Holmium-166 radioembolization in HCC: advances in personalized treatment

Abstract

Liver cancer is the second most common cause of cancer-related death. In most cases it regards hepatocellular carcinoma (HCC). People who are diagnosed with cancer usually do not live long. Furthermore, they usually experience annoying symptoms, such as jaundice and pain. There is a need for new treatment options. Holmium radioembolization is such an option. During radioembolization treatment, radioactive microspheres are injected as close to the cancer cells as possible. The cancer cells are damaged by the internal radiation from holmium or yttrium. Eventually, the cancer cells can stop growing or even completely die. Sometimes the patient’s symptoms will become less intense too. In this thesis the use of holmium microspheres was evaluated. Holmium radioembolization can be safely used in a specific HCC patient population. Besides, the amount of holmium that needs to be given to a patient to get the best response was investigated. Radiation is expressed in Gray (Gy), just like we express distance in meters (m). When the cancer cells receive a dose of at least 150 Gy, chances are high that the patient will respond to the treatment. Whether a patient is eligible for radioembolization is based on medical history, bloodwork and imaging. In addition, hepatobiliary scintigraphy can be used to assess a patient’s liver function. Research described in this thesis confirms that the size of the liver not always provides insight on the patients’ liver function. Future studies will need to focus on confirming the dose thresholds to be able to further individualize radioembolization to the patients’ needs.