Is Selective Internal Radioembolization Safe and Effective for Patients with Inoperable Hepatocellular Carcinoma and Venous Thrombosis?

Woodall, Charles E.; Scoggins, Charles R.; Ellis, Susan; Tatum, Cliff; Hahl, Michael J.; Ravindra, Kadiyala V.; McMasters, Kelly M.; Martin, Robert C.G.

doi:10.1016/j.jamcollsurg.2008.12.009

Cited by 58 publications

(32 citation statements)

References 37 publications

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“…Moreover, there is increasing evidence that TARE can be delivered safely and effectively in suitable HCC patients with PVTT, with several studies reporting median overall survival rates of approximately 10 months following the procedure in these patients (table 3) [36,45,46,47,48,49,50]. Again the extent of PVTT affected survival outcome.…”

Section: Locoregional Strategiesmentioning

confidence: 99%

“…Salem et al [36 ]reported that 4 of 92 patients with PVTT (2 cases with Child-Pugh class A and 2 with Child-Pugh class B disease) underwent liver transplant after responding to TARE. Overall, the tolerability of TARE in patients with PVTT appeared to be comparable to that in those without PVTT [45,46,49,50]. When safety issues were specifically investigated, liver decompensation was not observed in the 2-month period following TARE among HCC patients with PVTT [47], and clinical and laboratory adverse events in the 90-day period after TARE were not more frequent in patients with advanced-stage HCC than in those with early or intermediate stages [46].…”

Section: Locoregional Strategiesmentioning

confidence: 99%

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Treatment for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: The Emerging Role for Radioembolization Using Yttrium-90

et al. 2013

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Background/Purpose: Patients with hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) have an extremely poor prognosis and relatively few treatment options. Method: During a consensus meeting, experts met to examine the published data for HCC treatment strategies in patients with PVTT. Results: Many treatment guidelines consider the presence of PVTT a contraindication to partial hepatectomy or liver transplantation. Transarterial chemoembolization (TACE) is associated with an increased risk of ischemic necrosis of liver and of treatment-related death in patients with PVTT, and is, therefore, limited to a select group of patients with good hepatic function and adequate collateral circulation around the occluded portal vein. Systemic sorafenib results in survival benefit in patients regardless of the presence of PVTT. However, side effects are common, and there are no effects on time-to-symptom progression or quality of life. Transarterial radioembolization (TARE) with yttrium-90 microspheres is emerging as a valuable strategy. A wider range of patients with PVTT are suitable for this procedure compared to TACE. TARE is as effective as TACE in HCC and has quality-of-life advantages. Conclusion: In patients with HCC with PVTT, medical evidence suggests that TARE is a good choice of treatment.

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Section: Locoregional Strategiesmentioning

confidence: 99%

Section: Locoregional Strategiesmentioning

confidence: 99%

Treatment for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: The Emerging Role for Radioembolization Using Yttrium-90

et al. 2013

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“…Bezmialem Science 2016; 1: [25][26][27][28][29][30][31][32] curative therapy. The toxicity of the process is low, but because of the potential for serious complications, a multidisciplinary evaluation and rigorous technical application are required.…”

Section: Resultsmentioning

confidence: 99%

“…However, because RE has no macroembolic effect, it can be applied to patients with portal vein thrombosis (29, 30). Al- 28 though the width of portal thrombosis influences the survival time, no significant difference was found in terms of toxicity in the groups with and without portal vein thrombosis (29,31). According to a newly conducted study, in HCC patients with portal vein thrombosis, chemoembolization performed with particles secreting a drug with doxorubicin that leads to tumor necrosis at a high concentration was reported to provide better tumor control and improvement in survival than RE, and it was recommended that more studies should be conducted on this issue (32).…”

