SIR Spheres Therapy extends and adds quality to the life of liver cancer patients
Written by Kim O’Brien Root
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He was told he had only a 40 percent chance of lasting three years after carcinoid cancer was discovered in his small intestine and then throughout his gut, with numerous tumors spotting his liver.
Thanks to his team of doctors and updates in medical treatments, Ward is more than seven years past that initial diagnosis. And after receiving a specialized kind of radiation therapy at Sentara Norfolk General Hospital in Norfolk, Va., last year, Ward keeps defying the odds.
“It’s the first time since I’ve been diagnosed that I feel like I have a future,” says 49-year-old Ward, who lives in Richmond, Va., but travels to Hampton Roads for his cancer treatment. “The window isn’t limited to three years. It’s exciting to imagine being at my daughter’s wedding.”
That could still be a while. His daughter is only 8 years old.
What Ward had was a procedure called Selective Internal Radiation (SIR) Spheres Therapy, in which microscopic radioactive resin beads are used to target advanced liver cancer. Millions of beads the size of red blood cells—or about one-third the diameter of a human hair—are delivered to the liver through a catheter threaded through the femoral artery.
Once in the blood vessels of a tumor, the beads destroy cancerous cells with minimal impact to nearby healthy cells. The treatment allows the radiation—at higher levels than conventional techniques—to be concentrated within the tumor. The radiation gradually disappears.
“It radiates the tumors from the inside out,” says Dr. Harlan L. Vingan, a radiologist with Medical Center Radiologists, which provides radiology services for hospitals in South Hampton Roads.
More recently, doctors with the Sentara Cancer Network began performing another procedure that uses Selective Internal Radiation Therapy, but with glass beads vs. the SIR-Spheres resin beads. TheraSphere beads, as the glass beads are called, further expand the treatment options for patients with inoperable advanced liver cancer, especially those whose veins are compromised.
Norfolk General began offering the SIR-Spheres therapy in 2008. Since then, it’s been used to treat primary liver cancer, such as hepatocellular carcinoma, as well as metastasized tumors that spread from the colon, abdomen, pancreas and breast. It’s a non-surgical procedure that usually only requires one night’s stay in the hospital.
The American Cancer Society estimates a survival rate of five years after being diagnosed with liver cancer, meaning the patient is still alive at least five years after the diagnosis. The rates can vary, depending on the size and location of tumors and whether a liver transplant can be done.
Using the SIR-Spheres technique of radioembolization can help extend that survival rate by a year or two for patients with primary liver cancer, Vingan says.
With liver cancer, a transplant is the treatment of choice, adds Vingan, but that usually can’t be done right away because of availability. Resecting the liver—cutting out the tumors—is another option. But patients aren’t always immediate candidates for surgery, particularly when tumors aren’t in position to be removed or are too large.
Selective internal radiation therapy has been shown to shrink tumors, helping a patient get to the point where surgery can be performed.
“It gives them an option when they don’t have other options,” he says.
[quote]We can’t cure anyone of the disease, but we can maintain quality of life and improve survival. Improving longevity is part of the goal, and we believe these treatments do that.
– Dr. Harlan L. Vingan[/quote]
Prior to SIR-Spheres therapy being available, other arterial treatments did and still do exist, including those that use chemotherapy and/or block up blood vessels. But chemotherapy has more side effects, and patients tend to tolerate radioembulization better, Vingan says.
Close to 90 procedures using SIR Spheres have been done at Norfolk General over the past five years, with “very good results,” Vingan explains. There has been a low percentage of complications—in the one percent range, he adds.
So far, only three patients have so far received the TheraSphere treatment, which has been available at Norfolk General since September. The hospital first had to get approval from an institutional review board before offering the treatment, which is considered a Humanitarian Use Device (HUD. These devices or procedures are used to diagnose and treat rare conditions, so doctors use them selectively.
The TheraSphere glass beads, which contain radioactive yttrium-90, are smaller than the resin beads. The size makes them good for use in instances of portal vein thrombosis—when the veins to the liver have become clotted by blood. Vingan says the glass beads are a promising treatment for when there’s a lot of disease scattered throughout the liver.
Both kinds of radioactive beads have their place, he says, and doctors are careful to match the treatment to the patient and his or her disease. If a treatment doesn’t work, it doesn’t preclude trying another.
“We have to decide what’s best for each patient individually,” he says. “All these treatments are considered palliative. We can’t cure anyone of the disease, but we can maintain quality of life and improve survival. Improving longevity is part of the goal, and we believe these treatments do that.”
Roger Ward went through several other treatments before receiving the SIR-Spheres therapy just last year.
In 2006, doctors removed the 10 cm primary tumor in Ward’s small intestine, took out a third of his large intestine, resectioned the left lobe of his liver and removed tumors from lymph nodes and the right lobe of his liver. Some deep liver tumors remained, but were slow growing. He remained on medication.
It wasn’t until four years later that Ward’s doctor recommended he see Vingan and Dr. Mark Shaves, a radiation oncologist at Norfolk General, to talk about shrinking the remaining tumors. Because Ward’s liver function was good, the doctors decided to hold off.
But when the tumors started to grow, doctors decided to bring Ward in for the SIR-Spheres treatment. He went twice, in March and May 2012, for treatment of each liver lobe.
Lab work and MRIs have shown “results beyond our best expectations,” Ward says. His serotonin levels, which had been high due to his carcinoid tumor, dropped to their lowest since his initial diagnosis. He just plain feels better.
“This is the healthiest I’ve been since the development of the original tumor,” says Ward, a former transportation department manager for a Washington, D.C. trucking company. He’s on disability because of his disease, spending some 80 days a year dealing with medical issues.
For years, he says he’s focused on enjoying his three children—besides his daughter, he has two boys who will be 12 and 14 this summer—and teaching them character and ethics for their future. Even after he had the SIR-Spheres procedure, and experienced the expected flu-like symptoms for about a week afterward, Ward made sure he got to his kids’ ball games.
Now, he says, he feels like he can not just focus on his kids, but also his own future, along with encouraging others to take advantage of the same experiences he’s had. He also can’t say enough about the Hampton Roads doctors who’ve treated him.
“I may not need another procedure for another five years,” Ward says. “I truly feel it’s unlimited how long I can overcome this. With the research and advancement they have every year, there’s no limit how long we can manage this.”
Physicians or patients with questions about radioembolization and the SIR-Spheres and TheraSphere treatments can contact 1-888-220-2214 for information.
