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Liver Cancer Patients Have Local Access to Minimally Invasive, Life-Extending Treatment at Penn State Health St. Joseph Cancer Center

Originally Published in Central Pennsylvania MD News on October 18, 2018

Penn State Health St. Joseph Cancer Center integrates tissue-sparing yttrium-90 selective internal radiation therapy (Y-90 SIRT) into treatment of liver cancer, offering many local patients improved outcomes over conventional treatments alone.

Survival Benefit

For patients with metastatic right-sided colorectal cancer liver metastases, yttrium-90 selective internal radiation therapy (Y-90 SIRT) in addition to chemotherapy yields increased overall survival of approximately five months compared with chemotherapy alone, according to a study in Clinical Colorectal Cancer that was co-authored by Navesh Sharma, DO, PhD, FACRO, section chief of Radiation Oncology at Penn State Health St. Joseph Cancer Center and associate professor of radiation oncology at Penn State College of Medicine.

In patients with liver-only metastases from colorectal cancer, Y-90 SIRT in addition to chemotherapy improves control of disease in the liver by approximately eight months, according to a study led by Dr. Sharma and published in the Journal of Clinical Oncology

Y-90 SIRT is indicated for a wide range of patients with cancer in the liver, including those who are not candidates for surgery, and its local availability and the expertise at Penn State Health St. Joseph Cancer Center spare them the need to travel to major metropolitan facilities.

A Focus on Precision

Limiting damage to healthy tissue by precisely targeting cancer cells during radiation therapy is crucial because the liver is especially sensitive.

“A low dose of radiation to the entire liver can do great harm to a patient,” says Navesh Sharma, DO, PhD, FACRO, section chief of Radiation Oncology at Penn State Health St. Joseph Cancer Center and associate professor of radiation oncology at Penn State College of Medicine. “That’s why Y-90 SIRT is indicated for patients with liver-predominant disease that poses a risk for immediate liver-related problems.”

Y-90 SIRT delivers radiation to cancerous liver tumors through millions of resin microspheres containing yttrium-90. The procedure involves inserting a catheter into the femoral or radial artery through a small incision in the groin. The catheter is threaded to blood vessels that feed the tumors, and the spheres are delivered through the catheter.

“Yttrium-90 is a beta emitter, which emits radiation for only short distances,” Dr. Sharma explains. “That enables us to deliver a high dose to tumors without the radiation spreading too far, thus protecting the rest of the liver.”

Prior to the procedure, an arteriogram maps the area’s blood vessels, some of which are then blocked off to ensure the microspheres do not travel outside the prescribed area. The brevity of the procedure on the day of treatment — less than two hours, including half an hour to infuse the spheres — allows patients to return home from Penn State Health St. Joseph Cancer Center the same day.

Accurate Timing

The oncology team at Penn State Health St. Joseph Cancer Center maintains robust communication throughout a patient’s course of treatment to ensure optimal timing of Y-90 SIRT.

High-Level Expertise

A board-certified radiation oncologist, Navesh Sharma, DO, PhD, FACRO, section chief of Radiation Oncology at Penn State Health St. Joseph Cancer Center and associate professor of radiation oncology at Penn State College of Medicine, is an internationally recognized expert in yttrium-90 selective internal radiation therapy (Y-90 SIRT).

Dr. Sharma served as the United States’ principal investigator for an international phase III clinical trial on Y-90 SIRT that was published in the Journal of Clinical Oncology in 2016 and The Lancet Oncology in 2017.

“I’ve been involved with the procedure since 2010 and previously led one of the largest Y-90 SIRT programs in the country,” he says. “I’ve spent a lot of time learning the accurate dosimetry and application of Y-90 SIRT and its appropriate integration into the continuum of cancer care for patients.”

“Specialists in interventional radiology, radiation and medical oncology are all on the same floor as I am, so we can plan Y-90 SIRT before chemotherapy has even begun,” Dr. Sharma says. “We treat patients in a way that complements the flow of other treatments they are undergoing. That level of multidisciplinary collaboration in a high-volume center such as ours is rare.”

Lifesaving Care, Rapid Recovery

Thomas Souders, who was diagnosed with stage IV pancreatic cancer in 2012 and learned it had metastasized to his liver in 2015, has benefited from Dr. Sharma’s expertise. In 2015, Souders underwent Y-90 SIRT after having previously undergone chemotherapy.

“I was able to make it through Y-90 treatment much easier than chemotherapy,” he recalls. “It was more comfortable, and I had a quicker recovery. I even fell asleep during the procedure itself, and I was out of the hospital within an hour after it was over.”

Chemotherapy required him to visit the treatment center four times weekly for multiple weeks, whereas Y-90 SIRT required only three visits over three days. The first was to map the arteries that would carry the microspheres; the second and third were to administer treatment.

Souders doubts he would have known about Y-90 SIRT were it not for its local availability at Penn State Health St. Joseph Cancer Center. He believes that without the treatment, he would not be alive.

“The sooner patients seek treatment options, the better,” Dr. Sharma says. “In the past, the stage IV colorectal cancer survival rate was four to six months. Now, it’s over two years. Offering targeted Y-90 therapy for patients with liver-predominant disease allows them to sometimes get breaks from more toxic chemotherapy and improves their control of disease in the liver based on clinical trials. Integrating chemotherapy and Y-90 SIRT appropriately is what we are able to do well with the experience and open interaction we have here at St. Joseph Cancer Center.”

To learn more about Y-90 SIRT at Penn State Health St. Joseph Cancer Center or to refer a patient, visit thefutureofhealthcare.org/cancer-center/y-90 or call 610-898-SIRT (7478).

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