Selective Internal Radiotherapy in Liver Tumors: Early Promise Yet to be Fulfilled

Area of Science:

• Interventional Radiology
• Nuclear Medicine
• Oncology

Background:

• Selective intra-arterial radiotherapy (SIRT) is a specialized technique developed over 30 years.
• Primarily utilized for treating primary and secondary liver tumors.
• Relies on delivering radiopharmaceuticals via hepatic artery catheterization, exploiting tumor vascularity.

Purpose of the Study:

• To review the evolution and current applications of SIRT in liver cancer treatment.
• To highlight recent advancements improving the efficacy and delivery of SIRT.
• To discuss emerging radionuclides and techniques in SIRT.

Main Methods:

• Review of historical and contemporary SIRT practices.
• Analysis of radiopharmaceutical delivery via intra-arterial catheterization.
• Examination of clinical trial outcomes and technological advancements.

Main Results:

• Early SIRT with I-131 and Y-90 showed promise but faced challenges in randomized trials compared to chemotherapy.
• Current research indicates improved outcomes with higher radiation doses (≥60Gy) and combination systemic therapies.
• Advances in angiography enable day-case procedures, and new radionuclides (Ho-166, Re-188) expand SIRT options.

Conclusions:

• SIRT has evolved significantly, offering a targeted approach for liver malignancies.
• Optimizing radiation dose and integrating with systemic therapies are key to enhancing SIRT's clinical effectiveness.
• Ongoing innovation in radionuclides and delivery methods promises further refinement of SIRT techniques.