Journal of Liver Cancer

Review Article

Radioembolization for hepatocellular carcinoma: what clinicians need to know: Jin Woo Choi, Hyo-Cheol Kim; J Liver Cancer. 2022;22(1):4-13. Published online February 23, 2022; DOI: https://doi.org/10.17998/jlc.2022.01.16

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Transarterial radioembolization (TARE) with yttrium 90 (⁹⁰Y) has been used in the management of hepatocellular carcinoma (HCC) for more than 10 years in Korea. There are two types of ⁹⁰Y radioactive microspheres available, namely, glass and resin microspheres, with comparable clinical outcomes. In general, TARE outperforms transarterial chemoembolization regarding post-embolization syndrome, time to progression, tumor downsizing for liver transplantation, and hospitalization stay. Although TARE is commonly recommended for patients with unresectable large HCCs, it can be an alternative to or performed in combination with ablation, surgical resection, and systemic treatment. This review aimed to address ⁹⁰Y radioactive microspheres, patient selection, clinical outcomes, simulation tests, radioembolization procedures, follow-up imaging, and complications.

Citations

Citations to this article as recorded by

Unlocking Precision in Radioembolization: Navigating the Future of Holmium-166 Radioembolization Mapping and Lung Shunt Study by Implementing Scout Dosimetry
Peiman Habibollahi, Armeen Mahvash, Nima Kokabi, Nariman Nezami
CardioVascular and Interventional Radiology.2024; 47(4): 451. CrossRef
Feasibility of Liver Transplantation after 90Y Radioembolization: Lessons from a Radiation Protection Incident
Marine Soret, Jacques-Antoine Maisonobe, Philippe Maksud, Stéphane Payen, Manon Allaire, Eric Savier, Charles Roux, Charlotte Lussey-Lepoutre, Aurélie Kas
Health Physics.2024;[Epub] CrossRef
Liver-Directed Locoregional Therapies for Neuroendocrine Liver Metastases: Recent Advances and Management
Cody R. Criss, Mina S. Makary
Current Oncology.2024; 31(4): 2076. CrossRef
Transarterial chemoembolization as an alternative to radioembolization is associated with earlier tumor recurrence than in radioembolization-eligible patients
Sung Won Chung, Heejin Cho, Hyunjae Shin, Jeayeon Park, Ju Yeon Kim, Ji Hoon Hong, Moon Haeng Hur, Min Kyung Park, Yun Bin Lee, Su Jong Yu, Myungsu Lee, Yoon Jun Kim, Jin Chul Paeng, Jung-Hwan Yoon, Jin Wook Chung, Jeong-Hoon Lee, Hyo-Cheol Kim
Frontiers in Oncology.2023;[Epub] CrossRef
The evolution of immune checkpoint inhibitor combinations in advanced hepatocellular carcinoma – A systematic review
Brandon M. Meyers, Jennifer J. Knox, David M. Liu, Deanna McLeod, Ravi Ramjeesingh, Vincent C. Tam, Howard J. Lim
Cancer Treatment Reviews.2023; 118: 102584. CrossRef
Recent Advances in Image-Guided Locoregional Therapies for Primary Liver Tumors
Cody R. Criss, Mina S. Makary
Biology.2023; 12(7): 999. CrossRef
Multidisciplinary consensus recommendations for management of hepatocellular carcinoma in Middle East and North Africa region
Imam Waked, Sherif Alsammany, Sayed Hammad Tirmazy, Kakil Rasul, Jafar Bani‐Issa, Wael Abdel‐Razek, Ashraf Omar, Amr Shafik, Salem Eid, Amr Abdelaal, Ahmed Hosni, Gamal Esmat
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Impact of Low Skeletal Muscle Mass on Long-Term Outcomes in Hepatocellular Carcinoma Treated with Trans-Arterial Radioembolization: A Retrospective Multi-Center Study
Heechul Nam, Hyun Yang, Ho Soo Chun, Han Ah Lee, Joon Yeul Nam, Jeong Won Jang, Yeon Seok Seo, Do Young Kim, Yoon Jun Kim, Si Hyun Bae
Cancers.2023; 15(21): 5195. CrossRef

Case Reports

Advanced Stage Hepatocellular Carcinoma Successfully Treated with Liver-directed Concurrent Chemoradiotherapy and Sequential Transarterial Radio-embolization: Minho Noh, Beom Kyung Kim, Seung Up Kim; J Liver Cancer. 2021;21(1):97-103. Published online March 31, 2021; DOI: https://doi.org/10.17998/jlc.21.1.97

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Abstract PDF: Optimal treatment strategies for patients with advanced hepatocellular carcinoma (HCC) is yet to be determined. Herein, we present a case of advanced HCC with tumor invasion into the right anterior portal vein and right hepatic vein where complete response (CR) was achieved via a multidisciplinary approach. This patient had a 10.5 cm-sized HCC invading segment VI, without extrahepatic spread. Liver function was classified as Child-Pugh class A, and the performance status was good. Transarterial radio-embolization (TARE) was performed 6 weeks after the completion of liver-directed concurrent chemoradiotherapy, and CR was confirmed 3 months post-TARE. Adoptive cell therapies were performed as adjuvant therapy and CR was maintained for over 15 months, until the local recurrence of a 2 cm-sized HCC was found. Therefore, in selected cases with preserved liver function, combination therapies, including LRTs and systemic therapy, can be a useful therapeutic option for advanced HCC.

