Ian Murphy MBBCh, MRCS, Presenter: Nothing to Disclose

Lisa Lavelle MBBCh, MRCPI, Abstract Co-Author: Nothing to Disclose

Elaine Ni Mhurchu MBBCh, Abstract Co-Author: Nothing to Disclose

Jeffrey William McCann MBBCh, MSC, Abstract Co-Author: Nothing to Disclose

Colin Patrick Cantwell MD, Abstract Co-Author: Nothing to Disclose

David Paul Brophy MBBCh, Abstract Co-Author: Research Consultant, Marvao Medical Limited Shareholder, Marvao Medical Limited

Dermot E. Malone MD, Abstract Co-Author: Nothing to Disclose

Radioembolization using Yttrium-90 β-emitters are a competing technology for transarterial chemoebolizations in liver tumours and little randomized evidence exists comparing these two therapeutic modalities in primary or metastatic liver tumours. Our aim was to evaluate the evidence for the introduction of Y-90 in our instiution, in terms of benefit and risk for the patient, and cost.

A primary and secondary literature search was carried out using established evidence-based methods.  Secondary Evidence from UpToDate, TripDatabase, NGC, NICE, and Cochrane databases was reviewed.  Primary evidence was examined from the NCBI PubMed site using established MeSH terms of clincal papers examining the therapeutic impacts of Yttrium-90 radioembolization, and a database was compiled.  Evidence was reviewed and graded using evidence-based evaluation tools.

Secondary literature search revealed three systematic reviews and the primary review 320 appropriate original papers. The two modalities are likely to have similar efficacy.  Yttrium-90 is also found to have low side-effect and toxicity profile, though no prospective randomized trials have directly compared the two modalities. In hepatic metastases, Y-90 may be more efficacious in down-sizing to transplantable level; and in colorectal metastases, in conjunction with systemic chemotherapy, has been shown to be more efficacious than systemic chemotherapy alone. The pharmaceutical itself is more expensive, but evidence shows that overall costs may be equivalent. 

Evaluation of the literature through evidence-based medicine techniques revealed an emerging and worthwhile role for Yttrium-90 radioemboliztion in the treatment hepatocellular carcinoma and liver metastases.

Ytrrium-90 radioemboliztion is likely to be as efficacious as chemoembolization, and may be safer. Costs are likely to be equivalent.

Murphy, I, Lavelle, L, Ni Mhurchu, E, McCann, J, Cantwell, C, Brophy, D, Malone, D, Yttrium-90 Radioembolization vs Transarterial Chemoembolization in Liver Tumours – An Evidence Based Review.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12028553.html