New Liver Cancer Treatment Available at Marin General Hospital

Y-90 treats inoperable tumors, extends survival and improves patient quality of life

GREENBRAE, CA –- Marin General Hospital has added another high-tech weapon to its arsenal of liver cancer treatments: the use of Yttrium-90 (Y-90), a radioactive isotope used to bathe malignant tumors in extremely localized radiation.

Tiny microscopic spheres containing the isotopes are delivered to the tumor via a catheter inserted in the groin of the patient and threaded through the arteries to the liver. Because the spheres can deliver radiation precisely where it is needed, the treatment is more effective and minimizes damage to healthy tissue.

Patients typically are referred to the treatment when their tumor is inoperable, and the procedure is performed on an outpatient basis.

“Y-90 treatment is a major addition to the non-surgical treatments available for liver cancer. It significantly extends patients’ survival while preserving their quality of life,” says Adam Nevitt, M.D., Medical Director of Interventional Radiology, Marin General Hospital. “Most patients spend a half day at the hospital and a week of recovery from the treatment at home.”

Novato resident Constantine Fedoroff, 70, recently underwent the second of two planned Y-90 procedures to remove tumors which had spread to his liver after an original diagnosis of adrenal carcinoma, a rare form of cancer that attacks the adrenal gland located on top of the kidneys. Doctors had removed the affected adrenal gland and kidney last year, but an annual CT scan showed the cancer cells had returned and spread to the liver. Surgery to remove them was not an option.

A recent follow-up scan after the first Y-90 procedure was good news. Normal liver cells had already started to regenerate and were flowing into the now vacant space where the tumor had been.

“This was a new kind of treatment, but Dr. Nevitt had no trouble convincing me,” Mr. Fedoroff says. “For my case, it was the only treatment option I had.”

Mr. Fedoroff adds that he has the distinction of being the first adrenal carcinoma patient to be treated with Y-90 at Marin General Hospital. “I am so thankful that I didn’t have to travel to another state to have it done – something I had already begun to research. The technology and the treatment were available right here at home.”

What makes the treatment work, according to Dr. Nevitt, is the fact that the liver has two separate blood supply systems and cancerous tumors typically take blood only from the arterial system (representing about one-third of the total supply to the liver). Given these facts, it is possible to deliver the isotopes to the tumor through the arterial supply without introducing them into the larger portal venous supply.

Additionally, because it consumes so much more blood than healthy surrounding tissue, the tumor soaks up the radioactive spheres, concentrating them largely at the tumor site where their radiation attacks the malignancy.

“Few chemotherapies work well on a primary liver tumor,” says Dr. Nevitt. “There’s not a really good systemic treatment. So having this treatment available along with surgery and chemo-embolization really gives Marin General Hospital the ability to deliver a state-of-the-art level of care.”

Y-90 also can treat colon cancers and neuroendocrine tumors that have metastasized to the liver. 

“This isn’t a cure, but we can buy the patient a significant amount of time by temporarily stopping the progression of the disease or even shrinking the tumor,” says Dr. Nevitt. “Recent advances, including the possibility of using Y-90 as an adjuvant with chemotherapy, hold the promise of further advances against the disease.”

Although the Y-90 treatment was invented in 2000, it has been significantly refined and has recently become more widely used at major academic medical centers.