Advanced Stage Hepatocellular Carcinoma Successfully Treated with Transarterial Radioembolization and Multi-tyrosine Kinase Inhibitor Therapy: Myung Ji Goh, Wonseok Kang, Dong Hyun Sinn, Geum-Youn Gwak, Yong-Han Paik, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik; J Liver Cancer. 2020;20(2):160-166. Published online September 30, 2020; DOI: https://doi.org/10.17998/jlc.20.2.160

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Abstract PDF: Transarterial radioembolization (TARE) with yttrium-90 microspheres has become widely utilized in managing hepatocellular carcinoma (HCC). The utility of TARE is expanding with new insights through experiences from real-world practice and clinical trials, and recently published data suggest that TARE in combination with sorafenib may improve the overall survival in selected patients. Here, we report a case of advanced stage HCC that was successfully treated with TARE and sorafenib. The patient achieved complete response (CR) at 12 months after the initial treatment with TARE and sorafenib, followed by additional transarterial chemoembolization and proton beam therapy for local tumor recurrence at 19-month post-TARE. The patient was followed up every 3 months thereafter and still achieved CR both biochemically and radiologically for the following 12 months. A combination strategy of TARE and systemic therapy may be a useful alternative treatment option for selected patients with advanced stage HCC.

Hepatocellular Carcinoma with Segmental Portal Vein Invasion Exhibiting a Complete Response after Transarterial Radioembolization: Jun Sik Yoon, Su Jong Yu, Yun Bin Lee, Eun Ju Cho, Jeong-Hoon Lee, Yoon Jun Kim, Jung-Hwan Yoon; J Liver Cancer. 2019;19(2):159-164. Published online September 30, 2019; DOI: https://doi.org/10.17998/jlc.19.2.159

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Abstract PDF: The treatment options available for patients with hepatocellular carcinoma (HCC) with portal vein invasion (PVI) include sorafenib, transarterial radioembolization (TARE), radiation therapy (RT), transarterial chemoembolization with RT, and proton beam irradiation. Herein, we present a case of HCC with segmental PVI that was managed via TARE. The patient had a 4 cm HCC that invaded the segment VIII portal vein branch without extrahepatic spread. Liver function was Child-Pugh grade A, and performance status was good. TARE was performed without any adverse events, and a radiological complete response (CR) was achieved. Thereafter, the patient was followed-up every 3-6 months without any further treatment, and the CR was maintained for >3 years. Therefore, TARE may be a useful alternative therapeutic option for patients with HCC exhibiting segmental PVI.

Review Article

Role of Yttrium-90 Radioembolization in the Management of Hepatocellular Carcinoma: Do Young Kim; J Liver Cancer. 2015;15(1):11-18. Published online March 31, 2015; DOI: https://doi.org/10.17998/jlc.15.1.11

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Abstract PDF: Yttrium-90 radioembolization has emerged as a novel therapy for hepatocellular carcinoma (HCC) of intermediate or advanced stage. Yttrium-90 has characteristics of short half-life and tissue penetration depth. Potent anti-cancer effect by this isotope enables to kill the tumor for 6 months after administration. Although transarterial chemoembolization (TACE) is the standard modality for multinodular HCC without vascular invasion, big size or numerous nodules does not allow enough treatment effect of TACE. Post-embolization syndrome resulting poor quality of life, liver dysfunction and hepatic arterial damage are other pitfalls of TACE. In several studies, radioembolization showed survival comparable to TACE, shorter hospital stay and less treatment sessions. In advanced HCC with portal vein invasion, radioembolization demonstrated similar or better survival compared with sorafenib. The atrophy of lobe treated by radioembolization and hypertrophy in the contralateral lobe can be called radiation lobectomy, which makes it possible to perform a following curative therapy. The role of radioembolization in unresectable HCC in terms of downstaging or bridge to transplantation needs to be further studied. Radioembolization is contraindicated in HCC patients with main portal vein occlusion and with poor liver function. The International guidelines for HCC have some limitations and thus rooms for radioembolization to be incorporated.

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