J Liver Cancer.  2022 Mar;22(1):4-13. 10.17998/jlc.2022.01.16.

Radioembolization for hepatocellular carcinoma: what clinicians need to know

• Choi JW
• Kim HC

• KMID: 2528291
• DOI: http://doi.org/10.17998/jlc.2022.01.16

Abstract

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.

Keyword

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

Figure

• 

  Figure 1 An infiltrative hepatocellular carcinoma (HCC) in the right lobe of a 68-year-old man. Hepatitis B core antibody was positive, and Child-Pugh class was A5. His alpha fetoprotein level level was 112,600 ng/mL. (A) Computed tomography (CT) scan of the hepatic arterial phase showing an infiltrative HCC (star). Note the intense contrast enhancement of the hepatic artery (arrowhead) and the portal vein (arrow). (B) Hepatic angiogram showing a severe arterioportal shunt. The main portal vein (arrowhead) is filled with the contrast medium.

• 

  Figure 2 A 12-cm hepatocellular carcinoma (HCC) in the right lobe of a 69-year-old woman. The Child-Pugh class was A5. His alpha fetoprotein level was 29,360 ng/mL, and PIVKA-II was 2,129 mAU/mL. (A) Magnetic resonance image (MRI) showing the large HCC (arrowheads) in the right lobe. (B) Computed tomography (CT) scan taken 1 month after radioembolization showing slightly decreased tumor size (10 cm) (arrowheads) with persistent tumoral enhancement. (C) MRI taken 5 months after radioembolization showing complete disappearance of tumoral enhancement and decreased tumor size (4 cm) (arrowheads). Note the hypertrophy of the left lobe and atrophy of the right lobe of the liver.

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  Figure 3 A 67-year-old man had a 7-cm hepatocellular carcinoma (HCC) in the right lobe. He was positive for hepatitis B surface antigen (HBsAg), and Child-Pugh class was A5. His alpha fetoprotein level was 3.4 ng/mL, and PIVKA-II was 599 mAU/mL. (A) Computed tomography (CT) scan showing the 7-cm HCC (arrowheads) in the right lobe. A small arterioportal shunt (arrow) is also noted. (B) Positron emission tomography (PET)/CT performed at the next radioembolization showing high activity in the tumor (arrowheads) as well as in the arterioportal shunt (arrow). (C) CT scan taken 5 months after radioembolization showing nearly complete disappearance of tumoral enhancement (arrowheads). A new hypovascular lesion (arrow) is seen at the same location of the arterioportal shunt, which is thought to be radiation-induced necrosis.

Reference

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