Medical News
Yttrium-90 Microspheres May Increase Survival for Patients With Liver Cancer
Deborah Brauser
March 19, 2010 (Tampa, Florida) — An interventional radiology treatment using intra-arterial yttrium-90 (Y-90) microspheres (TheraSphere, MDS Nordion) shows promise in prolonging life for patients with hepatocellular carcinoma, according to results from a longitudinal cohort study presented here at the Society of Interventional Radiology (SIR) 35th Annual Scientific Meeting.
"More than 75% of hepatocellular carcinoma patients can't have surgery to remove their liver tumors, but this minimally invasive treatment may benefit them and give them more time," Riad Salem, MD, professor of radiology, medicine, and surgery, and director of interventional oncology at the Robert H. Lurie Comprehensive Cancer Center at Northwestern Memorial Hospital in Chicago, Illinois, told meeting attendees during his presentation.
"While patients aren't cured, their lives are being extended and their quality of life is improving," he added.
A Treatment for Patients Without Many Options
About 18,500 cases of primary liver cancer are diagnosed each year. The most common form is hepatocellular carcinoma — a tumor that begins in the main cells of the liver. Liver cancer treatment options are limited, Dr. Salem reminded SIR meeting attendees.
"Historically, chemotherapy drugs and external radiation therapy have been ineffective at curing inoperable liver cancer," said Dr. Salem in a statement. "Additionally, because of the compromised liver function, physicians must be careful that cancer treatments do not cause additional liver damage and toxicity, which could lead to death."
This new outpatient treatment combines the radioactive isotope Y-90 into microspheres that deliver radiation directly into a tumor. Each microsphere "bead" is about the width of 5 red blood cells. These beads are injected through a catheter from the groin into the artery supplying blood to the tumor.
"This is a particularly elegant way to give patients cancer treatment that doesn't harm the healthy cells. Patients don't feel sick or have many of the side effects that happen with standard cancer treatments," said Dr. Salem. "It's like a seed implantation but with extremely high doses, and is very localized."
He noted that this is a procedure that they have been working on "methodically" for the past 10 years.
For this study, the investigators enrolled 291 patients (77% male, 25% were more than 75 years old, and 73% had multifocal disease) between December 2003 and December 2008, and administered 526 Y-90 treatments. The patients were subdivided by their Barcelona Clinic Liver Cancer (BCLC) staging system (A or B) and Child-Pugh liver function score (A or B). A total of 43% of the patients had portal vein thrombosis.
This "was a high-risk patient population, with most having multiple tumors," noted Dr. Salem. "The median tumor size was about 7 cm, but overall they ranged from 1 to 22 cm in size."
The researchers reviewed 1250 scans to assess time to progression and treatment response rate. They also evaluated toxicity and survival by cancer stage, and used Response Evaluation Criteria in Solid Tumors (RECIST) to measure tumor shrinkage.
"This is the largest worldwide series ever presented of the treatment of primary unresectable liver cancer using radiation microspheres," reported Dr. Salem. "Our goal was to identify which patients were really benefiting and which ones potentially are not the best candidates for this therapy."
Improved Results, Dramatic Tumor Shrinkage
Results showed that overall time to progression was 7.9 months (95% confidence interval [CI], 6.0 - 10.3). "By oncologic standards for this disease, this is a very promising finding," said Dr. Salem.
Using World Health Organization guidelines, the overall response rate was 42%. Using the European Association for the Study of the Liver guidelines, the overall response rate was 57%.
Survival times differed significantly by cancer staging system (26.9 months for BCLC A vs 17.2 months for BCLC B) and by liver function score (17.2 months for Child-Pugh A vs 7.7 months for Child-Pugh B).
Child-Pugh B patients with portal vein thrombosis had the worst outcomes, with a median survival of only 5.6 months (95% CI, 4.5 - 6.7).
"Patients with Child-Pugh A disease, with or without portal vein thrombosis, benefited the most from Y-90 treatment, compared with those with type B disease (P = .002)," reported Dr. Salem.
The most common treatment-related adverse effects were fatigue (57%), vague abdominal pain (23%), and nausea/vomiting (20%).
NB!!!! Finally, the tumors from 58% of the patients followed long term were downstaged from T3 to T2, and 32 of the patients were considered transplantable.
