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Semin intervent Radiol 2020; 37(05): 537-542
DOI: 10.1055/s-0040-1720953
How I Do It

Yttrium-90 Radiation Segmentectomy

Guy E. Johnson
1   Section of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
,
Siddharth A. Padia
2   Section of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
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Superselective transarterial radioembolization, or radiation segmentectomy, is a novel curative-intent therapy for patients with localized hepatocellular carcinoma (HCC). Radiation segmentectomy was developed as a means of addressing two concerns in the treatment of patients with HCC. First, by selectively treating the tumor-bearing hepatic Couinaud segments, the dose of radiation to normal parenchyma is limited and, consequently, the toxicity of radiation segmentectomy is minimized. Second, selective treatment allows for utilization of a higher dose of radiation, which correlates with a higher likelihood of objective response. Radiation segmentectomy hinges on a vital physical property of yttrium-90 (90Y): the average penetration of the β-radiation emitted by the decaying 90Y is 2.5 mm in tissue.[1] This allows the radiation to be confined to the perfused volume of tumor-bearing liver in which the 90Y microspheres are deposited by the catheter, while the rest of the liver remains radiation naive. Additionally, the microembolic nature of 90Y microspheres (compared with particles used in chemoembolization) allows for maintaining arterial patency, and avoids tissue ischemia and postembolization syndrome. Radiation segmentectomy may be performed in a subsegmental fashion or, as Riaz et al originally described, ablative radioembolization may be used to treat more than one segment.[2]

Disclosure

G.E.J. is a consultant for Boston Scientific Corporation and Genentech. S.A.P. is a consultation for Boston Scientific Corporation and Bristol Meyer Squibb.




Publication History

Article published online:
11 December 2020

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