Interventional Oncologic Approaches to Liver Metastases

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Registered Radiologist Assistant: 5.25
Procedures: 5.25
Abdominal Section: 5.25

Radiation Therapy: 3.75
Patient Care: 2.00
Patient and Medical Record Management: 2.00
Procedures: 1.75
Treatment Sites and Tumors: 1.75

Vascular-Interventional Radiography: 5.25
Procedures: 5.25
Vascular Interventional Procedures: 4.00
Nonvascular Procedures: 1.25

Outline

1. Introduction
2. Overview of PVE
   1. Technique
   2. Indications and Results
3. Overview of HAIC
   1. Technique
   2. Indications and Results
4. Percutaneous Ablation Techniques
   1. Rationale
   2. RF Ablation
   3. Microwave Ablation
   4. Indications and Results of Thermal Ablation in Metastatic Liver Disease
5. Transarterial Embolization Techniques in Hepatic Metastases
   1. Indications
   2. Technical Considerations in Chemoembolization
   3. Clinical Results of Chemoembolization
6. Radioembolization of Liver Metastases
   1. Rationale for ⁹⁰Y Radioembolization
   2. Technical Considerations in Radioembolization
   3. Clinical Results of Radioembolization in Liver Metastases
   4. Toxicity and Complications in Transarterial Embolization Techniques
   5. Techniques Under Development
7. Conclusion

Objectives

Upon completion of this course, students will:

1. understand the number of patients that will die due to metastatic liver disease from colorectal liver metastases
2. communicate what treatment provides the best long term survival rate in patients with colorectal metastatic disease
3. explain the percentage of patients who are candidates for surgery to treat colorectal metastatic cancer
4. indicate what percentage of metastatic lesions in colorectal cancer patients will be completely sterilized by chemotherapy
5. identify a limit to liver resection
6. recognize the most feared post-operative complication after hepatectomy
7. understand what vessels are targeted during portal vein embolization
8. visualize portogram images at all stages of portal vein embolization procedures
9. explain which approach to the portal venous system may damage future remnant liver
10. understand the most frequently reported embolic materials used for portal vein embolization
11. communicate what area of the liver is most commonly targeted for PVE
12. indicate the percentage of future remnant liver volume patients must have to be considered for portal vein embolization
13. discuss what liver condition will produce better portal vein embolization outcomes
14. understand how liver metastases receive blood supply
15. indicate the percentage of FUDR extraction in the liver that occurs during hepatic artery infusion chemotherapy
16. explain why permanent access to a hepatic artery is necessary for hepatic artery infusion chemotherapy
17. identify the routes for catheter placement into the hepatic artery
18. understand when hepatic artery infusion chemotherapy is utilized
19. communicate the most common side effects of FUDR used in hepatic artery infusion chemotherapy
20. indicate the benefits to hepatic artery infusion chemotherapy
21. be aware of multiple percutaneous ablation techniques
22. communicate the intent of ablation therapy
23. understand the three phenomena that define the results of hyperthermal ablation
24. identify the limitations to surgical resection of liver metastases
25. indicate what therapy utilizes direct injection of pure alcohol into cancer cells
26. discuss methods used to perform microwave ablation therapy
27. understand the technical advantage of microwave therapy over radiofrequency therapy
28. be aware of the advantages of thermal ablation over resection
29. explain what size metastatic liver tumors respond best to thermal ablation therapy
30. discuss the advantages of intraoperative radiofrequency ablation
31. recognize the survival rate for patients receiving thermal ablation of liver metastases caused from neuroendocrine tumors
32. state the two types of transarterial embolization
33. explain the Eastern Cooperative Oncology Group scoring system
34. describe the ECOG status of 2 required for transarterial treatment
35. list the indications for radioembolization in colorectal metastases to the liver
36. understand pre-treatments required for chemoembolization patients
37. describe the type of diagnostic angiography necessary for chemoembolization patients
38. list the most commonly used chemotherapeutic agents
39. describe the types of metastases for which chemoembolization has been utilized
40. indicate what percent of the population receiving chemoembolization will experience major complications
41. understand why care must be taken when advancing catheters during chemoembolization procedures
42. understand the rare, non-vascular complications associated with chemoembolization
43. identify the two materials used in radioactive microspheres
44. select which commercially available ⁹⁰Y particles are comprised of glass or resin
45. communicate the three qualifications for radioembolization
46. discuss the importance of pre-radioembolization angiography
47. summarize studies on radioembolization of liver metastases from NET, breast cancer, and uveal melanoma
48. communicate the difference in toxicity levels between radioembolization and chemoembolization
49. state the more serious complications involved with radioembolization
50. recognize the new techniques under development for cancer treatment