Journal of Liver Cancer

Review Articles

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.

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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
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Riccardo Inchingolo, Francesco Cortese, Antonio Rosario Pisani, Fabrizio Acquafredda, Roberto Calbi, Riccardo Memeo, Fotis Anagnostopoulos, Stavros Spiliopoulos
World Journal of Gastroenterology.2024; 30(18): 2379. CrossRef
Transarterial chemoembolization as an alternative to radioembolization is associated with earlier tumor recurrence than in radioembolization-eligible patients
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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
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Transarterial Approach in Early Stage HCC: From Palliative Therapy to Curative Therapy: Jung Suk Oh, Ho Jong Chun; Journal of the Korean Liver Cancer Study Group. 2012;12(2):93-96. Published online September 30, 2012

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Abstract PDF: Early stage hepatocellular carcinoma (HCC) based on BCLC staging system can be curatively treated by liver transplantation, surgical resection or percutaneous ablation. However, transarterial approaches, including transarterial chemoembolization (TACE) or transarterial radioembolization (TARE), are standard of care for intermediate stage HCC and can be an alternative treatment in the patients with early stage HCC which are unresectable, unsuitable for percutaneous ablation, or not eligible for liver transplantation. Many previous TACE studies in early stage HCC revealed that the overall survival rate was competitive with those of curative therapies considering their operation risks, but recurrence-free survival rate was significantly lower than curative therapies. Moreover, the histopathologic reports about TACE in early stage HCC demonstrated that only 38% of the HCC nodules were completely necrotic after TACE and only 81% of the nodules with complete response by EASL criteria showed complete necrosis. Although there is no long-term survival data about TARE in early stage HCC, a histopathologic report about TARE showed that 73% of the HCC nodules were completely necrotic after TARE and 100% of the nodules with complete response by EASL criteria showed complete necrosis. In conclusion, TACE is now limited to be categorized into a curative therapy in early stage HCC, according to the previous data about TACE. However, new recent technologies including C-arm CT, superselective embolization technique, drug-eluting bead (DEB) may sufficiently improve the survival data of TACE to prove its curative role. Considering its RFA-comparable histopathologic tumor response, TARE may prove to be a potential curative therapeutic for early stage HCC.

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