"This was a really dramatic finding. We were able to shrink patients' [tumors] to potential transplant or cure," said Dr. Salem. "The concept of converting incurable disease to transplantable and potentially curable is certainly very appealing. In some cases, we were able to downstage from unresectable to resection/surgical removal, also a potential cure."
"These are early promising results and show that there is a defining and evolving role for Y-90 microspheres in primary liver cancer. Our study showed who can benefit from this treatment, letting us know how to triage patients and prognosticate based on the things that they and their families want to know," he summarized.
Dr. Salem noted that the part that he finds most interesting is "this concept of downstaging to potential cure. If you have a patient with an incurable condition that you can potentially downstage to a cure with surgery, surgical resection, or transplant, that is just very exciting."
He reported that his investigational team has started a new trial that randomizes patients to receive either the Y-90 treatment or "the more standard therapies, such as radiofrequency, ablation, or chemoembolization." Eventually, they hope to look at trials that combine the best of the therapies.
Practice Changing
"This almost sounds too good to be true," SIR president Brian F. Stainken, MD, adjunct professor of radiology at Boston University School of Medicine in Massachusetts and department chair at Roger Williams Hospital in Providence, Rhode Island, said to Dr. Salem during a press conference.
"We're looking at a disease that kills over 18,000 people a year, at people who don't have a clear curative surgical option," said Dr. Stainken, who was not involved in the study. "You're treating them with an outpatient procedure, with no hospitalization, that is very well tolerated and converting many of them to curable. Those that you don't [downstage], you're expanding their life span. Where does this fit in the context of cancer care?"
"The thing we've learned is how potent this radiation really is when administered in this manner," explained Dr. Salem. "It is very dramatic to see 20 cm tumors shrink to 5 cm and get resected. These are downstaging concepts we've talked about for years. And the very notion of taking someone who has a median survival of 3 to 6 months or 6 to 12 months and having 7 to 8 years of follow-up on them is almost unheard of in therapies."
"This really challenges the paradigm of what we thought we knew. Maybe in certain cases we really can convert people to cures," he added.
After Dr. Salem's presentation, Dr. Stainken told Medscape Radiology that the Y-90 treatment shows "a lot of promise" for these patients. "It's moved from the initial trials to a much larger series, and the data seem to be remarkably consistent in a disease without many good options."
He added that "this is a disease that is not rare and this is a solution that has minimal risk, minimal morbidity, and little to no recovery time. It's almost like a magical treatment, but it's proving itself through rigorous investigation."
It's also proving that it does have a role in treating this disease and is changing practice. It should be on the list of options for every patient with liver cancer to consider."
In the future, we need to determine "where it fits and how it can be integrated into other treatments that are currently available," concluded Dr. Stainken.
This study was supported by TheraSphere. Dr. Salem reports receiving funding "relevant to the Y-90 microspheres." Dr. Stainken has disclosed no relevant financial relationships.
Society of Interventional Radiology (SIR) 35th Annual Scientific Meeting: Abstract 34. Presented March 14, 2010.
Thursday, March 10, 2011
Sunday, March 6, 2011
Cheaper to let Canadians die?
As you can see the beads used in this are made in Canada but it seems the treatment is not available in Canada. Cheaper for the Canadian health care system to let us die!!!.
Extending and improving life
Dr. Charles Nutting works on Socrates Sclavenitis, a patient with stage 4 liver cancer, during a procedure that is expected to relieve him of pain and extend his life. Sky Ridge Medical Center is one of few facilities nationwide to send radioactive beads into the body via catheter to attack a tumor. Patients have come from all over the world to seek help and comfort from Nutting, chief of interventional radiology at Sky Ridge. Photo by Chris Michlewicz
By Chris Michlewicz
Published: 03.04.11
The patients who enter Dr. Charles Nutting's world often have only been given months to live. They seek his help because he offers them the one thing others have not: hope.
A few have come from the corners of the earth, only finding out about his gift through the Internet or a specialist in their home country. On a sunny morning in mid-February, Nutting is preparing to operate on a handful of patients. First up is Socrates Sclavenitis, a Denver man whose wife sits faithfully by his bedside as he gets ready for the procedure. He has been diagnosed with stage 4 primary liver cancer, and the tumor has taken hold of his internal organs.
