Tiny beads deliver time

Time, for Ann Ward, arrives as thousands of tiny beads hot with the radioactive element yttrium-90. The Y-90-treated microspheres are delivered through her hepatic artery directly into her liver, where they will wage a life-and-death battle against the malignant tumor that's trying to kill her.

If the treatment wins, she will have more time and a higher quality of life. She has been diagnosed with stage-4 cancer that spread to her liver. Repeated tests have failed to pinpoint the original tumor, but there's no question the one in her liver is life-threatening.

The image-guided, minimally invasive outpatient procedure is a form of selective internal radiation therapy reserved for inoperable cancers in the liver — either primary liver cancers or metastatic cancer that has moved into the liver. Although the Y-90 therapy is FDA approved, use for this purpose is considered "off label," though growing in popularity. It has only recently come to Utah, under the auspices of the Huntsman Cancer Hospital at the University of Utah.

Dr. James Carlisle, an interventional oncologist in the U.'s Department of Interventional Radiology, is currently the only practitioner trained in the therapy in the region.

Kent Sorensen was diagnosed two years ago, at age 49, with a rare and lethal soft-tissue sarcoma. Called hemangiopericytoma, the blood-vessel-involved cancer started in his abdomen and was very aggressive. Last February, doctors found it had spread to his liver.

He tried chemotherapy several times, but got little result. He was referred to Carlisle, who delivered the first good news Sorensen had had in a while: His cancer was now confined to the liver. And Carlisle had just been approved to do Y-90 treatment. Sorensen had researched and knew about the treatment, but his insurance company wouldn't pay for him to go to Chicago to have it done. And it hadn't been available locally before.

The treatment is often used for colorectal cancer that spreads into the liver, which "with the best of all chemotherapies prolongs life about two years," Carlisle says. "If we just do the simplest chemotherapy and yttrium-90, we get at least that survival."

Y-90 therapy's a precise process. The first step is called a coil embolization. The oncologist goes in through the groin and places coils in blood vessels in the liver that tie into other organs so that none of the radioactive beads (each about a third the diameter of a hair) will wander where they don't belong.

A tiny amount of radiation is also injected into the hepatic artery to see if any of it goes into the lungs, since some tumors feed into the lungs. If that doesn't happen, treatment proceeds about three weeks later.