Researchers target liver tumors with precision radiation bombs

Volume 9, Issue 3, December 2020


Higher radiation doses enabled by radioembolization may expand options for liver cancer treatment.

Photograph of Beau Toskich, M.D.

Beau Toskich, M.D.

Mayo Clinic scientists are finding new ways to harness old technology to treat liver cancer.

In the 1960s, scientists developed a form of cancer therapy called radioembolization, which uses microscopic radioactive spheres delivered through a blood vessel to reach a tumor and kill tumor cells.

"Think of it as a tiny radiation bomb that's delivered directly where it's most needed," said Beau Toskich, M.D., an interventional radiologist who specializes in interventional oncology at Mayo Clinic in Florida.

In previous decades, radioembolization was used as a palliative treatment option to slow progression of advanced liver cancer in patients who had typically undergone chemotherapy but weren't candidates for curative therapies.

Today, Dr. Toskich and colleagues are conducting research to revisit this technology, finding new ways to maximize its capabilities to benefit more patients.

For most cancer types, radiation therapy originates outside the body, penetrating through skin, bone and adjacent organs to reach malignant cells, in a process that can limit the amount of radiation that can be given safely.

But many liver tumors have a unique property that makes radioembolization possible: They base their blood supply almost entirely on a few arteries that normally nourish portions of the liver. If radioembolization is delivered through only the liver arteries that are responsible for supplying the tumor, higher doses of radiation can be safely administered.

"It's like a contained nuclear explosion that surrounds the cancer, while the untreated liver has little to no radiation exposure," Dr. Toskich explained.

Research conducted by Dr. Toskich's team centers on mapping specific liver blood supply territories using small catheters and mini-CT scans to analyze the blood vessels responsible for nourishing a patient's tumor. After mapping is complete, the patient typically receives treatment during a single outpatient session.

As the radiation takes effect over the course of several months, the liver uses its inherent regenerative abilities to recover from the small portion of itself that had been treated alongside the tumor.

In another project, Dr. Toskich is working with Kabir Mody, M.D., an oncologist at Mayo Clinic in Florida, to determine whether radioembolization can stimulate the body's immune response to fight liver cancer.

With higher radiation doses enabled by this more precise radioembolization approach, tumors are showing promising response in early research. As a result, the team is optimistic about its ability to increase the number of patients with liver cancer who are candidates for tumor-removal surgery, either through resection or transplantation of a healthy new liver, or with radioembolization as the sole therapy in select circumstances.

"We are finding that in patients who received liver transplantation after high-dose radioembolization, about half of targeted tumors show complete cell death and over 95% show extensive treatment response," Dr. Toskich said. "Certain tumors are being eradicated by radioembolization, which used to only be capable of slowing the progression of liver cancer when other treatments were not an option."

Radioembolization has an important role in controlling tumor growth in patients with liver cancer while they await a transplant, said gastroenterologist Tushar C. Patel, M.B., Ch.B., dean for research at Mayo Clinic in Florida, who is collaborating on this work. "We think that it may also be used as curative treatment in patients with very early liver cancer," he said. "Mayo's extensive efforts in liver cancer research, combined with our comprehensive interdisciplinary care capabilities, are helping us develop unique treatment strategies."