Nutting, chief of interventional radiology at Sky Ridge Medical Center in Lone Tree, uses the latest technology to treat late-stage cancer
patients. He has mastered a procedure called radioembolization and has spent the better part of the last few years teaching other doctors how to administer the incredible therapy.
"To really be able to have results I think is what he and his team find so amazing. They really can give people life," said Linda Watson, spokeswoman for Sky Ridge, as she watches the team prepare for a thersphere radioembolization.
Using medical instruments and computer-guided imagery, Nutting goes into select parts of the body to inject a treatment directly into the tumor. On this particular day, an assistant inserts a catheter into Sclavenitis' groin. Nutting then uses the catheter as a guide to find a main artery into the liver before hooking into it with a machine that resembles a small hamster cage.
The machine contains the special potion, Yttrium-90, which is made up of small radioactive beads manufactured by a company in Canada. About 4 million beads each the size of a grain of sand are fed into the artery with saline via the catheter, and the blood-thirsty tumor sucks them in. Once the beads are trapped inside the
tumor, they go to work for roughly two weeks, exerting radioactive energy and shrinking the tumor.
Radioembolization helps loosen the tumor's grip on nerve fibers that cause discomfort or pain, improving quality of life for 90 percent of his patients. Instead of going through other, more debilitating treatments, the procedure eventually allows them to resume daily activities.
Nutting, a good-natured Lone Tree resident with an obvious passion for his job, said the role is attractive because he has the ability to change lives.
"We're actually offering hope to people that everybody else has said nothing can be done, so it's very rewarding to see patients come back," he said.
Nutting recalls the Christmas cards and wreaths he receives from former patients who are understandably grateful for another chance. Sometimes, his patients want to spend another holiday with their family or see a child graduate. It is hearing about those special moments that makes the treatment worth while.
"It will shrink the tumors and extend the life of the patient for sometimes many more years than they would ever have been projected," Watson said. "It really is quite amazing what he does in there."
However, Nutting says he is cautious not to give false hope and is always "realistic about expectations." A patient's survival depends on several factors, including the type of tumor, the amount of disease they have coming in, and whether it has metasticized.
Some patients have seen as many as 10 specialists before they end up in the suite where Nutting works his magic. A 14-year-old boy from Chicago was given three months to live and his hospital would no longer treat him. Nutting performed a radioembolization on him and the young man lived two more fulfilling years.
Nutting's patients end up in interventional radiology because they are non-surgical candidates, meaning the cancer has progressed to the point that doctors cannot go in and remove the mass. Only about 15 percent of late-stage cancer patients can have surgery, he says.
Radioembolization is a minimally invasive procedure that takes 20-30 minutes. Patients are under conscious sedation so they are comfortable, can follow directions to hold their breath so doctors can take X-rays during the procedure. Patients typically go home the same day. The beads will remain in their body forever.
Guided imagery is key to the success of radioembolization. Nutting uses a 54-inch television screen that enables him to see various scans, including real-time images that show the heart, liver, spleen, gall bladder and the location of the tumor. The surgical suite has only been in operation for six months, but it has everything in one place.
"The administration at Sky Ridge is very forward-thinking. They said 'how can we pull the different therapies and modalities into one room to give the patient the best care?'" Nutting said, adding that Sky Ridge is the only facility in Colorado that offers this type of treatment.
Nutting performs about 100 infusions of radioactive beads per year and the number is climbing. He is also able to use needles to inject cancer-fighting solutions into the lungs, bones and kidneys to shrink tumors.
"We're doing things here that no one else does," he said. "It's the combination of therapy and imaging that really makes it work."
Source URL/photo/online video:
http://coloradocommunitynewspapers.com/articles/2011/03/06/lone_tree_voice/news/03_cm_surgery_ltv.txt
Bruce DeVenne
b1devenne@ns.sympatico.ca
Extending and improving life
Dr. Charles Nutting works on Socrates Sclavenitis, a patient with stage 4 liver cancer, during a procedure that is expected to relieve him of pain and extend his life. Sky Ridge Medical Center is one of few facilities nationwide to send radioactive beads into the body via catheter to attack a tumor. Patients have come from all over the world to seek help and comfort from Nutting, chief of interventional radiology at Sky Ridge. Photo by Chris Michlewicz
By Chris Michlewicz
Published: 03.04.11
The patients who enter Dr. Charles Nutting's world often have only been given months to live. They seek his help because he offers them the one thing others have not: hope.
