Is prior radioembolization with Yttrium-90 microspheres for a primary liver cancer a contra-indication to external beam radiation therapy with either stereotactic body radiation therapy (SBRT) or proton beam therapy?   

Great question. The original ACR SIRT/RE guideline listed previous external beam as a relative contraindication to Y90 RE.*RE is safe for patients who have had "minimal prior exposure" to external beam radiation. While there is limited published literature on the combination of RE and EBRT/SBRT, one...

I have also used Y90 and SBRT (and repeat unilobar Y90 for that matter) in select patients.  As @Tracey Schefter mentioned, there are very limited data to guide such practice but anectodal experiences suggest that it can be done safely.  One of the major problems is that there are cur...

Mt. Sinai recently published a retrospective series which included 31 patients who received SBRT and had a history of y90. They were up to Child pugh B9 disease. They nicely contoured out the treated liver for dose constraint purposes. The most common dose was 40 Gy in 5 fractions every other day. T...