79445 Radiopharmaceutical therapy, by intra-arterial particulate administration

Name of the Procedure:

Radiopharmaceutical Therapy, by Intra-arterial Particulate Administration
Common name: Targeted Radioembolization, Selective Internal Radiation Therapy (SIRT)

Summary

Radiopharmaceutical Therapy by intra-arterial particulate administration is a targeted cancer treatment. It involves injecting small radioactive particles directly into the arteries that supply blood to a tumor, primarily in the liver. This allows high doses of radiation to be delivered to the cancer cells while minimizing the effects on surrounding healthy tissue.

Purpose

This procedure is primarily used to treat liver tumors, either primary (such as hepatocellular carcinoma) or metastatic (cancers that have spread to the liver from other parts of the body). The goal is to destroy the cancer cells, shrink the tumor, and alleviate related symptoms. It aims to improve the patient's quality of life and prolong survival.

Indications

• Primary liver cancer (hepatocellular carcinoma)
• Metastatic liver cancer (cancers from colon, breast, etc. that have spread to the liver)
• Patients who are not candidates for surgery or other localized treatments

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Medication adjustments may be required; certain medications might need to be stopped.
• Pre-procedure tests may include blood tests, imaging studies like CT scans or MRI, and an angiogram to map the blood vessels in the liver.

Procedure Description

1. The patient is typically given local anesthesia and sometimes mild sedation.
2. A small catheter is inserted into the femoral artery in the groin.
3. Using X-ray guidance, the catheter is navigated to the hepatic artery, which supplies blood to the liver.
4. Radiopaque material is injected to visualize the blood vessels.
5. Once the catheter is in the correct position, microscopic radioactive beads are injected directly into the artery.
6. These particles lodge in the small blood vessels around the tumor, delivering a high dose of radiation over several days or weeks.
7. The catheter is then removed, and the insertion site is bandaged.

Duration

The procedure typically takes between 60 to 90 minutes.

Setting

The procedure is performed in a hospital's interventional radiology suite.

Personnel

• Interventional Radiologist
• Radiology Technician
• Nurse
• Anesthesiologist (if deeper sedation or anesthesia is required)

Risks and Complications

• Mild to moderate pain at the catheter insertion site
• Fatigue
• Liver inflammation or damage
• Post-embolization syndrome (fever, nausea, vomiting, pain)
• Infection
• Rare complications: radiation injury to other organs, blood clots

Benefits

• Targets high doses of radiation directly to the tumor
• Minimizes exposure and side effects to healthy tissues
• Can effectively shrink or destroy tumors
• May improve symptoms and prolong survival

Recovery

• Patients are usually monitored for a few hours post-procedure.
• Most are discharged the same day or the next day.
• Common post-care instructions include avoiding heavy lifting and strenuous activity for a few days.
• Follow-up appointments may include blood tests and imaging studies to monitor the effects of the treatment.

Alternatives

• Surgical resection (removal of the tumor)
• Systemic chemotherapy
• Ablative therapies (e.g., radiofrequency ablation, microwave ablation)
• Transarterial chemoembolization (TACE)
• Each alternative has its own advantages and disadvantages which should be discussed with a healthcare provider.

Patient Experience

During the procedure, patients might feel slight pressure or mild discomfort at the catheter insertion site. Post-procedure, they may experience fatigue, mild pain, or nausea that can be managed with medications. Regular follow-ups are crucial to assess the tumor response and manage any side effects.

Note: The above information is meant for educational purposes and should not replace professional medical consultation. Always refer to a healthcare provider for advice tailored to individual health needs.