A few have come from the corners of the earth, only finding out about his gift through the Internet or a specialist in their home country. On a sunny morning in mid-February, Nutting is preparing to operate on a handful of patients. First up is Socrates Sclavenitis, a Denver man whose wife sits faithfully by his bedside as he gets ready for the procedure. He has been diagnosed with stage 4 primary liver cancer, and the tumor has taken hold of his internal organs.
Nutting, chief of interventional radiology at Sky Ridge Medical Center in Lone Tree, uses the latest technology to treat late-stage cancer
patients. He has mastered a procedure called radioembolization and has spent the better part of the last few years teaching other doctors how to administer the incredible therapy.
"To really be able to have results I think is what he and his team find so amazing. They really can give people life," said Linda Watson, spokeswoman for Sky Ridge, as she watches the team prepare for a thersphere radioembolization.
Using medical instruments and computer-guided imagery, Nutting goes into select parts of the body to inject a treatment directly into the tumor. On this particular day, an assistant inserts a catheter into Sclavenitis' groin. Nutting then uses the catheter as a guide to find a main artery into the liver before hooking into it with a machine that resembles a small hamster cage.
The machine contains the special potion, Yttrium-90, which is made up of small radioactive beads manufactured by a company in Canada. About 4 million beads each the size of a grain of sand are fed into the artery with saline via the catheter, and the blood-thirsty tumor sucks them in. Once the beads are trapped inside the
tumor, they go to work for roughly two weeks, exerting radioactive energy and shrinking the tumor.
Radioembolization helps loosen the tumor's grip on nerve fibers that cause discomfort or pain, improving quality of life for 90 percent of his patients. Instead of going through other, more debilitating treatments, the procedure eventually allows them to resume daily activities.
Nutting, a good-natured Lone Tree resident with an obvious passion for his job, said the role is attractive because he has the ability to change lives.
"We're actually offering hope to people that everybody else has said nothing can be done, so it's very rewarding to see patients come back," he said.
Nutting recalls the Christmas cards and wreaths he receives from former patients who are understandably grateful for another chance. Sometimes, his patients want to spend another holiday with their family or see a child graduate. It is hearing about those special moments that makes the treatment worth while.
"It will shrink the tumors and extend the life of the patient for sometimes many more years than they would ever have been projected," Watson said. "It really is quite amazing what he does in there."
However, Nutting says he is cautious not to give false hope and is always "realistic about expectations." A patient's survival depends on several factors, including the type of tumor, the amount of disease they have coming in, and whether it has metasticized.
Some patients have seen as many as 10 specialists before they end up in the suite where Nutting works his magic. A 14-year-old boy from Chicago was given three months to live and his hospital would no longer treat him. Nutting performed a radioembolization on him and the young man lived two more fulfilling years.
Nutting's patients end up in interventional radiology because they are non-surgical candidates, meaning the cancer has progressed to the point that doctors cannot go in and remove the mass. Only about 15 percent of late-stage cancer patients can have surgery, he says.
Radioembolization is a minimally invasive procedure that takes 20-30 minutes. Patients are under conscious sedation so they are comfortable, can follow directions to hold their breath so doctors can take X-rays during the procedure. Patients typically go home the same day. The beads will remain in their body forever.
Guided imagery is key to the success of radioembolization. Nutting uses a 54-inch television screen that enables him to see various scans, including real-time images that show the heart, liver, spleen, gall bladder and the location of the tumor. The surgical suite has only been in operation for six months, but it has everything in one place.
"The administration at Sky Ridge is very forward-thinking. They said 'how can we pull the different therapies and modalities into one room to give the patient the best care?'" Nutting said, adding that Sky Ridge is the only facility in Colorado that offers this type of treatment.
Nutting performs about 100 infusions of radioactive beads per year and the number is climbing. He is also able to use needles to inject cancer-fighting solutions into the lungs, bones and kidneys to shrink tumors.
"We're doing things here that no one else does," he said. "It's the combination of therapy and imaging that really makes it work."
