Transarterial radioembolization for hepatocellular carcinoma: a review

Sacco, Rodolfo; Conte, Caterina; Tumino, E.; Parisi, Giuseppe Fabio; Marceglia, Sara; Metrangolo, S.; Eggenhöffner, Roberto; Bresci, G.; Cabibbo, Giuseppe; Giacomelli, Luca

doi:10.2147/jhc.s50359

Cited by 37 publications

(24 citation statements)

References 63 publications

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“…Transcatheter arterial radiation embolization (TARE) uses microspheres containing Yttrium-90 ( 90 Y) to suppress tumor growth 58 , 59 , which is well tolerated and has a low complication rate due to the limited radiation range of beta rays. However, the main disadvantage of TARE is that 90 Y is unable to carry chemotherapeutic agents and the tolerable radiation dose of the liver tissue limits retreatment with TARE 60 . Although TACE provides a survival benefit in patients with intermediate HCC, it may result in suboptimal and incomplete tumor responses 13 .…”

Section: Discussionmentioning

confidence: 99%

¹³¹I-Labeled Copper Sulfide-Loaded Microspheres to Treat Hepatic Tumors via Hepatic Artery Embolization

Liu

Qian

et al. 2018

Theranostics

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Purpose: Transcatheter hepatic artery embolization therapy is a minimally invasive alternative for treating inoperable liver cancer but recurrence is frequent. Multifunctional agents, however, offer an opportunity for tumor eradication. In this study, we were aim to synthesized poly (lactic-co-glycolic acid) (PLGA) microspheres encapsulating hollow CuS nanoparticles (HCuSNPs) and paclitaxel (PTX) that were then labeled with radioiodine-131 (131I) to produce 131I-HCuSNPs-MS-PTX. This compound combines the multi-theranostic properties of chemotherapy, radiotherapy and photothermal therapy. In addition, it can also be imaged with single photon emission computed tomography (SPECT) imaging and photoacoustic imaging.Methods: We investigated the value of therapeutic and imaging of 131I-HCuSNPs-MS-PTX in rats bearing Walker-256 tumor transplanted in the liver. After the intra-arterial (IA) injection of 131I-HCuSNPs-MS-PTX, 18F-Fluorodeoxyglucose (18F-FDG) micro-positron emission tomography/computed tomography (micro-PET/CT) imaging was used to monitor the therapeutic effect. PET/CT findings were verified by immunohistochemical analysis. SPECT/CT and photoacoustic imaging were performed to demonstrate the distribution of 131I-HCuSNPs-MS-PTX in vivo.Results: We found that embolization therapy in combination with chemotherapy, radiotherapy and photothermal therapy offered by 131I-HCuSNPs-MS-PTX completely ablated the transplanted hepatic tumors at a relatively low dose. In comparison, embolization monotherapy or combination with one or two other therapies had less effective anti-tumor efficacy. The combination of SPECT/CT and photoacoustic imaging effectively confirmed microsphere delivery to the targeted tumors in vivo and guided the near-infrared laser irradiation.Conclusion: Our study suggests that there is a clinical theranostic potential for imaging-guided arterial embolization with 131I-HCuSNPs-MS-PTX for the treatment of liver tumors.

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Section: Discussionmentioning

confidence: 99%

¹³¹I-Labeled Copper Sulfide-Loaded Microspheres to Treat Hepatic Tumors via Hepatic Artery Embolization

Liu

Qian

et al. 2018

Theranostics

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“…By establishing thresholds for these two baseline parameters, we aimed to provide easy assessable and safety-orientated cutoff levels for prognostic serum biomarkers that can assist in patient selection for RE. RE has been shown to be a safe and effective treatment option in unresectable HCC [22][23][24][25][26][27] as well as ICC [3,28]. The rising incidence of HCC, which is the most common type of primary liver cancer and the second cause of death due to malignancy [29], might augment the importance of RE in the near future.…”

Section: Discussionmentioning

confidence: 99%

Impact of Baseline Cholinesterase in Patients with Primary Liver Tumors Undergoing Radioembolization: Impact on Outcome

Galiè

Paprottka

Ingrisch

et al. 2018

SN Compr. Clin. Med.

