Abstract
Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer and affects millions worldwide. Due to the lack of effective systemic therapies for HCC, researchers have been investigating the use of locoregional tumor control with Yttrium-90 (Y90) radioembolization since the 1960s. Following the development of glass and resin Y90 microspheres in the early 1990s, Y90 radioembolization has been shown to be a safe and efficacious treatment for patients with HCC across Barcelona Clinic Liver Cancer (BCLC) stages. By demonstrating durable local control, good long term outcomes, and equivalent if not superior tumor responses and tolerability when compared to alternative therapies including transarterial chemoembolization (TACE) and sorafenib, Y90 radioembolization is being increasingly used in HCC treatment. More recently, investigations into variations in Y90 radioembolization technique including radiation segmentectomy and radiation lobectomy have further expanded its clinical utility. Here, we discuss the history and evolution of Y90 use in HCC. We outline key clinical trials that have established the safety and efficacy of Y90 radioembolization, and also summarize trials comparing its efficacy to existing HCC treatments. We conclude by reviewing the techniques of radiation segmentectomy and lobectomy, and by discussing dosimetry.
Highlights
Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer
We review important clinical trials comparing Y90 to existing HCC
In the first long term outcomes analysis for 291 HCC patients treated with Y90 radioembolization using glass microspheres, Salem et al measured response rate, time to progression (TTP), and survival across stages [25]
Summary
Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer. Every year, there are approximately 700,000 new cases and 600,000 deaths attributable to HCC worldwide [1,2,3]. For unresectable early stage (BCLC A) patients, radiofrequency ablation (RFA) is recommended. B patients, whereas radioembolization in BCLC and C patients is not recommended compared to TACE or sorafenib [5]. TACE benefits or sorafenib, the technique hasversus demonstrated several trials that have failed to versus show survival of Y90 radioembolization. TACE or durable local and a good safety profile, andlocal ongoing trials seeking to elucidate itsongoing optimal sorafenib, the control technique has demonstrated durable control andare a good safety profile, and patient we its examine thepatient history and evolution. Y90 studies radioembolization andits summarize key efficacy, studies that its safety, earlyWe efficacy, review important clinical trials comparing. We review important clinical trials comparing Y90 to existing HCC sorafenib.including.
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