Source URL/photo/online video:
http://coloradocommunitynewspapers.com/articles/2011/03/06/lone_tree_voice/news/03_cm_surgery_ltv.txt
Bruce DeVenne
b1devenne@ns.sympatico.ca
Friday, December 31, 2010
What's really behind this?
There's got to be something going on here we don't see.
1. The Province is bankrupt,
2. The biggest Hospital, the VG looks like something in the 3rd world with the signs on the sinks, "do not drink the water bottled water available on request" and
3. The city has an antiquated water and sewer system that has to be replaced and
4. The half assed sewer treatment plant is already obsolete according to new federal guidelines
5. All of the overpasses are starting to decay and need costly repair. They did Fairview cove and are now doing the recent one at the end of the BiHi
6. The city is continually cutting back on services
7. The province is cutting education health everywhere and anywhere
Yet Dexter and Kelly are spending money like Drunk Marines in a Cambodian Cathouse on.....
1. conventions centres.
2. monster libraries with no reference department while people are more and more getting books off line with the new electronic readers..
3. A stadium that will cost tens if not hundreds of millions that will sit idle most of the time unless we spend tens of millions more bribing some sporting event to go there.
4. Don't forget Peter Kelly's insane high speed ferry because I'm sure he hasn't.
5. None of this spending makes any financial sense in this at all. Surely to God they aren't stupid enough to think they can spend their way out of debt. Anybody have a theory as to what's behind it because it's not fiscal responsibility.
Bruce DeVenne
1. The Province is bankrupt,
2. The biggest Hospital, the VG looks like something in the 3rd world with the signs on the sinks, "do not drink the water bottled water available on request" and
3. The city has an antiquated water and sewer system that has to be replaced and
4. The half assed sewer treatment plant is already obsolete according to new federal guidelines
5. All of the overpasses are starting to decay and need costly repair. They did Fairview cove and are now doing the recent one at the end of the BiHi
6. The city is continually cutting back on services
7. The province is cutting education health everywhere and anywhere
Yet Dexter and Kelly are spending money like Drunk Marines in a Cambodian Cathouse on.....
1. conventions centres.
2. monster libraries with no reference department while people are more and more getting books off line with the new electronic readers..
3. A stadium that will cost tens if not hundreds of millions that will sit idle most of the time unless we spend tens of millions more bribing some sporting event to go there.
4. Don't forget Peter Kelly's insane high speed ferry because I'm sure he hasn't.
5. None of this spending makes any financial sense in this at all. Surely to God they aren't stupid enough to think they can spend their way out of debt. Anybody have a theory as to what's behind it because it's not fiscal responsibility.
Bruce DeVenne
Monday, December 27, 2010
news maker? What about the crooks
News maker of the year: Jacques Lapointe
Mon, Dec 27 - 7:32 AM
IT might be a bit of an understatement to name the understated Jacques Lapointe Nova Scotia’s News maker of the Year. You bet he is.
The soft-spoken Mr. Lapointe is hardly a natural-born spotlight-grabber. But when he did grab it in February, it was to shine it not on himself, but into the shadows of the legislature.
http://thechronicleherald.ca/Editorials/1219077.html
Shouldn't the news makers of the year be those politicians who, in most people's opinion. stole from the public? Paying legal Ass'n fees why over what was necessary. When the Pemier got caught he suddenly decided is was OK to pay the $350 per year now that it was coming out of his pocket.
The laptops for them and family members, coffee machines, generators, high end digital cameras not needed in their work, you name it and they bought it as long as the public was paying.
The news makers of the year
should be the crooks in government and/or the mounties who can't seem to get any investigation into this matter into gear. If it had been you or me involved we'd be in jail long ago
Bruce DeVenne
Mon, Dec 27 - 7:32 AM
IT might be a bit of an understatement to name the understated Jacques Lapointe Nova Scotia’s News maker of the Year. You bet he is.
The soft-spoken Mr. Lapointe is hardly a natural-born spotlight-grabber. But when he did grab it in February, it was to shine it not on himself, but into the shadows of the legislature.
http://thechronicleherald.ca/Editorials/1219077.html
Shouldn't the news makers of the year be those politicians who, in most people's opinion. stole from the public? Paying legal Ass'n fees why over what was necessary. When the Pemier got caught he suddenly decided is was OK to pay the $350 per year now that it was coming out of his pocket.
