A Treatment of Unresectable Hepatocellular Carcinoma With TheraSphere®

The purpose of this protocol is to provide supervised access at this institution to TheraSphere® treatment for a heterogeneous population of patients with unresectable primary liver tumors, with the liver being the only dominant site of disease. Based on experience gained in previous studies and well-established interventional radiology techniques, this protocol allows multiple treatments with TheraSphere® that may be delivered on an inpatient or out patient basis. Patients may receive a single dose to the whole liver, or lobar treatment delivered as a sequence of treatments approximately 30 - 90 days apart. The investigator, working with co-investigators in radiation oncology, interventional radiology and nuclear medicine, will develop a specific treatment plan for each patient, based upon the presenting condition of the patient, the vascular anatomy, and the desired goal of treatment.

Inclusion criteria

• Confirmed diagnosis of hepatocellular carcinoma. The histopathology confirmation criterion may be waived in patients with a radiographically identifiable liver mass with known laboratory or clinical risk factors for cancer or elevated tumor markers such as AFP (clinical diagnosis)
• Surgical evaluation must conclude the patient is not a candidate for resection or ablation.
• ECOG Performance Status Score 0 - 2.
• Age 18 years or older.
• Able to comprehend and provide written informed consent in accordance with institutional and federal guidelines.

Exclusion criteria

Any pre-treatment laboratory findings within 15 days of treatment demonstrating:

• Absolute granulocyte count less than or equal to 1,500/ul
• Uncorrected Platelet count less than or equal to 75,000/ul
• Serum creatinine greater than or equal to 3.0 mg/dl
• Serum bilirubin greater than or equal to 2.0 mg/dl
• Any of the following contraindications to angiography and selective visceral catheterization, 1.)History of severe allergy or intolerance to any contrast media, narcotics, sedatives, or atropine, 2.) Bleeding diathesis, not correctable by usual forms of therapy, and/or 3.) Severe peripheral vascular disease that would preclude catheterization.
• Portal hypertension with portal venous shunt away from the liver.
• Evidence of potential delivery of greater than 16.5 mCi (30 Gy absorbed dose) of radiation to the lungs on either: 1) first TheraSphere® administration; or 2) cumulative delivery of radiation to the lungs > 30 Gy over multiple treatments.
• Evidence of any detectable Tc-99m MAA flow to the stomach or duodenum, after application of established angiographic techniques to stop such flow.
• Significant extrahepatic disease representing an imminent life-threatening outcome.
• Severe liver dysfunction (Childs' Classification C) or pulmonary insufficiency (requiring continuous oxygen therapy).
• Active uncontrolled infection
• Significant underlying medical or psychiatric illness.
• Pregnant women may not participate.
• Children may not participate due to lack of clinical experience.