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Review
. 2016 May;33(5):699-714.
doi: 10.1007/s12325-016-0324-7. Epub 2016 Apr 2.

Transarterial Radioembolization with Yttrium-90 for the Treatment of Hepatocellular Carcinoma

Joseph Ralph Kallini  1 , Ahmed Gabr  1 , Riad Salem  1   2   3 , Robert J Lewandowski  4
Affiliations
Review

Transarterial Radioembolization with Yttrium-90 for the Treatment of Hepatocellular Carcinoma

Joseph Ralph Kallini et al. Adv Ther. 2016 May.

Abstract

Background: Hepatocellular carcinoma (HCC) is a common cause of worldwide mortality. Transarterial radioembolization (TARE) with yttrium-90 (Y90), a transcatheter intra-arterial procedure performed by interventional radiology, has become widely utilized in managing HCC.

Methods: The following is a focused review of TARE covering its commercially available products, clinical considerations of treatment, salient clinical trial data establishing its utility, and the current and future roles of TARE in the management of HCC.

Results: TARE is indicated for patients with unresectable, intermediate stage HCC. The two available products are glass and resin microspheres. All patients undergoing TARE must be assessed with a history, physical examination, clinical laboratory tests, imaging, and arteriography with macroaggregated albumin. TARE is safe and effective in the treatment of unresectable HCC, as it has a safer toxicity profile than chemoembolization, longer time-to-progression, greater ability to downsize and/or bridge patients to liver transplant, and utility in tumor complicated by portal vein thrombosis. TARE can also serve as an alternative to ablation and chemotherapy.

Conclusion: TARE assumes an integral role in the management of unresectable HCC and has been validated by numerous studies.

Keywords: Hepatocellular carcinoma (HCC); Oncology; Radioembolization; Transarterial radioembolization (TARE); Yttrium-90 (Y90).

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Figures

Fig. 1
Fig. 1
BCLC staging system and treatment strategy (adapted from [3]). i Very early stage 0: single lesion <2 cm, carcinoma in situ. ii Early stage A: single or 3 nodules ≤3 cm. iii Intermediate stage B: multinodular. iv Advanced stage C: portal invasion, ≥1 involved lymph node, or metastasis. v Prognostic factors include variables mostly related to HCC that are defined as the “Milan criteria”: (single tumors less than 5 cm or 3 nodules less than 3 cm). Whether patients at stage 0 can be offered local ablation as a first-line treatment option is a topic of controversy since transplantation is potentially curative [3]. vi TACE transarterial chemoembolization
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