Yttrium-90 Radiation Segmentectomy for the Treatment of Liver Tumors, MARGIN Trial
This phase I trial tests the safety, side effects, and best dose of yttrium-90 (Y90) to one or two segments of the liver (radiation segmentectomy) that is needed to completely destroy (or ablate) parts of the liver that have cancer among patients with liver tumors that include hepatocellular cancer, cholangiocarcinoma and cancer that has spread to the liver and cannot be removed by surgery or standard ablation techniques. Y-90 is a radioactive form of the rare metal yttrium that is used in radiation therapy to treat some types of tumors. Y90 radiation segmentectomy is a treatment that delivers tiny radioactive beads into the blood vessels feeding the liver tumor. These beads give off radiation that helps kill the tumor cells from the inside, right where the tumor is located. This approach allows doctors to target the tumor very precisely, while keeping the rest of the liver as healthy as possible. However, the exact dose needed to fully ablate a tumor without damaging healthy liver tissue is not well established. To determine this, this trial uses specialized imaging with positron emission tomography (PET)/computed tomography (CT) or PET/magnetic resonance imaging (MRI) scans before and after treatment. In a PET/CT scan, two types of imaging are performed during the same session. The PET scan detects signals from an injected radioactive substance and shows how the liver is functioning at a molecular level. The CT scan, which uses x-rays to create detailed cross-sectional images of the body, provides a precise anatomical map that helps localize these functional signals. Together, they give a clear picture of both the structure and activity within the liver. PET/MRI works similarly but uses magnetic fields and radio waves instead of x-rays. It combines the functional information from the PET scan with the highly detailed soft-tissue images from MRI, which can be especially useful in evaluating the liver. This imaging may be able to evaluate how the radiation is distributed in the liver and how the liver responds over time. This trial may help researchers determine the best "ablative dose" of Y90 radiation segmentectomy for treating patients with liver tumors.