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For the latter to be effective, the vessels feeding the tumor are filled with chemotherapeutic agents and are subsequently embolized with particles to ensure a static, ischemic environment in order to maximize exposure to those agents, and to promote ischemic necrosis. In contrast, for intra-arterial radioembolization to be effective, optimal perfusion and blood flow are required to allow the generation of free radicals by ionization of the water molecules near the DNA of the tumor cells. In the presence of normal oxygen tension, permanent DNA damage is caused to one or both DNA strands, and apoptosis is initiated or reproductive death is eventually achieved[18]. Maximal cytoreduction by radiation requires not only normal oxygen tension in the target cells but also sufficient microsphere coverage of the tumor nodule to avoid gaps in cumulative radiation due to crossfire ����cold spots���� or a low total dose MAPK of radiation in the tumor[18]. For this reason, the particles used for radioembolization must be small enough (approximately 20 to 40 mm) to allow optimal access into the tumor nodules and deposition within the tumor plexus, without creating ischemia, but large enough to prevent selleckchem the passage of microspheres through the capillary bed into the venous circulation leaving the liver. Two types of microspheres loaded with 90Y are commercially available, one made of resin (SIR-Spheres; Sirtex Medical, Sidney, N.S.W., Australia) and an alternative made of glass (TheraSpheres, MDS Nordion, Toronto, Ont, Canada); the differences include the amount of activity contained in each microsphere see more and the number of microspheres injected in a single treatment (