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St. Vincent Healthcare, 05 September 2015
BILLINGS – Millions of tiny glass beads have given some liver cancer patients in Billings another option in their fight against the disease.
The treatment injects the radioactive glass beads directly into the tumor – in both primary and metastatic liver cancer cases – to deliver a radioactive isotope called yttrium-90 that can break down the tumor from the inside with minimal side effects.
“It’s becoming more commonplace,” said Dr. Brian Christenson, an interventional radiologist at St. Vincent Healthcare who performs the procedure. “Over the last five years, it’s become (a) more and more common therapy.”
The basic idea behind the procedure – in its general form called radioembolization – is that Y90-coated beads will flow directly to the liver, embed themselves in the tiny blood vessels around the tumor and deliver a targeted dose of radiation with little or no impact to surrounding, healthy tissue.
Christenson uses TheraSphere, one of two U.S. Food and Drug Administration-approved brands, beads in treatments at St. Vincent. He said that it can extend the lives of patients by 12 to 18 months over those who haven’t had the treatment.
Doctors diagnosed Billings resident David Madril, 75, with liver cancer in May 2014 and soon told him that, while his tumor’s growth had slowed but not stopped, it was inoperable.
While chemotherapy was an option, the retired Air Force medic and first medical sergeant had seen people go through painful treatments and still die. Since he wasn’t feeling any effects of the cancer, he opted out of the treatment.
“Even to this day, if they hadn’t told me (I had cancer) I would’ve never known,” he said. “They said mine is incurable. If chemo’s not going to cure it, why should I put myself through that trauma?”
But earlier this year, his doctor at the Frontier Cancer Center referred Madril to Christenson as a possible Y90 candidate. He went in for an appointment the next day and geared up for the treatment not long after, having learned there was a chance it could slow or eliminate his tumor.
The treatment is actually two separate surgeries. In the first, Christenson makes a small incision in the patient’s groin and runs a catheter through an artery to the liver, maps the arteries and blood vessels, determines liver blood-flow volumes and identifies areas to block to make sure that blood carrying the beads doesn’t flow from the liver.
After the procedure, if everything is fine, Christenson orders the beads to the correct dose and, one to two weeks later, performs the second procedure.
For that surgery, he goes back in through the original incision and using the mapping and information gained from the first time, delivers the beads – each only about one-third the width of a human hair – to the liver.
“There, they deliver a strong amount of radiation over a small area,” Christenson said. “It’s usually over just a couple of millimeters of tissue. Most people do really well.”
For Madril, the procedure seems to have gone well. In July, he said his most recent CT scan showed shrinkage in the tumor.
He has another scan scheduled for September to monitor any progress and could undergo a second Y90 treatment if necessary.
Madril’s side effects were, for the most part, minimal. He said his quality of life hasn’t changed, although he’s seen some differences in body functions and early on experienced a loss of appetite and lost about 30 pounds.
Both sessions are oupatient surgeries.
Christenson said that Y90 hasn’t been approved for other types of cancers, although studies are underway, and that it’s ideal for liver cancer because the liver has two sources of blood flow, meaning healthy blood can flow through one source while the other is blocked during the procedures.
“All of the patients we’ve treated so far have done very well,” he said.
For one of them – Madril – the Y90 treatment provided extra time in a life he said has been well-lived.
When he first learned of the cancer, Madril was ready for it to end his life, something he was OK with after a long life in which his “bucket list is completed,” but Y90 gave him the chance to spend a little more time doing the things he loves – following cross country, spending time with family, exercising and maybe seeing more of the world.
“If I had to bite the big enchilada, I know I’ve had a good life,” he said. “I’ve traveled the world. I’ve been in about 70-some-odd countries and lived in six or seven of them. But when this came up, I felt good about it, and I’ll take whatever I could get.
“This is a blessing. I get to spend time with my grandchildren. I’m very fortunate they gave me this opportunity."