BackTable Vascular & Interventional Ep. 561 Dosimetry University VI: Challenging Case Review with Dr. Tyler Sandow and Dr. Zach Berman
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Jul 29, 2025 Dr. Tyler Sandow and Dr. Zach Berman, both interventional radiologists, dive into the complexities of treating metastatic diseases with Y90. They discuss the types of metastases they handle and how Y90 can alleviate tumor-related pain. Key topics include the differences between liver-dominant and liver-only conditions, advanced dosing techniques, and the significance of mutation status in treatment. They also share compelling case studies to highlight the decision-making process for various treatment strategies, ensuring improved patient outcomes.
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Y90 Treats Diverse Metastases
- Y90 treatment can be effective for a wide range of metastatic tumors beyond colorectal, including lung, cholangiocarcinoma, breast, and melanoma.
- Treatment feasibility depends on mapping results and tumoral dose achievable.
Treat Liver Disease to Prolong Life
- Treat liver metastases to prevent liver failure as it's the most common cause of death.
- Offer Y90 even in liver-dominant disease with extrahepatic spread if palliation of liver symptoms is needed.
Avoid Abscopal Effect Outside Trials
- Avoid relying on sub-ablative Y90 doses to induce an abscopal immune effect outside clinical trials.
- Prefer ablative dosing when treating tumors to ensure direct tumor control.