The AMARA (As Much As Reasonably Achievable) Study

The AMARA (As Much As Reasonably Achievable) Study: Radioembolization of Large Inoperable Liver Tumors

Subjects with large inoperable liver tumors defined as at least 1 lesion larger than 5cm in maximum diameter. For the purposes of the present study, we define the AMARA principle in intensified regional TARE as a planned irradiated tumor dose >200Gy by the partition model. The purpose of the study is to evaluate the safety and efficacy of Y90 high dose radioembolization for the management of large inoperable liver tumors. In addition, to correlate the safety and efficacy with the post-treatment dosimetry analysis (by MIM Software Inc) based on 90Y-PET/CT imaging.

Inclusion Criteria:

• Age >18 yr
• Both sexes eligible for study
• Patients with primary or secondary liver tumors
• Liver dominant disease
• At least one lesion greater than 5.0 cm in maximum diameter
• Life-expectancy > 3 months
• FLR >40% or greater than 500mls
• Must be able to tolerate pre-treatment CT scan , DSA and 99mTc-MAA infusion and imaging with SPECT/CT scan
• Able to schedule and tolerate post-treatment Y90 PET/CT imaging
• Able to tolerate follow-up imaging with dynamic contrast CT liver phase or MRI with liver specific contrast at 3mo, 6mo, 9mo, 1yr, 2.0 yr, and 3.0 years.

Exclusion Criteria:

• Child Pugh > B
• Bilirubin >2 mg/dl
• Albumin<3.0
• Central portal invasion
• Multi-focal bilobar disease
• Disseminated extrahepatic disease
• Lung shunt >20% or a estimated Lung dose > 20 Gy
• Focuses of extra-hepatic liver uptake.
• Patients that cannot tolerate addition follow-up imaging.