DECATUR - It comes in a vial smaller than a pinky finger, but this treatment available at Decatur Memorial Hospital has given hope to liver cancer patients seeking to prolong and improve their lives.

A few eligible candidates who have exhausted other treatment options are benefitting from TheraSphere, a therapy that localizes radiation treatment into the tumor bed within the liver.

A dose of TheraSphere contains from two million to 10 million minuscule glass particles with Yttrium 90 radiation attached. Each tiny pellet is about 30 microns across, interventional radiologist Dr. Greg Gordon said. That's much smaller than the period at the end of this sentence.

During the treatment, doctors thread a catheter into the femoral artery and through the arterial system to the desired treatment area. Consulting the plan they've carefully mapped out, they snake the catheter into the spot in the liver, via the hepatic artery, where radiation will most effectively attack the tumor.

They then attach tubing to the catheter and, careful to ensure correct timing and prevent spills, slowly infuse the dose of radiation beads under a certain amount of pressure.

But candidates for TheraSphere treatment are a select few. Those with primary liver cancer, or hepatoma, or colon cancer that has spread to the liver are the most common candidates.

"There's really not a lot of treatments for them except for surgery, Gordon said. "But the vast majority of them are not surgical candidates, and so, therefore, the life expectancy of somebody who gets diagnosed with a hepatoma is probably in the order of three to six months if you don't treat them."

But in rarer cases, patients battling other cancers that have spread to the liver, such as carcinoid tumors and melanoma, also have been candidates. A multidisciplinary approach helps the team in interventional radiology identify and help those who are eligible. After an oncologist refers a patient to Thera-

Sphere, Dr. Edward Elliott, the director of DMH's radiation oncology department, also sees the patient. An entire committee must agree on the candidacy of the patient to move forward.

"We try to approach the whole person and the whole disease process," Gordon said, adding that patient activity level, lab tests to examine the function of the liver and the ability to access the correct treatment area through the patient's arterial system are other important criteria for treatment, Gordon said.

"The best way to do it is to bring the brightest people together to do it together, and everybody brings their strength," Gordon said.

Once the doctors agree on the decision to move forward with treatment, they determine and order the appropriate dose.

"The patient goes home the same day, and that's what's great about it," Gordon said, adding that the beads won't travel more than a third of an inch within the body.

Once it is determined that the patient is not emitting any radioactivity, he or she is allowed to leave, interventional radiology clinical manager Louise Kennedy said.

Because they don't go very far, Elliott said, the amount of radiation given in TheraSphere treatments can be quite strong.

"What's also great about this therapy is that people might feel a little bit weak and a little fatigued and maybe a little flulike, but overall, there is almost no pain involved in this procedure, and people are back to normal activity relatively quickly," Gordon said.

He added that the lack of pain and side effects are advantages because it allows the patients, many of whom are at their sickest and weakest, to endure the treatment without further diminishing their ability to continue living their daily lives.

"Besides Chicago, we're the only place in Illinois that has this," Gordon said. "St. Louis doesn't have this." The TheraSphere Web site, www.mds.nordion.com/therasphere, listed fewer than 50 treatment sites nationwide. DMH was the first community hospital nationwide to offer the treatment, Kennedy said, and it has done so for a little more than a year.

The ability to treat patients using TheraSphere relies on the talent and dedication of all parties involved, from the nursing staff to the radiation physicist, Gordon said.

"You realize that the dedication to do this to free up a morning for one patient when we would probably be seeing 10 or 15 other patients is just an incredible testament to the personnel involved in this."

Before TheraSphere became available, the standard alternative was hepatic artery chemoembolization, which cuts off the blood supply considerably and delivers chemotherapy to the treatment area. The treatment is effective, Gordon said, but it is more painful and can hurt future treatment options. Sometimes TheraSphere can be a bridge to surgery or transplant, Kennedy said.

Annie Getsinger can be reached at agetsinger@herald-review.com 421-6968.