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The purpose of our study was to determine cutoff values for baseline cholinesterase (CHE) and bilirubin levels prognostic for outcome after radioembolization (RE) in patients with primary liver tumors. In this retrospective single-center study, a threshold for baseline levels of CHE and bilirubin was determined based on overall survival (OS) of patients with refractory primary liver tumors who underwent RE. Between-group differences based on the dichotomized cohort were assessed with the log-rank test. We analyzed N = 92 patients (median age 66.6 years (60.6-73.6 interquartile range), 79% male) with primary liver tumors (57 with hepatocellular carcinoma and 35 with intrahepatic cholangiocarcinoma) who were treated with RE. The median baseline level for bilirubin was 0.7 mg/dl (0.5-1.1 IQR) and for CHE 5.10 kU/l (3.64-6.56), respectively. Median OS in all patients was 429 days (307-550). Cutoff values of baseline bilirubin at 1.6 mg/dl and for CHE at 5 kU/l effectively allowed to differentiate survival groups. In patients with baseline bilirubin ≤ 1.6 mg/dl, OS was significantly higher than in those with bilirubin (> 1.6 mg/dl, P < 0.001). Patients with a baseline CHE of > 5 kU/l showed a significantly longer OS than those with CHE ≤ 5 kU/l, P < 0.001). We suggest that baseline CHE and bilirubin levels have prognostic impact on survival in patients with primary liver tumors after RE. Cutoff values of baseline liver parameters as determined in our study (bilirubin 1.6 mg/dl and CHE 5 kU/l) may help to better select patients eligible for RE. Keywords Brachytherapy. Hepatocellular carcinoma. Intrahepatic cholangiocarcinoma. Bilirubin. Cholinesterase Abbreviations ICC Intrahepatic cholangiocarcinoma CHE Cholinesterase EHD Extrahepatic disease ECOG Eastern Cooperative Oncology Group HCC Hepatocellular carcinoma Franziska Galiè and K. J. Paprottka contributed equally to this work. This article is part of the Topical Collection on Imaging Key points • Cutoff values of baseline bilirubin and cholinesterase show a prognostic impact on survival in patients with primary liver tumors after radioembolization. • Baseline levels of bilirubin of 1.6 mg/dl and cholinesterase of 5 kU/l effectively allowed to differentiate survival groups. • Cutoff values for liver function parameters may help to further guide patient selection for radioembolization.

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“…Apart from the lack of high quality evidence to support its efficacy on high-burden HCC, TARE is an expensive procedure and it requires specialized training for implementation [96] . Given the promising results from retrospective studies, more clinical trials are needed in the coming years to formally evaluate its effectiveness and safety profile, and its potential to replace TACE's role in the treatment of unresectable highburden HCC.…”

Section: Transarterial Radioembolizationmentioning

confidence: 99%

Treatment of high-burden hepatocellular carcinoma: an oncologist perspective

Chan¹,

Chan²

2018

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Hepatocellular carcinoma (HCC) is recognized as a major global healthcare burden. Although there have been tremendous improvements in cancer screening and treatment, HCC mortality rate remains high. Many patients with HCC present late to medical attention and thus are not candidates for curative treatment. They typically have high tumor burden at presentation showing heterogeneity in anatomical factors and biochemical profile. Despite the relatively poor prognosis for these patients, significant improvements can still be made in survival if the optimal treatment modality is chosen. Currently, there is no international consensus on how to manage this group of heterogeneous, high-burden HCC. In this article, we will address this question by reviewing the latest available evidences. Our definition of "high-burden HCC" will be based on three factors: size, number of tumors and the presence of macrovascular invasion. The different treatment modalities, namely surgery, intra-arterial therapy, radiotherapy and systemic therapy, and their respective supportive evidences, will be discussed. In the end, we will summarize with our views on the future direction of research priorities for the management of high-burden HCC.

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Transarterial radioembolization for hepatocellular carcinoma: a review

Cited by 37 publications

References 63 publications

¹³¹I-Labeled Copper Sulfide-Loaded Microspheres to Treat Hepatic Tumors via Hepatic Artery Embolization

¹³¹I-Labeled Copper Sulfide-Loaded Microspheres to Treat Hepatic Tumors via Hepatic Artery Embolization

Impact of Baseline Cholinesterase in Patients with Primary Liver Tumors Undergoing Radioembolization: Impact on Outcome

Treatment of high-burden hepatocellular carcinoma: an oncologist perspective

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Transarterial radioembolization for hepatocellular carcinoma: a review

Cited by 37 publications

References 63 publications

131I-Labeled Copper Sulfide-Loaded Microspheres to Treat Hepatic Tumors via Hepatic Artery Embolization

131I-Labeled Copper Sulfide-Loaded Microspheres to Treat Hepatic Tumors via Hepatic Artery Embolization

Impact of Baseline Cholinesterase in Patients with Primary Liver Tumors Undergoing Radioembolization: Impact on Outcome

Treatment of high-burden hepatocellular carcinoma: an oncologist perspective

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¹³¹I-Labeled Copper Sulfide-Loaded Microspheres to Treat Hepatic Tumors via Hepatic Artery Embolization

¹³¹I-Labeled Copper Sulfide-Loaded Microspheres to Treat Hepatic Tumors via Hepatic Artery Embolization