Recent Advances in Hepatocellular Carcinoma Treatment with Radionuclides

Abstract

As the third leading cause of cancer death worldwide, hepatocellular carcinoma (HCC) is characterized by late detection, difficult diagnosis and treatment, rapid progression, and poor prognosis. Current treatments for liver cancer include surgical resection, radiofrequency ablation, liver transplantation, chemotherapy, external radiation therapy, and internal radionuclide therapy. Radionuclide therapy is the use of high-energy radiation emitted by radionuclides to eradicate tumor cells, thus achieving the therapeutic effect. Recently, with the continuous development of biomedical technology, the application of radionuclides in treatment of HCC has progressed steadily. This review focuses on three types of radionuclide-based treatment regimens, including transarterial radioembolization (TARE), radioactive seed implantation, and radioimmunotherapy. Their research progress and clinical applications are summarized. The advantages, limitations, and clinical potential of radionuclide treatment of HCC are discussed.

Keywords: hepatocellular carcinoma; radioactive seed implantation; radioimmunotherapy; transarterial radioembolization.

Figure 1

Adjuvant intra-arterial injection of iodine-131-labeled lipiodol after resection of HCC. (A) Disease-free survival of patients in the 2 treatment groups (p < 0.02). (B) Overall survival of patients in the 2 treatment groups (p < 0.02). Adapted with permission from [32].

Figure 2

Radioembolization with yttrium-90 glass microspheres in hepatocellular carcinoma. (A) TTP (with progression defined according to RECIST with the recent NCI amendments) in 76 of 108 HCC patients treated by Y-90 glass microsphere radioembolization for which radiological response data were available. The solid line displays the Kaplan–Meier estimator, with marks representing censored events. The shaded area marks the limits of the pointwise 95% CIs. (B) Overall survival in 108 HCC patients treated by Y-90 glass microsphere radioembolization. The solid line displays the Kaplan–Meier estimator, with marks representing censored events. The shaded area marks the limits of the pointwise 95% CIs. Adapted with permission from [48].