The role of 90Y-radioembolization in downstaging primary and secondary hepatic malignancies: a systematic review

Abstract

Radioembolization (RE) is an emerging treatment strategy for patients with primary hepatic malignancies and metastatic liver disease. Though RE is primarily performed in the palliative setting, a shift toward the curative setting is seen. Currently, hepatic resection and in selected cases liver transplantation are the only curative options for patients with a hepatic malignancy. Unfortunately, at diagnosis most patients are not eligible for liver surgery due to the imbalance between the necessary liver resection and the remaining liver remnant. However, in borderline resectable cases, tumor volume reduction and/or increasing the future liver remnant can lead to a resectable situation. The combination of selective tumor treatment, the induction of hypertrophy of untreated liver segments, and its favourable toxicity profile make RE an appealing strategy for downstaging. The present review discusses the possibilities for RE in the preoperative setting as a downstaging tool or as a bridge to liver transplantation.

Contralateral Liver Hypertrophy and Oncological Outcome Following Radioembolization with 90Y-Microspheres: A Systematic Review

“…An FLR and TLV ratio of 20-30% has been suggested as a threshold for patients with normal liver parenchyma and 40-45% for patients with liver cirrhosis [35]. To date, the impact of RE-induced contralateral liver hypertrophy has been assessed in two systematic reviews, including seven and eight studies, respectively [10,17]. Teo et al reported only the relative degree of hypertrophy regardless of the oncological outcome, and no data on the ratio of FLR to TLV.…”

“…Surgical resection after radioembolization was carried out in 109 out of 362 patients (30%). Although the available data suggest that radioembolization prior to major hepatectomy is safe with a promising oncological outcome, the definitive role of radioembolization requires assessment within controlled clinical trials.Cancers 2020, 12, 294 2 of 14 results for ALPPS in patients with primary liver malignancies have been disappointing due to high perioperative morbidity and mortality rates [8].Recently, there has been increasing interest in radioembolization with 90 Y-microspheres (also known as selective internal radiation therapy), as this treatment offers local tumor control with simultaneous hypertrophy of the contralateral lobe [9,10]. Radioembolization (RE) is a minimally invasive procedure with transarterial delivery of 90 Y-loaded microspheres made of glass (diameter: 25 ± 10 µm; activity per particle: 2500 Bq) or resin (diameter: 35 ± 10 µm; activity per particle: 50 Bq) [11,12].…”

“…However, the effective hypertrophy rate and its simultaneous impact on local tumor control remains unclear. Although several reviews about 90 Y-microspheres have been reported in the literature before, the effectiveness of 90 Y-microspheres in liver preconditioning and its simultaneous oncological outcome for the treatment of primary and/or secondary liver malignancies have not been thoroughly assessed [10,12,16,17,19,20].Therefore, the aim of this analysis was to summarize the evidence of RE as a method to induce contralateral liver hypertrophy with simultaneous ipsilateral control of tumor growth.…”

“…Recently, there has been increasing interest in radioembolization with 90 Y-microspheres (also known as selective internal radiation therapy), as this treatment offers local tumor control with simultaneous hypertrophy of the contralateral lobe [9,10]. Radioembolization (RE) is a minimally invasive procedure with transarterial delivery of 90 Y-loaded microspheres made of glass (diameter: 25 ± 10 µm; activity per particle: 2500 Bq) or resin (diameter: 35 ± 10 µm; activity per particle: 50 Bq) [11,12].…”

Transarterial radioembolization for liver tumors as neoadjuvant therapy: three case reports

“…(7) In systematic review, Braat et al, presented studies that showed evidences of benefits of neodjuvant use of TARE in intra-hepatic colangiocarcinoma, in addition to hepatocarcinoma. (9) There were no cases of progression of the disease during time of waiting for surgical intervention. All patients reported to be with an accompanying person (mean of 25.6 months after definitive surgical treatment; ranging from 8 to 35 months) and without recurrent of the disease.…”