Abstract
Radioembolization is an emerging treatment modality in patients with hepatocellular carcinoma (HCC) and is a form of brachytherapy in which intra-arterially injected Ytrrium-90 microspheres are used for internal radiation purpose. Ytrrium-90 is a high energy beta particle-emitting radioisotope. Ytrrium-90 microspheres administered via arterial route direct the highly concentrated radiation to the tumor while normal liver parenchyma is relatively spared due to its preferential blood supply from portal venous blood. Main complications do not result from the microembolic effect, even in patients with portal vein thrombosis, but rather from an excessive irradiation to the non-target tissues including the liver. All the evidence that support the use of radioembolization in HCC is based on retrospective series or non-controlled prospective studies. However, reliable data can be obtained from the literature, particularly since the recent publication of large series. When compared to the standard of treatment for the intermediate and advanced stages (TACE and sorafenib), radioembolization consistently provides similar survival rates. Many randomized controlled trials using radioembolization are underway and will provide optimal evidences as standard treatment for unresectable HCC.
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