Hepatic Arterial Radioembolization Therapy
Update Date：2024/09/05，
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Cancer treatment techniques are rapidly evolving. With advancements in medical technology and imaging, options for treating cancer have expanded beyond just surgery and chemotherapy. In the past, when cancer metastasized to the liver, patients had to rely on chemotherapy, external beam radiation therapy, or targeted therapy. However, each of these methods has its limitations: chemotherapy can lead to systemic side effects, radiation therapy may cause damage to healthy tissues surrounding the tumor, and while targeted therapy generally has fewer side effects, it can still produce adverse reactions.
Transarterial Radioembolization (TARE) is a precise internal radiation therapy technique. It involves the interventional radiologist inserting a catheter into the liver's blood vessels and, based on preoperative 3D imaging data, delivering a specific dose of radioactive microspheres to the liver. After the procedure, the patient undergoes a PET-CT scan to confirm that the radioactive microspheres have accurately targeted the intended liver area. A month later, follow-up is conducted through CT or MRI to assess the treatment's effectiveness.
Before undergoing Transarterial Radioembolization (TARE), patients must undergo a meticulous planning process. Initially, Tc99m nuclear medicine imaging is performed to assess the blood supply to the liver tumors and to evaluate the vascular connections between the liver and lungs. If excessive blood flow from the liver to the lungs is detected, the patient may not be suitable for this treatment, as the radioactive microspheres could harm the lungs.
After completing the Tc99m imaging, the radiologist and physicist use 3D imaging to calculate the volumes of the tumor and liver (Figure 1) and, with the assistance of the nuclear medicine physician and technologists, determine the appropriate radiation dose. Treatment is only carried out after thorough discussions with the patient and their family.
Because the production and preparation of radioactive microspheres are performed abroad and require transportation under strict radiation safety measures, the cost is relatively high. A single treatment session costs approximately NT$600,000, and currently, it is not covered by national health insurance, so patients must pay out-of-pocket.
In 2023, our department introduced the latest combined sliding-rail CT scanner and advanced bi-plane angiography X-ray machine (Figure 2). This integration provides patients with a one-stop diagnostic and treatment experience, eliminating the need for frequent transfers between floors and examination rooms. The new equipment allows for real-time CT imaging during the procedure, significantly reducing treatment time. Additionally, it supports a multidisciplinary team approach, enabling comprehensive evaluations and tailored treatment plans.
Common side effects of Transarterial Radioembolization (TARE) include weakness, nausea, fatigue, and abdominal discomfort, which typically resolve on their own within two weeks. In rare cases, radioactive microspheres may cause gastrointestinal damage, leading to complications such as ulcers. Patients can usually get out of bed, walk, and eat normally on the same day as the treatment, and are typically discharged after 1-2 days of inpatient observation.
It is important to note that the radioactive microspheres used in the treatment may emit some high-energy radiation. Therefore, for two weeks following the procedure, patients are advised to maintain a distance of at least 2 meters from family and friends and to avoid contact with pregnant women, breastfeeding mothers, and young children.
After the treatment, patients undergo a PET-CT scan in nuclear medicine to ensure that the radioactive microspheres have accurately targeted the intended area of the liver. One month after the treatment, follow-up assessments are performed using CT or MRI to evaluate the effectiveness of the radioembolization therapy.
With advancements in medicine, cancer treatment has become increasingly diverse and precise. Transarterial Radioembolization (TARE) represents a novel treatment approach for metastatic liver cancer and primary liver cell carcinoma, offering patients a new therapeutic option.
[Figure 1] 3D volumetric imaging reconstruction technology calculates the volumes of the liver and tumors, allowing physicians to select the most appropriate treatment dose.
[Figure 2] In 2023, our department introduced the latest combined sliding-rail CT scanner and advanced bi-plane angiography X-ray machine, providing patients with a one-stop diagnostic and treatment experience that significantly reduces treatment time. Additionally, this setup supports a multidisciplinary team approach, allowing for comprehensive evaluations and tailored treatment plans.