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DOI: 10.1148/rg.281075115
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RadioGraphics 2008;28:101-117
© RSNA, 2008

EDUCATION EXHIBIT

Recent Advances in Transarterial Therapy of Primary and Secondary Liver Malignancies1

Sanjeeva P. Kalva, MBBS, MD, Ashraf Thabet, MD, and Stephan Wicky, MD

1 From the Division of Cardiovascular Intervention, Department of Radiology, Massachusetts General Hospital, Gray 2, 55 Fruit St, GRB-290, Boston, MA 02114. Presented as an education exhibit at the 2006 RSNA Annual Meeting. Received May 16, 2007; revision requested June 13 and received July 19; accepted August 20. S.P.K. and S.W. received funding from Johnson & Johnson (Cordis) and Cook Group; A.T. has no financial relationships to disclose. Address correspondence to S.P.K. (e-mail: skalva{at}partners.org).

The management of liver malignancies presents many challenges. Few patients with primary hepatocellular carcinoma or metastatic disease of the liver are eligible for surgery, which is the only curative therapeutic option. Because the hepatic tumor burden is often a determinant of eligibility for surgery and is a primary contributor to morbidity and mortality, an increasing number of innovative techniques based on the transarterial administration of liver-directed drug-eluting or radiation-emitting microspheres are being tested for use in cytoreductive and palliative therapy. The delivery of therapy via a transarterial route takes advantage of the fact that hepatic malignancies are primarily supplied by the hepatic artery. The early results of clinical trials are promising; the clinical effectiveness and safety of drug-eluting and yttrium-90–bearing microspheres have been demonstrated; however, further clinical investigation is needed to verify a benefit in survival. Transarterially administered gene therapy holds promise but is still in the early stages of investigation. For all transarterial therapies, the outcome depends heavily on meticulous patient selection, careful preparation and administration of therapy, and early and regular follow-up evaluations by using an interdisciplinary approach.

© RSNA, 2008


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