The American Brachytherapy Society consensus statement for permanent implant brachytherapy using Yttrium-90 microsphere radioembolization for liver tumors.

PURPOSE: To develop a multidisciplinary consensus for high quality multidisciplinary implementation of brachytherapy using Yttrium-90 (90Y) microspheres transarterial radioembolization (90Y TARE) for primary and metastatic cancers in the liver. METHODS AND MATERIALS: Members of the American Brachytherapy Society (ABS) and colleagues with multidisciplinary expertise in liver tumor therapy formulated guidelines for 90Y TARE for unresectable primary liver malignancies and unresectable metastatic cancer to the liver. The consensus is provided on the most recent literature and clinical experience. RESULTS: The ABS strongly recommends the use of 90Y microsphere brachytherapy for the definitive/palliative treatment of unresectable liver cancer when recommended by the multidisciplinary team. A quality management program must be implemented at the start of 90Y TARE program development and follow-up data should be tracked for efficacy and toxicity. Patient-specific dosimetry optimized for treatment intent is recommended when conducting 90Y TARE. Implementation in patients on systemic therapy should account for factors that may enhance treatment related toxicity without delaying treatment inappropriately. Further management and salvage therapy options including retreatment with 90Y TARE should be carefully considered. CONCLUSIONS: ABS consensus for implementing a safe 90Y TARE program for liver cancer in the multidisciplinary setting is presented. It builds on previous guidelines to include recommendations for appropriate implementation based on current literature and practices in experienced centers. Practitioners and cooperative groups are encouraged to use this document as a guide to formulate their clinical practices and to adopt the most recent dose reporting policies that are critical for a unified outcome analysis of future effectiveness studies.

Selective Internal Radiation Therapy in the Multidisciplinary Management of Liver Metastases From Colorectal Carcinoma.

Colorectal cancer (CRC) is the fourth most common cancer in the United States. Most patients diagnosed with CRC will eventually develop metastases. The liver is the most common site of metastases from CRC and liver metastases are the most common cause of death for patients with CRC. Selective internal radiotherapy (SIRT) using yttrium 90 microspheres has emerged as a safe and effective treatment modality for controlling hepatic tumor burden in inoperable patients with liver-only or liver-predominant metastatic CRC. This article serves to review the available data on SIRT in the treatment of liver metastases from CRC in the salvage and first-line setting. Recently published phase III randomized data showing a significant improvement in liver progression-free survival from the addition of SIRT to standard chemotherapy in the first-line setting, while demonstrating no significant improvement in overall survival, will be reviewed. In addition, the present article examines the role of SIRT in the management of CRC liver metastases from right-sided colon cancers in which SIRT has been shown to improve overall survival when combined with chemotherapy in the first-line setting and explores appropriate patient selection for future studies.