Fighting cancer with a dose of beads

Dr. David Liu shakes the vial of cloudy liquid and holds it up to the light. From a distance, it’s not that impressive: just a beige slurry contained in an acrylic case.

But like Liu, the newest member of Sacred Heart Medical Center’s interventional radiology team, the material masks a powerful potential to heal in an unassuming package.

In the six months since he arrived in Spokane, the boyish 33-year-old has boosted the hospital’s regional and national profile by becoming the first doctor in the state to use tiny radiation beads to kill the most virulent forms of liver cancer from the inside out.

The liquid in the vial is actually not liquid at all. Instead, it’s a dose of 40 million glass spheres, each treated with a cancer-destroying jolt of radiation made with an isotope of a rare metal known as yttrium.

In a nation where only 25 medical centers offer the procedure, known as Y-90, Liu is one of the top five doctors who can perform it. In fact, he’s a proctor who teaches others how to thread tiny catheters through a puncture in a patient’s groin and up into the liver, then flood blood vessels that surround tumors with the targeted radiation beads, which stay “hot” for two weeks.

“You use the tumor’s own blood supply to choke it off,” explains Liu.

So far, he has performed 300 of the nonsurgical procedures, including about 15 in Spokane, with another dozen or so procedures scheduled in the next two weeks.

Among those who can testify to Liu’s skill is Ron Gallinger, a 52-year-old former construction worker from Greenacres, who was diagnosed in May 2006 with cancer from an unknown source that had spread and lodged in his liver.

“It was a complete surprise,” said Gallinger, whose first liver scan showed at least three dozen tumors. “The doctor said we could start chemotherapy or I could go fishing for six months.”

Instead, Gallinger went searching for alternative therapies. A Seattle doctor advised chemotherapy before mentioning, almost as an aside, that he’d heard of a doctor in Portland who was offering a new kind of liver cancer treatment. Within weeks, Gallinger was in Liu’s Oregon office at Providence St. Vincent’s Medical Center.

“He walked in and I thought, ‘Oh my God, he’s just a kid,’ ” Gallinger recalled.

But Liu’s enthusiasm was matched with expertise. He carefully explained how he’d treat first one half of the liver, then the other, with the intent to leave only scar tissue where the tumors once were. The procedure involves careful timing of the delivery of the beads, which gradually lose their power. “He calls the tumors ‘cooked carrots,’ ” Gallinger said, chuckling. “He’s so confident, I said, ‘Whatever you want to do to me, go ahead.’ ”

Part of Liu’s confidence comes from a long association with a technology that dates to the late 1960s but has been approved in the U.S. only since 1999. Two primary companies produce the Y-90 radiation beads, marketed as TheraSphere by the Canadian firm MDS Nordion and as SIR-Spheres by Sirtex of Australia.

Liu acknowledges he has participated in sponsored studies funded by both firms but said he has received no payments or other stipends from them. He’s reluctant to discuss the differences in the products offered by the individual makers, referring instead to Y-90 therapy in general, and declining to talk about market shares and sales.

“That’s like asking whether Coke and Pepsi like each other,” he said. “I deliberately detach myself from the marketing aspects. I don’t get involved in what I regard as their petty politics.”

More interesting to Liu than marketing is the potential to treat one of the world’s most virulent cancers. Primary liver cancer is rare but deadly in the United States, where about 19,000 cases are expected to be diagnosed this year, and nearly 17,000 people are expected to die, according to the American Cancer Society. It’s much more prevalent in other parts of the world. Worldwide, more than 500,000 people are diagnosed annually, particularly in Africa and East Asia.

That’s partly because the cancer is linked to endemic levels of hepatitis B and hepatitis C infection in those countries, Liu said. However, he added, the rates of the viruses are on the rise in the U.S., and with them, an increase in liver cancer.

Many of those who develop liver cancer will not be candidates for surgery or for transplants, he noted. Without another option, many sufferers will die. What Y-90 offers is the potential to increase survival rates to nearly triple the time offered through chemotherapy, Liu said.

It’s an expensive chance, to be sure. Gallinger figures each of his two radiation bead treatments cost $40,000, for a total of $80,000. He had good insurance through the sprinkler fitters union, so the procedures were paid for. Several insurance companies cover the cost of Y-90 therapy, including Medicare.

But Liu said he believes the innovative procedure is worth it. He doesn’t mind that many of those who develop liver cancer do so because of chronic alcohol and drug abuse.

“We’re all going to die,” he said. “It’s an opportunity to give somebody a little bit of their life back.”

Adding Liu’s skills to Sacred Heart’s repertoire was a coup, said Gerry Altermatt, the hospital’s director of radiology. The department had decided more than a year ago to focus on expanding, particularly cancer treatment. The three doctors who specialize in that area – Cam Seibold, Ken Symington and Jayson Brower – were pleased when Liu expressed interest in joining them.

“They were quite thrilled and they felt they had a good catch,” Altermatt said.

For his part, Liu says he was attracted by the skills of the existing staff, the reputation of the director, Dr. Rod Raabe, and by the collegiality of the Spokane medical community.

“It’s very collaborative,” said Liu, who hopes to expand that cooperation statewide.

For Gallinger, having Liu move his practice to Spokane simply means he doesn’t have to travel so far for follow-up visits. They’ll continue every couple of months, but so far, the prognosis is bright. In fact, as far as Gallinger is concerned, his young doctor’s innovative procedure has succeeded by the most important measure of all.

“It seemed to work pretty good,” Gallinger said. “I’m not dead.”