multichannel leader in health care events and education, with a mission to improve patient care. The company produces accredited medical education events and clinically relevant, evidence-based content for the global health care community across a range of therapeutic areas. Its brands include Consultant360, the year-round, award-winning platform relied upon by primary care providers and other specialists; Psych Congress, the largest independent mental health meeting in the U.S.; EMS World Expo, North America’s largest EMT and paramedic event; and the Symposium on Advanced Wound Care (SAWC), the largest wound care meeting in the world. For more information, visit hmpglobal.com.