Regional Brings Advanced Liver Cancer Treatment to the Black Hills

Charles Voigt, MD, an interventional radiologist at Regional Health Rapid City Hospital is now offering a type of radiation therapy for inoperable liver cancer that is new to the Black Hills.

Known by several names, including Selective Internal Radiation Therapy (SIRT), radioembolization, or simply “Y90”, it is a minimally invasive procedure that involves injecting tiny resin beads filled with the radioactive isotope yttrium Y-90 inside the blood vessels that feed liver tumors. The spheres, which are just 20 to 60 microns in diameter, stay in the body indefinitely but lose their radioactivity within a couple of weeks.

The purpose of the treatment is two-fold; the microspheres block the tumor’s blood supply, causing it to shrink, while the radioactive isotope makes its way into cancer cells to destroy them. It can be used to treat inoperable tumors that originate in the liver, as well as those that have metastasized to the liver from other parts of the body.

Although the procedure itself is not new, this year marks the first time it has been available in Western South Dakota, thanks in part to the efforts of Dr. Voigt and his colleagues in radiology and nuclear medicine.

“The truth is that this is just one more tool for us to use in combating liver cancer, but we felt it was important to bring here because, once cancer happens inside the liver, systemic chemotherapy is not usually very effective,” explains Dr. Voigt. “So our liver cancer patients who needed this option were travelling five hours to Sioux Falls to get it, which is hard on patients and families.”

Because it involves radioactive material, the procedure requires a great deal of careful planning and is very much a team effort. First an angiogram is performed to map out the arteries feeding the liver. Then a diagnostic material is used along with a camera to determine how much of the Y90 is likely to stay in the liver and how much could migrate to other parts of the body.

“A clinical representative from the company [SIRTeX] comes out and helps us with the setup and delivery of the angiogram,” explains LaNae Hamblet, Supervisor of Interventional Radiology. “After that is done, we can determine whether or not to proceed with the procedure.”

Certain arteries may be embolized to keep as much Y90 as possible in the liver. Finally, the liver is treated, one lobe at a time, about a month apart.

“It was a long and arduous process to get licensed to do this through the Nuclear Regulatory Commission,” says Lowell Husman, Director of Nuclear Medicine. “There are many, many safety aspects that need to be followed but we have been found to be in full compliance.”

The team has treated four liver cancer patients since the procedure was first available in January.