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Review
. 2024 May 14;30(18):2379-2386.
doi: 10.3748/wjg.v30.i18.2379.

Selective internal radiation therapy segmentectomy: A new minimally invasive curative option for primary liver malignancies?

Riccardo Inchingolo  1 , Francesco Cortese  2 , Antonio Rosario Pisani  3 , Fabrizio Acquafredda  2 , Roberto Calbi  4 , Riccardo Memeo  5 , Fotis Anagnostopoulos  6 , Stavros Spiliopoulos  6
Affiliations
Review

Selective internal radiation therapy segmentectomy: A new minimally invasive curative option for primary liver malignancies?

Riccardo Inchingolo et al. World J Gastroenterol. .

Abstract

Transarterial radioembolization or selective internal radiation therapy (SIRT) has emerged as a minimally invasive approach for the treatment of tumors. This percutaneous technique involves the local, intra-arterial delivery of radioactive microspheres directly into the tumor. Historically employed as a palliative measure for liver malignancies, SIRT has gained traction over the past decade as a potential curative option, mirroring the increasing role of radiation segmentectomy. The latest update of the BCLC hepatocellular carcinoma guidelines recognizes SIRT as an effective treatment modality comparable to other local ablative methods, particularly well-suited for patients where surgical resection or ablation is not feasible. Radiation segmentectomy is a more selective approach, aiming to deliver high-dose radiation to one to three specific hepatic segments, while minimizing damage to surrounding healthy tissue. Future research efforts in radiation segmentectomy should prioritize optimizing radiation dosimetry and refining the technique for super-selective administration of radiospheres within the designated hepatic segments.

Keywords: Hepatocellular carcinoma; Personalised dosimetry; Primary liver malignancies; Radiation segmentectomy; Selective internal radiation therapy; Transarterial radioembolization.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
72-year-old man with hepatocellular carcinoma unfit for surgery due to comorbidities (alpha-fetoprotein 2235 ng/mL). A: Computed tomography (CT) showing large hepatocellular carcinoma nodule (7 cm) located in S3; B and C: Angiography and cone beam CT demonstrating superselective catheterization of the segmental S3 artery with perfused nodule; D-F: Single-photon emission tomography combined with CT showing 99mTc-MAA uptake into S3 without uptake in the remaining liver parenchyma or other organs.
Figure 2
Figure 2
Same patient of figure 1. A and B: Post-transarterial radioembolization, axial and coronal positron emission tomography-computed tomography (CT) views of the Y-90 dose distribution demonstrating high uptake in the tumor without any nontarget activity; C and D: Four-months follow-up CT scan (axial and coronal view) showing necrotic nodule with segmental S3 atrophy (alpha-fetoprotein 7 ng/mL).
See this image and copyright information in PMC

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