Mangaluru: A.J. Hospital & Research Centre is one of the first hospitals in Coastal Karnataka to perform TARE- an advanced minimally invasive liver cancer treatment using radioactive medicine; on 4th August 2020. This treatment was performed on a 53-year-old man, by a team of doctors and support staff led by Interventional Radiologist Dr. Ashwin Polnaya and Nuclear Medicine Physicians Dr. Sujith Rai, and Dr. Radhamohan and Gastroenterologist Dr. Raghavendra Prasada.
Liver cancer is the sixth most common cancer worldwide, with an increase of 75 percent worldwide in its diagnoses between the 1990s and 2015. Hepatocellular carcinoma (HCC) is one of the most common types of primary liver cancer, which occurs mostly with people who have chronic liver diseases, such as cirrhosis caused by hepatitis B or hepatitis C infection.
‘TARE (Transarterial Radioembolization)’ which is also known as ‘Y-90 Microsphere Therapy’ is a procedure performed usually for the treatment of liver cancer.
Radioembolization can shrink a tumor making it easier to remove, kill cancer cells, or slow cancer growth to give more time for the availability of transport organs, or help to make the symptoms better.
With 10 years of experience in the medical field, Dr. Ashwin Polnaya says, ” It’s a liver-directed treatment for liver cancer or any cancer that is unresponsive to regular oncological treatment. Primary liver cancers such as HCC are treated with Radioembolization.”
Dr.Ashwin emphasizes the treatment as an angiographic procedure, where they study the liver angioarchitecture first, to see if it’s feasible and assess whether the medicine or the radioisotope can be used on the patient. “It’s a multidisciplinary decision. Before the treatment, we assess with scans first, and if the parameters are feasible, we place the order, as we need to import this from abroad. That includes assessing the patient, to see the performance status. This treatment can be used in patients who are inoperable, which offers disease control and good quality of life. Surgery can be performed in patients who are on the borderline initially, for surgical removal. The procedure is followed to onstage the disease, making it beneficial for a liver transplant.”
TARE allows doctors to deliver radiation treatment directly to the liver using a minimally invasive technique that most patients tolerate with few side effects. The treatment is performed by ‘ Pin Hole’ access in the groin, i.e a small incision in the patient’s upper thigh through the artery. A catheter is then passed into the artery that goes directly to the liver, supplying the tumor, with millions of tiny ‘beads’ or ‘microspheres’ containing radioactive component (Y-90) or Yttrium 90 that is injected through the catheter which gets localized within the tumor tissue.
High doses of radiation are emitted directly to the tumor cells by the microspheres, to destroy them. This targeted nature of the procedure enables doctors to deliver up to 40 times more radiation to the liver tumors than would be possible using normal external radiation therapy. As a result, sparing the healthy normal liver tissue from radiation toxicity.
Although the radiation emission decreases over 2 weeks period, the internal radiation effect continues its tumoricidal action, and peak effect is seen in 6-12 weeks with tumor becoming inactive and showing signs of progressive shrinkage.
The therapy also has its own limits, where sometimes the doctors combine it with systematic therapy to get a combined result, on the basis of optimum and clinical conditions of the liver or the patient. “If the disease has only spread to the liver, such patients will benefit the most. If the disease has spread to other organs, treating just the liver region will not make sense. Such patients need to opt for other systematic procedures” says Dr.Ashwin.
This method of treatment helps in local disease control of locally advanced liver tumors and helps in downstaging patients for curative surgical resection/liver transplantation so as to improve patient outcomes.
The treatment is well tolerated by the patients who can be discharged from the hospital very next day and offers a good quality of life post-intervention.
To sum up, TARE treatment can improve the overall outcome of the patient as it helps to control the disease burden in the liver. However, the side effects of the TARE procedure can include fatigue, abdominal pain, and nausea which usually lasts a week.
“Most patients recover from these and tolerate it well. Liver function recovers well in time and disease control is also achieved.”
With 6 years of work experience in Tata Memorial Hospital in Mumbai, Dr. Ashwin has routinely performed these procedures before and required some regulatory clearances for getting the radioisotopes and the treatment that took place in AJ Hospital, Mangalore.
The radioactive medicine required for the procedure was imported from Singapore. The procedure can be done in a variety of liver tumors both originating within the liver or which have spread from other organs when primary oncology treatment has failed.
For more details about the treatment, contact: Dr. Ashwin Polnaya (9900458946).