Section: Portal Vein Thrombosismentioning

confidence: 99%

Radioembolization Treatment for Liver Cancer

Erdoğan¹,

Özdemir²,

Aydın³

2016

Bezmialem Science

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Although curative treatment is surgery (resection/transplantation) and for small lesions ablative strategies, in primary liver carcinomas such as hepatocellular carcinoma and cholangiocellular carcinoma, palliative treatment is used for most of these patients because of lack of surgical options. These treatments are regional treatments such as transarterial chemoembolization, radiofrequency ablation, or microwave ablation and systemic treatments such as tyrosine kinase inhibitors. Surgery and chemotherapy are the main treatment options for metastatic liver tumors, particularly in colorectal tumors, although local treatment options are used for these patients. In recent years, transarterial radioembolization with yttrium-90 microsphere has emerged as a local treatment option in primary and metastatic liver tumors. The aim of this treatment is to provide an effective radiation dose distribution for the tumor in the liver tissue and to give the lowest dose in order to not harm the intact liver tissue. Radioembolization has proven to be as effective as other available palliative treatments in primary and secondary liver tumors and is a treatment method that is well tolerated. It has a risk for serious life-threatening complications, although this rate is low. Toxicity can be kept at a minimum with adequate technical and rigorous application in experienced hands and in accordance with multidisciplinarity. It is hoped that the effectiveness of radioembolization is further increased in the future by technological developments, researches on dosimetry, its use along with radiosensitizing agents, and various treatment combinations.Keywords: Radioembolization, Yttrium-90 microsphere, liver treatment IntroductionHepatocellular carcinoma (HCC) is one of the world's most common abdominal malignancies. Most patients have an underlying liver disease. The stage of tumor and the functional capacity of the liver determine the prognosis. A practical staging system based on the tumor burden, the liver function reserve, physical condition, and symptoms associated with cancer was developed by the Barcelona group (Barcelona Clinic Liver Cancer, BCLC). The tumor burden is determined by the number of tumors, size of tumor, portal vein invasion, or presence of extrahepatic metastasis. Here, the functional reserve of the liver is determined according to the Child-Pugh staging system (consists of serum albumin and bilirubin levels, the presence of acid and encephalopathy, prothrombin time/INR findings) and the physical condition is determined according to the performance classification of the Eastern Cooperative Oncology Group (ECOG). This staging system and accordingly, the overall treatment approach are summarized in Table 1 (1, 2).While only 30%-40% of patients are appropriate for curative treatment (resection, transplantation and ablation for small lesions), the vast majority of about 60% is in the middle (B) or advanced (C) stage (2). The general prognosis is poor in these patients with no potential curative treatment. Until n...

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“…Radioembolization is an investigational technique which has given some promising results in preliminary experiences [31][32][33]. It is defined as the infusion of radioactive substances (such as Iodine-131-labelled lipiodol or microspheres containing Yttrium-90) into the hepatic artery [1].…”

Section: Radioembolizationmentioning

confidence: 99%

Intermediate hepatocellular carcinoma: current treatments and future perspectives

et al. 2013

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Current guidelines recommend transarterial chemoembolization (TACE) as the standard treatment of Barcelona-Clinic Liver Cancer (BCLC)-B patients. However, the long-term survival outcomes of patients managed with this technique do not appear fully satisfactory; in addition, intermediate-stage hepatocellular carcinoma (HCC) includes a heterogeneous population of patients with varying tumour burdens, liver function and disease aetiology. Therefore, not all patients with intermediate-stage HCC may derive similar benefit from TACE, and some patients may benefit from other treatment options, which are currently approved or being explored. These include different TACE modalities, such as selective TACE or drug-eluting beads TACE and radioembolization. The introduction of sorafenib in the therapeutic armamentarium for HCC has provided a new therapeutic option for the treatment of BCLC-B patients who are unsuitable to TACE or in whom TACE resulted in unacceptable toxicity. In addition, clinical trials aimed at investigating the potential role of this molecule in the treatment of patients with intermediate-stage HCC within combination therapeutic regimens are ongoing. This narrative review will present and discuss the most recent evidence on the locoregional or medical treatment with sorafenib in patients with intermediate-stage HCC.

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Is Selective Internal Radioembolization Safe and Effective for Patients with Inoperable Hepatocellular Carcinoma and Venous Thrombosis?

Cited by 58 publications

References 37 publications

Treatment for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: The Emerging Role for Radioembolization Using Yttrium-90

Treatment for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: The Emerging Role for Radioembolization Using Yttrium-90

Radioembolization Treatment for Liver Cancer

Intermediate hepatocellular carcinoma: current treatments and future perspectives

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