Radioembolization for the treatment of hepatocellular carcinoma

Abstract

Transarterial radioembolization (TARE) with yttrium 90 (⁹⁰Y), an intra-arterial procedure performed by interventional radiologists, has begun being utilized in managing hepatocellular carcinoma (HCC) in Korea. There are two available TARE products: glass and resin microspheres with different physical characteristics. All patients undergoing TARE must be assessed with clinical examination and laboratory tests as well as a thorough angiographic evaluation. TARE is safe and effective in the treatment of unresectable HCC, as it has longer time-to-progression, greater ability to downsize tumors for liver transplantation, less post-embolization syndrome, and shorter hospitalization compared with chemoembolization. TARE can also serve as an alternative to ablation, surgical resection, portal vein embolization, and sorafenib. The utility of TARE continues to expand with new insights in interventional oncology.

Keywords: Hepatocellular carcinoma; Radioembolization; Transarterial radioembolization (TARE); Yttrium-90 (90Y).

Figure 1.

A 78-year-old man has 13 cm sized tumor in liver S4/8. Viral markers were negative, and Child-Pugh class was A5. Alpha fetoprotein was 769 ng/mL and PIVKA was 75,000 mAU/mL. (A) CT scan shows 13cm sized well-demarcated hypervascular tumor (arrows) in liver S4/8. (B) MR image 1 month after two sessions of TARE shows no enhancement of tumor (arrows). Note shrinkage of tumor to 7cm and hypertrophy of S2/3.