Radioembolization for Advanced Hepatocellular Carcinoma

Radioembolization for Advanced Hepatocellular Carcinoma Background: Hepatocellular carcinoma (HCC) is the sixth most common tumor worldwide with a rising incidence in the western world. Most patients are diagnosed at an advanced stage, in which curative treatments are not feasible any more. Method: Literature review. Results: Selective intraarterial radiotherapy (SIRT) is one new option of local ablative treatment of HCC. Radioactive microspheres (Yttrium-90) are applied to the liver via intraarterial catheter. The distribution of the spheres depends on the arterial blood flow; therefore, the microspheres are mainly distributed to arterial hypervascular tumors such as HCC. Arterial hypervascularity is one of the most important conditions to perform SIRT. Studies in advanced HCC, even with underlying portal vein thrombosis, showed its safety and efficiency. Studies even demonstrate efficiency in downstaging and bridging to transplantation by SIRT. Median overall survival was approximately 16 months in several studies. Conclusions: Randomized studies in comparison with the standard treatments as established in the guidelines (transarterial chemoembolization in intermediate stages; sorafenib in advanced stages) are not available yet; therefore, SIRT is not included in these guidelines. Studies to prove its significance in treating HCC need to be carried out. However, future treatment of HCC will also include personalized therapies and combinations of systemic and local ablative therapies.