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Millions of little glass beads, each about one-half the diameter of a human hair and impregnated with radioactive yttrium-90, are some of the latest tools in the fight against liver cancer at the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine. Darryl Zuckerman, MD, assistant professor of radiology and surgery, is leading Siteman’s effort to become one of a few centers in the region to offer the treatment. 

The beads, named TheraSpheres, are delivered through the hepatic artery allowing radiation to be delivered directly to a tumor with doses significantly higher than what is possible from traditional external radiation therapies. The benefits also include minimal side effects usually associated with high-dose systemic chemotherapies, such as nausea. Also unlike conventional therapies, TheraSpheres have been demonstrated to not significantly alter blood flow to the liver and tumors, resulting in less hepatic toxicity and pain. As a result, it can be repeated on some patients. 

The procedure can be done on an outpatient basis, does not require an overnight stay, and is usually performed with the patient conscious throughout the event. 

The FDA approval was expanded in 2007 to allow treatment of patients with hepatocellular carcinoma (HCC) who may also have partial or branch portal vein thrombosis (PVT). It is injected by a physician into the main artery of the liver through a catheter, which allows the treatment to be delivered directly to the tumor via blood vessels. 

The American Cancer Society estimates there were 21,370 new cases of liver cancers diagnosed in the United States in 2008, including hepatocellular carcinoma. More than 18,410 people will die from these cancers, and the numbers are expected to grow particularly because of the increased incidence of Hepatitis C, a leading cause of HCC. 
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