Abstract
Limited therapeutic options are available for hepatic malignancies. Image guided targeted therapies have established their role in management of primary and secondary hepatic malignancies. Radioembolization with yttrium-90 (90Y) microspheres is safe and efficacious for treatment of hepatic malignancies. The tumoricidal effect of radioembolization is predominantly due to radioactivity and not ischemia. This article will present a comprehensive review of the side effects that have been associated with radioembolization using 90Y microspheres. Some of the described side effects are associated with all transarterial procedures. Side effects specific to radioembolization will also be discussed in detail. Methods to decrease the incidence of these potential side effects will also be discussed.
Highlights
PRIMARY HEPATIC MALIGNANCIES Hepatocellular carcinoma (HCC) and intra-hepatic cholangiocarcinoma (ICC) are primary liver malignancies
Radioembolization is an alternative locoregional therapy, which has established its role in the management of primary liver tumors
If the lung shunt fraction (LSF) is greater than 20%, treatment is not recommended
Summary
PRIMARY HEPATIC MALIGNANCIES Hepatocellular carcinoma (HCC) and intra-hepatic cholangiocarcinoma (ICC) are primary liver malignancies. TheraSpheres® are FDA approved under HDE (humanitarian device exemption) for radiation treatment or as neo-adjuvant to surgery or transplantation in patients with HCC who can have appropriately placed hepatic arterial catheters [12]. Pre-treatment clinical evaluation A multidisciplinary team consisting of hepatologists, medical/surgical/radiation oncologists, transplant surgeons, and interventional radiologists should select patients for radioembolization. Collateral hepaticoenteric flow can develop following coil embolization This may increase aberrant microsphere deposition on following repeat treatments. Pre-treatment cross-sectional imaging evaluation A triphasic liver CT or MRI is usually performed to evaluate the following: a) Extent of disease b) Location of disease c) Relative tumor hypervascularity d) Variant vascular anatomy. Pre-treatment angiography Angiography prior to radioembolization is essential This provides the interventional radiologist with knowledge of the hepatic arterial anatomy and aberrant vasculature [14].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
