KMC says demand grows for high-tech cancer therapy

Journal of Business, May 1, 2008 by Proffitt, Emily

Kootenai Medical Center, of Coeur d'Alene, says demand is rising for a cutting-edge radiation treatment for liver cancer that it started offering in the fall of 2006.

Rather than employing an external radiation beam, the treatment involves infusing into the liver via a catheter millions of microscopic radioactive beads, called microspheres, says Dr. Casey Fatz, an interventional radiologist at Kootenai Outpatient Imaging. Since KMC launched the treatment, which it says is called the yttrium-90 treatment, or the Y-90 treatment, Dr. David Liu, who had practiced in Oregon before joining Spokane-based Inland Imaging LLC last year, began performing the procedure here.

The Y-90 treatment, which was approved by the U.S. Food and Drug Administration in 2002, has provided an important breakthrough in liver cancer treatment because it involves a targeted method for killing tumors internally while sparing healthy liver tissue, Fatz says. The liver is particularly sensitive to external radiation beams, which aren't as effective as the Y-90 treatment in targeting tumors without damaging surrounding tissue. The treatment typically is reserved for patients who have exhausted their options for chemotherapy and whose liver tumors can't be removed surgically, Fatz says.

The diameter of the tiny beads that contain the Y-90 radioactive element is one-third that of a strand of hair. The catheter is inserted through an incision in the groin and is guided into the liver's hepatic artery. The microspheres flood into the artery, which research has shown to be the primary deliverer of a liver tumor's blood supply, he says. Healthy liver tissue is fed primarily by the liver's portal vein.

"The blood goes where the tumors are, and (the microspheres) go where the blood flows," Fatz says.

The microspheres lodge in the small blood vessels surrounding the tumors and emit a dose of radiation over the course of about two weeks that shrinks or destroys them, he says. The radioactive element bonds to the microspheres, so it can't leak out and harm other tissues in the body, he says.

The treatment usually is administered as an outpatient procedure. It's typically delivered in two sessions about a month apart, with half of the liver treated at a time, Fatz says. The procedure can be repeated, depending on what physicians deem to be a safe radiation dose for the patient, he says.

Prior to receiving the treatment, a patient first must undergo a series of tests so that doctors can get an accurate picture of his or her liver, he says. The patient also receives a test dose of the treatment to determine if any of the radiation travels into the lung, since some liver tumors drain particles out into a vein, which sends them to the heart and then to the lungs. If high amounts of the radiation end up in the lungs, the patient either must receive a lower dose or can't undergo the treatment, he says.

Patients also are ineligible for treatment if their liver's blood vessels can't receive the microspheres or if their liver is too deteriorated, he says.

The procedure generally is used to treat primary liver cancer or colon cancer that has spread to the liver, Fatz says. He adds, though, that researchers also are finding promising results when using it to treat other cancers, including metastasized breast cancer, that have spread to the liver.

Demand for the treatment at KMC started off slowly, but has been picking up lately, Fatz says. While Medicare will cover the procedure, one of the primary reasons behind the somewhat slow start has been that some insurers don't cover it, he says. Fatz estimates that each of the two radiation doses costs $15,000, excluding the costs for related tests and other hospital fees.

Two companies manufacture the radiation materials used in the Y-90 treatment. KMC buys its Y-90 doses, marketed as SIR-Spheres, from Australian-based Sirtex. The other company that makes the beads is Canada-based MDS Nordion, which markets the treatment as TheraSphere.