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World J Gastroenterol. Jun 7, 2015; 21(21): 6518-6525
Published online Jun 7, 2015. doi: 10.3748/wjg.v21.i21.6518
Transarterial radioembolization for hepatocellular carcinoma: An update and perspectives
Rodolfo Sacco, Valeria Mismas, Sara Marceglia, Antonio Romano, Luca Giacomelli, Marco Bertini, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Ambra Corti, Manuel Tredici, Michele Piccinno, Luigi Giorgi, Carlo Bartolozzi, Irene Bargellini
Rodolfo Sacco, Valeria Mismas, Antonio Romano, Luca Giacomelli, Marco Bertini, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Ambra Corti, Department of Gastroenterology, Pisa University Hospital, 56124 Pisa, Italy
Sara Marceglia, Department of Electronics, Information technology and Bioengineering, Engineering School of Milan, 20100 Milan, Italy
Manuel Tredici, Department of Nuclear Medicine, Pisa University Hospital, 56124 Pisa, Italy
Michele Piccinno, Division of Health Physics, Pisa University Hospital, 56124 Pisa, Italy
Luigi Giorgi, Carlo Bartolozzi, Irene Bargellini, Department of Radiology, Pisa University Hospital, Pisa 56124, Italy
Author contributions: All the authors provided substantial contributions to conception of the manuscript; helped drafting the article or making critical revisions related to important intellectual content of the manuscript; and approved the final version of the article to be published.
Conflict-of-interest: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Rodolfo Sacco, MD, PhD, Department of Gastroenterology, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy. r.sacco@ao-pisa.toscana.it
Telephone: +39-50-997411 Fax: +39-50-997412
Received: December 1, 2014
Peer-review started: December 1, 2014
First decision: January 22, 2015
Revised: March 13, 2015
Accepted: April 28, 2015
Article in press: April 28, 2015
Published online: June 7, 2015
Abstract

In the last decade trans-arterial radioembolization has given promising results in the treatment of patients with intermediate or advanced stage hepatocellular carcinoma (HCC), both in terms of disease control and tolerability profile. This technique consists of the selective intra-arterial administration of microspheres loaded with a radioactive compound (usually Yttrium90), and exerts its therapeutic effect through the radiation carried by these microspheres. A careful and meticulous selection of patients is crucial before performing the radioembolization to correctly perform the procedure and reduce the incidence of complications. Radioembolization is a technically complex and expensive technique, which has only recently entered clinical practice and is supported by scant results from phase III clinical trials. Nevertheless, it may represent a valid alternative to transarterial chemoembolization (TACE) in the treatment of intermediate-stage HCC patients, as shown by a comparative retrospective assessment that reported a longer time to progression, but not of overall survival, and a more favorable safety profile for radioembolization. In addition, this treatment has reported a higher percentage of tumor shrinkage, if compared to TACE, for pre-transplant downsizing and it represents a promising therapeutic option in patients with large extent of disease and insufficient residual liver volume who are not immediately eligible for surgery. Radioembolization might also be a suitable companion to sorafenib in advanced HCC or it can be used as a potential alternative to this treatment in patients who are not responding or do not tolerate sorafenib.

Keywords: Hepatocellular carcinoma, Radioembolization, Transarterial chemoembolization, Sorafenib, Staging, RECIST, Modified RECIST, Downsizing, Clinical trial

Core tip: This review provides an overview of trans-arterial radioembolization, a new therapeutic option for patients with hepatocellular carcinoma. In particular, the practical aspects of the technique and available data on disease control will be presented, with reference to patients in either early or advanced stages of disease, treated with trans-arterial embolization alone or within combination regimens.