A research consortium of Radboud university medical center, the University of Twente, University Medical Center Groningen and five companies will be using a grant from the Dutch Research Council (NWO) to optimize the treatment of liver tumors with radioembolization.
Each year, 1.5 million people around the world are affected by liver malignancies. For patients who cannot receive surgery or chemotherapy, radioembolization can be a treatment option. Radioembolization is a technique in which tiny radioactive beads (microspheres) are injected in the hepatic artery via a catheter and flow to the tumor in the liver. In the tumor, the microspheres become trapped in the capillaries, where they irradiate the liver tumor from within. For this reason, radioembolization is also referred to as selective internal radiation therapy (SIRT).
The effect of radioembolization depends on the exact location where the microspheres become trapped in the liver. This concerns several questions: Where in the hepatic vasculature should the microspheres be injected? At what speed should they be administered? How are they distributed? “In recent years several clinical trials have shown varying results for radioembolization. This probably has to do with the distribution of the microspheres in and around the tumor,” explains project coordinator Frank Nijsen of Radboud university medical center’s Department of Medical Imaging. “With this research, we would like to gain more insight into the factors that influence the distribution of the microspheres in the liver. Once we can predict microsphere distribution, it will be possible to target the irradiation of the tumor tissue more precisely, translating to fewer side effects in patients and more effect of the therapy in terms of stop of tumor growth or even tumor shrinkage.
Making treatment visible
Radioactive yttrium and holmium microspheres are most commonly used for radioembolization. The latter were developed by Quirem Medical, a company that is also involved in this project, along with Terumo, Organ Assist, Femto and Siemens Healthineers. An important characteristic of the holmium microspheres is that, unlike yttrium microspheres, they are easy to visualize on MR and CT and SPECT images. Particularly with MRI, we are able to measure and analyze microsphere distribution in the liver very precisely and in high resolution. Nijsen, “This project fits perfectly within the research that we are doing at the Radboud university medical center on image-guided radionuclide interventions and the improvement of techniques in order to arrive at the best outcomes for patients.”
Reliable computer model
This research program includes fundamental, experimental and patient-related research. “We use experimental set-ups, phantoms, animal livers left over from butchering and not clinically usable human livers that become available in the process of liver donation and liver transplantation,” continues Nijsen. “All knowledge that we develop in this project is intended to ultimately result in a computer model. Based on the patient’s vasculature, this computer model will be able to predict where the catheter should be placed and how many microspheres should be used to provide the optimal treatment—a high activity in the tumor and minimal activity in the healthy liver tissue.”
The research on optimal treatment will be concluded with the actual treatment of patients in the special MITeC operating rooms at Radboud university medical center. Nijsen, “There, we will test whether our computer model does indeed allow a better patient treatment. This research is to result in a validated, generally applicable treatment method, with the objective of achieving better and more consistent results with radioembolization.”
NWO’s Open Technology Programme is open to excellent research, with a view to the possible application of results. The program offers companies and other organizations an accessible way of connecting with scientific research that is intended to generate applicable knowledge. Research project: Understanding Liver Treatment to Improve Microsphere Optimal distribution (Ultimo)
For additional information:
Radboud university medical center:
University of Twente:
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