24 - Special Procedures (SIRT)

24 - Special Procedures (SIRT) - Lecture # 24 Special...

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Special Procedures Tarun K. Podder, PhD, DABR Department of Radiation Oncology Brody School of Medicine Leo Jenkins Cancer Center East Carolina University March 14, 2011 Lecture # 24
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2 Strontium-90 is produced by nuclear fission, Strontium-90 decays to yttrium-90 by emitting a beta particle, Yttrium-90 decays to zirconium-90 by emitting a more energetic beta particle with a half-life of 64 hours . Selective Internal Radiation Therapy (SIRT) with Y 90 Microspheres
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3 SIRT with Y 90 microspheres 1. Introduction 2. Patient evaluation Candidate for 90 Y microspheres Lung shunt fraction Tumor-normal liver uptake ratio Tumor volume Liver volume 3. Dose calculation 4. Written directive 5. Ordering SIR-sphere source 6. Source delivery & storage 7. Dose preparation & transportation to CVIR 8. Administration of SIR-spheres in CVIR 9. Patient discharge 10. Radiation safety 11. Disposal of radioactive waste 12. Lessons learned
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CT and/or MRI FDG-PET OctreoScan Introduction Radiation Oncology Interventional Radiology Angiogram Tc-MAA Team Reviews Imaging, planning tumor, proposed dose, optimal catheter placement Pre-Treatment Screening Evaluation Bremsstrahlung (Gamma) Scan, SPECT Post-implant QA Documentation Delivery of Y 90 to PTV Safe delivery achievable Tumor mapping Consultation - Tumor Board Medical Oncology Surgical Oncology Nuclear Medicine Consensus for SIRT with Y 90 Vessel mapping 1-2 weeks 1-2 weeks Same day 1 week Liver predominant dz
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5 Introduction Before treatment 6 weeks after treatment
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6 Introduction SIRT – Radio embolization having two components Embolization - the angiographic endpoints of embolization and stasis, and the need to modify the delivery according to angiographic findings under fluoroscopy Brachytherapy - the administration and delivery of radiation with modification of dose based on tumor and target volume
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7 Introduction SIRT with Y 90 microspheres Resin microspheres or SIR-spheres ® (Worldwide) • Glass microspheres or Therasphere ® (North America only) Ref. REBOC (May 2007)
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8 Introduction In the United States , Glass Y 90 microspheres are approved by the FDA for treatment of unresectable hepatocellular carcinoma under the provisions of a “humanitarian device exemption” (HDE no. H9800006). Resin Y 90 microspheres have received FDA (premarket) approval for treatment of hepatic metastases from colorectal cancer , concurrent with fluorodeoxyuridine (FUDR); Class III product .
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9 Introduction REBOC R adio e mbolizaton B rachytherapy O ncology C onsortium An independent group of experts from the fields of 1) Interventional radiology 2) Radiation oncology 3) Nuclear medicine 4) Medical oncology 5) Surgical oncology May 2007
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10 Introduction The REBOC panel strongly emphasizes that a multidisciplinary team approach, which should include individuals with expertise necessary to - 1) assume overall medical management of the cancer patient, 2) perform vascular catheterization, 3) perform and interpret radiologic scans, 4) assume responsibility for the delivery of the Y 90 microspheres and be the
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This note was uploaded on 01/21/2012 for the course PHYS 6720 taught by Professor Hu during the Spring '10 term at East Carolina University .

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24 - Special Procedures (SIRT) - Lecture # 24 Special...

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