Radioembolization of liver tumors

Radioembolization is a therapy during which radioactive microspheres are administered through a microcatheter placed in the hepatic arterial vasculature in order to irradiate liver tumors from within. In the past decennium, this treatment has evolved as a safe and effective treatment option for patients with chemorefractory liver metastases and locally advanced primary liver tumors. Yet, there are still aspects that require improvement before this treatment can live up to its true potential. Various studies with the aim to optimize treatment workup to evaluation, performed at the Department of Radiology and Nuclear Medicine of the University Medical Center Utrecht between 2012 and 2015, are presented in this dissertation. Part I gives a comprehensive overview of hepatic radioembolization. Part II describes anatomical considerations and imaging strategies that are important during the workup of radioembolization candidates. Part III describes different aspects of the treatment itself, including the use of a single-session treatment approach, a novel anti-reflux catheter and holmium-166 microspheres. Part IV is concerned with the evaluation of treatment toxicity and efficacy. Thus, we have tried to provide more insight into the many challenges that arise in clinical practice, and provide much-needed scientific evidence for decision-making. Large randomized controlled trials are currently comparing the treatment efficacy of radioembolization to standard-of-care therapies on a group level. Yet, further research is still required to optimize treatment planning, strategy and evaluation in the individual patient