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4 | Health Matters: Providence Holy Cross Medical Center P rovidence Holy Cross Medical Center is honored to be top in the nation for treating liver cancer via a highly specialized treatment: radioembolization, also known as Y90. This minimally invasive and targeted treatment extends the lives of patients with inoperable tumors—and does so with minimal pain and few, if any, side effects. "This is truly remarkable! Not so long ago, if a patient presented with stage 4 cancer of the liver, the number of treatment options accessible was limited for them," says Navid Eghbalieh, MD, medical director of vascular and interventional oncology at Providence Holy Cross Medical Center. "This is no longer the case. Patients who receive Y90 treatment leave the hospital the same day and experience none of the traditional side effects from cancer treatments. "It's a game changer," he says. HOW DOES Y90 WORK? Radioembolization combines embolization and radiation therapy. It begins with a thin wire inserted at the wrist or inner thigh, which gains access to the blood vessels leading into the liver and tumor(s). Tiny glass or resin beads filled with the radioactive isotope yttrium-90 (Y90) are then directed through a small catheter inside the blood vessels that feed a tumor. This blocks the supply of blood to the cancer cells and delivers a high dose of radiation to the tumor while sparing normal surrounding tissue. Since the liver is the only organ with three blood supplies, the treatment can be contained within a portion of the liver as blood flow into and out of that area is restricted. "And what's even more fascinating is that the liver is an organ that regenerates its tissues quickly, making Y90 even more viable for patients with primary or metastatic liver cancer," explains Dr. Eghbalieh. SO WHAT CAN YOU EXPECT? If multiple lesions are present within the liver, typically Y90 will be conducted twice. "This allows the physician to map and then eradicate tumors in one half of the liver while keeping tissues in the other half free from radiation. The patient goes home while tissues repair. Approximately a month later, Y90 treatment is done on the other half of the liver. If there are single liver lesions, the patient may require only a single treatment. Patients experience no typical symptoms post-procedure but may feel mildly tender at the insertion point, at either the wrist or groin," explains Dr. Eghbalieh. What makes Y90 particularly successful is that our physicians at Providence Holy Cross have a precise understanding of how well patients will respond, thanks to a mapping procedure done beforehand. A mapping angiogram takes one to two hours and is not invasive or painful. During mapping, a small catheter is inserted into the groin or wrist and a special tracer agent is injected into the blood vessels of the liver. Then X-rays are taken, to map how much tracer enters the tissues around the liver or flows to other organs such as the lungs. This determines whether Y90 radiotherapy will work well and allows a physician to know exactly what to expect during Y90 radiotherapy for each patient. While the liver is the only organ that Y90 is currently approved for, Dr. Eghbalieh is participating in an FDA-backed clinical trial to determine whether the treatment can safely treat cancer in other organs and treat different kinds of tumors within the liver. FROM A MAJOR SCARE TO BACK TO WORK When Elvia Escobar learned she had stage 4 liver cancer, she already was receiving chemotherapy treatment for breast cancer that was diagnosed in July 2020. The 58-year- old, from the Antelope Valley community of Littlerock, couldn't bring herself to tell her husband of 40 years, or their three children, about an additional diagnosis of metastatic liver cancer. Escobar says she didn't have "the heart to scare them," as late-stage liver cancer has a grim prognosis. She silently endured systemic chemotherapy treatment for multiple liver lesions in October of that year. When the tumors in her liver were still present, Escobar was referred to Dr. Eghbalieh as a candidate for Y90. "I waited to tell my family about my stage IV cancer until I saw Dr. Navid. I knew my family would fall apart thinking I was dying," explains Escobar. But once she received the positive news Dr. Navid Eghbalieh NOT SO LONG AGO, IF A PATIENT PRESENTED WITH STAGE 4 CANCER OF THE LIVER, THE NUMBER OF TREATMENT OPTIONS ACCESSIBLE WAS LIMITED FOR THEM. THIS IS NO LONGER THE CASE. PATIENTS WHO RECEIVE Y90 TREATMENT LEAVE THE HOSPITAL THE SAME DAY AND EXPERIENCE NONE OF THE TRADITIONAL SIDE EFFECTS FROM CANCER TREATMENTS.

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