Current status of transarterial radioembolization

Abstract

Unresectable primary and secondary liver malignancies present a major problem in the treatment of solid tumors. Transarterial radioembolization (TARE) is an increasingly used technique for treating various types of malignant liver tumors. This approach is appealing, as the mechanism of action is independent from other loco-regional treatments and potentially complementary to systemic therapies. There are two commercially available products in use for TARE: (90)Y-resin and (90)Y-glass microspheres. Currently available data indicates TARE so be safe and effective in hepatocellular carcinoma (HCC) and metastatic liver disease. In HCC the results compare well with chemoembolization, while the role of TARE in combination with kinase inhibitors has yet to be established. Current data on TARE in metastatic liver disease is promising, but there is a strong need for prospective randomized trials comparing TARE and modern chemotherapeutic regimen to support the growing role of TARE in metastatic liver disease.

Keywords: Hepatocellular carcinoma; Liver; Metastasis; Neoplasm; Radioembolization; Selective internal radiation therapy.

Figure 1

Case study of a 64-year-old female patient suffering from liver metastases from a midgut neuroendocrine tumor. A: Contrast enhanced MRI shows a large liver metastasis in the right hemiliver; B: Prior to TARE an angiogram of the hepatic arteries was obtained; C: The gastroduodenal artery was occluded with multiple microcoils; D: Contrast enhanced MRI obtained 24 mo after therapy shows a maintained partial response of the liver metastasis. MRI: Magnetic resonance imaging; TARE: Transarterial radioembolization.