The laptops for them and family members, coffee machines, generators, high end digital cameras not needed in their work, you name it and they bought it as long as the public was paying.
The news makers of the year
should be the crooks in government and/or the mounties who can't seem to get any investigation into this matter into gear. If it had been you or me involved we'd be in jail long ago
Bruce DeVenne
Thursday, December 16, 2010
The two faces of Mayor Kelly!
From the left hand face we hear, we can afford the new Convention centre despite the hundreds of millions it will cost us.
From the right hand face he tells us we have tens of millions in "short falls" and we will face tax hikes (as always) and service cuts (as always) with no decrease in taxes to match the decrease in service
You have to wonder if either head has a brain that can do basic math and add and subtract!
SOME SUGGESTIONS
We pay for the services leave them in place as mandated
Kill the new Convention centre
Revise the way over priced excessive new library to a sensible building.
Kill the football stadium that will sit Idle most of the year
Kill the high speed ferry from Bedford.
Stop paying to bring money losing concerts and sporting events to HRM.
Cut council numbers in half
Remove the discretionary spending fund.
If Mayor Kelly can't see the savings in this I will be glad to buy him a calculator.
Monday, November 29, 2010
City council hits the wall
Halifax budget: Which wall?
"WE HAVE HIT THE WALL, finance staff told Halifax council in a sobering presentation last week on the outlook for the next two municipal budgets."
Where does this wall come from? Mayor Peter Kelly and his council keep building or trying to build it with our money no less.
The list is long and self evident to almost everybody but our Mayor Kelly lead City Council.
1. The Commonwealth Games
2. The new Convention centre
3. The way over priced excessive new library.
4, A football stadium that will sit Idle most of the year
5. The high speed ferry from Bedford.
6. Paying to bring money losing concerts and sporting events to HRM.
7. Building things like the Bedford rink without waiting for federal financial support.
The answer is simple. Council get your act together and spend money on what you are mandated to do, what the majority of the taxpayers need and that will benefit the majority of taxpayers and stop pandering to the few.
Accept the fact that, contrary to your evident beliefs, the tax well is not bottomless, that there is a limit and you've passed it. Spend money the way we have to and you personally do by accounting for every cent and the need of spending it.
Its not hard to do look at what you have in the bank and use it wisely don't squander money on economic black holes today with the idea that you will cover it with tax hikes and service cuts next year.
If you want to spend money like Moncton. Toronto Vancouver move there and get yourself elected to that council.
Bruce DeVenne
Full article @ http://thechronicleherald.ca/Editorials/1214390.html#comments
Sunday, November 21, 2010
Our lipstick on a pig award today goes once again to Mayor Peter Kelly for political and fiscal hairsplitting.
In Sundays Herald he says:
It ( the $35 million they were short) was a "Funding gap,’ not shortfall" and goes on to add," City hall’s latest money woes are certainly challenging but not insurmountable, Halifax Mayor Peter Kelly said Saturday" and " Such fiscal measures as service cuts or increased taxes — or both — could be on the way.
We need to look at the way we do our business," to see if there’s a better method of managing expenses with monies received, Kelly said.
"Funding gap,’ not shortfall" Try being a few thousand short on your mortgage or car payments and see if this hairsplitting works with your bank. NO way so why should it work with the HRM taxpayer? If you were in this mess you could
We need to look at the way we do our business," to see if there’s a better method of managing expenses with monies received, Kelly said.
"Funding gap,’ not shortfall" Try being a few thousand short on your mortgage or car payments and see if this hairsplitting works with your bank. NO way so why should it work with the HRM taxpayer? If you were in this mess you could
A Cut back spending and buy less costly goods
B Get a second job
Mayor Kelly and his council won't be getting second jobs to cover the shortfall oops the funding gap and they show no intention of killing the white elephants they plan to spend our money on so get ready for large annual tax hikes and regular cuts in service which seem to be the only way Mayor Kelly plans to work. Remember Mayor Kelly wasn't short the money he just didn't take enough from us but is seems he is ready to remedy this oversight
Full article at http://thechronicleherald.ca/Front/1213140.html
Bruce DeVenne
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