Just two years earlier, a study published in the International Journal of Radiation Oncology Biology Physics2 found that the use of radioembolization in a similar patient population resulted in a median survival rate of 10.5 months. This illustrates how we are using this growing body of information to even further refine patient selection, dosing, and administration of targeted therapies.

Other important research includes a seminal paper by Kulik3 and colleagues in HCC patients with and without obstruction of the portal vein treated with Y-90 microspheres. A total of 108 patients from two medical centers were treated in a phase II study with excellent follow-up. In this very difficult patient population, exciting long-term survival was seen with few adverse events.

Liver metastases from neuroendocrine tumors are the subject of three new reports with impressive response rates and improvement in carcinoid symptoms.4-6 This patient group is especially challenging as there are few active chemotherapy regimens to use, and liver metastases are a major source of pain, carcinoid syndrome, and eventual death.

WHAT THE FUTURE HOLDS

While we have made great strides in using targeted treatments to provide patients safer and more effective treatment options, the truth is we are only beginning to learn how we can best utilize these therapies to further improve survival rates. Further research will allow for more selective imaging of tumors and antitumor effects. Investigators are also working to develop more specific anticancer cell agents and increase our ability to irradiate small tumors in critical areas, either by implanting radiation (brachytherapy) or via external beam. Improvements in and use of 4D radiation treatment planning and image-guided and intensity- modulated radiotherapy push the frontiers of externally delivered radiotherapy, and they are helping more patients than ever.

As physicians, it is critical that we embrace the opportunities that targeted and innovative therapies bring to bear. These treatments, once considered renegade by many in the medical community, are now being accepted and used in conjunction with traditional therapies. Just as no two cancer cells are alike, there is no one-size-fitsall approach to treating metastatic tumors. As research continues to evolve, so will the options we can offer to our patients. By targeting tumors with the most effective doses of medication in the most efficient ways possible, we will continue to make great strides in improving patient survival rates and, equally important, patients' overall quality of life.