PDF herunterladen
Semin intervent Radiol 2015; 32(04): 388-397
DOI: 10.1055/s-0035-1564704
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Yttrium-90 Radioembolization of Hepatocellular Carcinoma–Performance, Technical Advances, and Future Concepts

Christopher Molvar
1   Section of Vascular and Interventional Radiology, Department of Radiology, Loyola University Medical Center, Maywood, Illinois
,
Robert Lewandowski
2   Division of Interventional Oncology, Section of Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
10. November 2015 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Hepatocellular carcinoma (HCC) is a lethal tumor, claiming over half a million lives per year. Treatment of HCC is commonly performed without curative intent, and palliative options dominate, including catheter-based therapies, namely, transarterial chemoembolization and yttrium-90 (90Y) radioembolization. This review will showcase the performance of 90Y radioembolization for the treatment of HCC, focusing on recent seminal data and technical advances. In particular, novel radioembolization treatment concepts are discussed and compared with conventional HCC therapy.

Keywords

radioembolization - therapy - hepatocellular carcinoma - liver cancer - interventional radiology
 

  • References

  • 1 El-Serag HB. Hepatocellular carcinoma and hepatitis C in the United States. Hepatology 2002; 36 (5) (Suppl. 01) S74-S83
    CrossrefPubMedGoogle Scholar
  • 2 Kim WR, Gores GJ, Benson JT, Therneau TM, Melton III LJ. Mortality and hospital utilization for hepatocellular carcinoma in the United States. Gastroenterology 2005; 129 (2) 486-493
    CrossrefPubMedGoogle Scholar
  • 3 Salem R, Mazzaferro V, Sangro B. Yttrium 90 radioembolization for the treatment of hepatocellular carcinoma: biological lessons, current challenges, and clinical perspectives. Hepatology 2013; 58 (6) 2188-2197
    CrossrefPubMedGoogle Scholar
  • 4 Llovet JM, Real MI, Montaña X , et al; Barcelona Liver Cancer Group. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 2002; 359 (9319) 1734-1739
    CrossrefPubMedGoogle Scholar
  • 5 Lo CM, Ngan H, Tso WK , et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002; 35 (5) 1164-1171
    CrossrefPubMedGoogle Scholar
  • 6 Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 1999; 19 (3) 329-338
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 7 Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet 2003; 362 (9399) 1907-1917
    CrossrefPubMedGoogle Scholar
  • 8 Thomas MB, Jaffe D, Choti MM , et al. Hepatocellular carcinoma: consensus recommendations of the National Cancer Institute Clinical Trials Planning Meeting. J Clin Oncol 2010; 28 (25) 3994-4005
    CrossrefPubMedGoogle Scholar
  • 9 Benson III AB, Abrams TA, Ben-Josef E , et al. NCCN clinical practice guidelines in oncology: hepatobiliary cancers. J Natl Compr Canc Netw 2009; 7 (4) 350-391
    PubMedGoogle Scholar
  • 10 Geschwind JF, Salem R, Carr BI , et al. Yttrium-90 microspheres for the treatment of hepatocellular carcinoma. Gastroenterology 2004; 127 (5) (Suppl. 01) S194-S205
    CrossrefPubMedGoogle Scholar
  • 11 Ingold JA, Reed GB, Kaplan HS, Bagshaw MA. Radiation hepatitis. Am J Roentgenol Radium Ther Nucl Med 1965; 93: 200-208
    PubMedGoogle Scholar
  • 12 Gil-Alzugaray B, Chopitea A, Iñarrairaegui M , et al. Prognostic factors and prevention of radioembolization-induced liver disease. Hepatology 2013; 57 (3) 1078-1087
    CrossrefPubMedGoogle Scholar
  • 13 Lencioni R. Loco-regional treatment of hepatocellular carcinoma. Hepatology 2010; 52 (2) 762-773
    CrossrefPubMedGoogle Scholar
  • 14 Salem R, Lewandowski RJ. Chemoembolization and radioembolization for hepatocellular carcinoma. Clin Gastroenterol Hepatol 2013; 11 (6) 604-611 , quiz e43–e44
    CrossrefPubMedGoogle Scholar
  • 15 Sato K, Lewandowski RJ, Bui JT , et al. Treatment of unresectable primary and metastatic liver cancer with yttrium-90 microspheres (TheraSphere): assessment of hepatic arterial embolization. Cardiovasc Intervent Radiol 2006; 29 (4) 522-529
    CrossrefPubMedGoogle Scholar
  • 16 Hilgard P, Hamami M, Fouly AE , et al. Radioembolization with yttrium-90 glass microspheres in hepatocellular carcinoma: European experience on safety and long-term survival. Hepatology 2010; 52 (5) 1741-1749
    CrossrefPubMedGoogle Scholar
  • 17 Llovet JM, Ricci S, Mazzaferro V , et al; SHARP Investigators Study Group. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 2008; 359 (4) 378-390
    CrossrefPubMedGoogle Scholar
  • 18 Salem R, Lewandowski RJ, Mulcahy MF , et al. Radioembolization for hepatocellular carcinoma using Yttrium-90 microspheres: a comprehensive report of long-term outcomes. Gastroenterology 2010; 138 (1) 52-64
    CrossrefPubMedGoogle Scholar
  • 19 Sangro B, Carpanese L, Cianni R , et al; European Network on Radioembolization with Yttrium-90 Resin Microspheres (ENRY). Survival after yttrium-90 resin microsphere radioembolization of hepatocellular carcinoma across Barcelona clinic liver cancer stages: a European evaluation. Hepatology 2011; 54 (3) 868-878
    CrossrefPubMedGoogle Scholar
  • 20 Bruix J, Sherman M ; American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology 2011; 53 (3) 1020-1022
    CrossrefPubMedGoogle Scholar
  • 21 Bruix J, Sherman M, Llovet JM , et al; EASL Panel of Experts on HCC; European Association for the Study of the Liver. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. J Hepatol 2001; 35 (3) 421-430
    CrossrefPubMedGoogle Scholar
  • 22 European Association For The Study Of The Liver; European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012; 56 (4) 908-943
    CrossrefPubMedGoogle Scholar
  • 23 Raoul JL, Sangro B, Forner A , et al. Evolving strategies for the management of intermediate-stage hepatocellular carcinoma: available evidence and expert opinion on the use of transarterial chemoembolization. Cancer Treat Rev 2011; 37 (3) 212-220
    CrossrefPubMedGoogle Scholar
  • 24 Mazzaferro V, Sposito C, Bhoori S , et al. Yttrium-90 radioembolization for intermediate-advanced hepatocellular carcinoma: a phase 2 study. Hepatology 2013; 57 (5) 1826-1837
    CrossrefPubMedGoogle Scholar
  • 25 Salem R, Lewandowski RJ, Kulik L , et al. Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology 2011; 140 (2) 497-507.e2
    CrossrefPubMedGoogle Scholar
  • 26 Hanje AJ, Yao FY. Current approach to down-staging of hepatocellular carcinoma prior to liver transplantation. Curr Opin Organ Transplant 2008; 13 (3) 234-240
    CrossrefPubMedGoogle Scholar
  • 27 Lewandowski RJ, Kulik LM, Riaz A , et al. A comparative analysis of transarterial downstaging for hepatocellular carcinoma: chemoembolization versus radioembolization. Am J Transplant 2009; 9 (8) 1920-1928
    CrossrefPubMedGoogle Scholar
  • 28 Salem R, Gilbertsen M, Butt Z , et al. Increased quality of life among hepatocellular carcinoma patients treated with radioembolization, compared with chemoembolization. Clin Gastroenterol Hepatol 2013; 11 (10) 1358-1365.e1
    CrossrefPubMedGoogle Scholar
  • 29 Mannelli L, Kim S, Hajdu CH, Babb JS, Clark TW, Taouli B. Assessment of tumor necrosis of hepatocellular carcinoma after chemoembolization: diffusion-weighted and contrast-enhanced MRI with histopathologic correlation of the explanted liver. AJR Am J Roentgenol 2009; 193 (4) 1044-1052
    CrossrefPubMedGoogle Scholar
  • 30 Chapiro J, Duran R, Geschwind JF. Combination of intra-arterial therapies and sorafenib: is there a clinical benefit?. Radiol Med (Torino) 2014; 119 (7) 476-482
    CrossrefPubMedGoogle Scholar
  • 31 Sergio A, Cristofori C, Cardin R , et al. Transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC): the role of angiogenesis and invasiveness. Am J Gastroenterol 2008; 103 (4) 914-921
    CrossrefPubMedGoogle Scholar
  • 32 Carpizo DR, Gensure RH, Yu X , et al. Pilot study of angiogenic response to yttrium-90 radioembolization with resin microspheres. J Vasc Interv Radiol 2014; 25 (2) 297-306.e1
    CrossrefPubMedGoogle Scholar
  • 33 Folkman J. Angiogenesis: an organizing principle for drug discovery?. Nat Rev Drug Discov 2007; 6 (4) 273-286
    CrossrefPubMedGoogle Scholar
  • 34 Vouche M, Kulik L, Atassi R , et al. Radiological-pathological analysis of WHO, RECIST, EASL, mRECIST and DWI: Imaging analysis from a prospective randomized trial of Y90 ± sorafenib. Hepatology 2013; 58 (5) 1655-1666
    CrossrefPubMedGoogle Scholar
  • 35 Chow PK, Poon DY, Khin MW , et al; Asia-Pacific Hepatocellular Carcinoma Trials Group. Multicenter phase II study of sequential radioembolization-sorafenib therapy for inoperable hepatocellular carcinoma. PLoS ONE 2014; 9 (3) e90909
    CrossrefPubMedGoogle Scholar
  • 36 Crocetti L, de Baere T, Lencioni R. Quality improvement guidelines for radiofrequency ablation of liver tumours. Cardiovasc Intervent Radiol 2010; 33 (1) 11-17
    CrossrefPubMedGoogle Scholar
  • 37 Vouche M, Habib A, Ward TJ , et al. Unresectable solitary hepatocellular carcinoma not amenable to radiofrequency ablation: multicenter radiology-pathology correlation and survival of radiation segmentectomy. Hepatology 2014; 60 (1) 192-201
    CrossrefPubMedGoogle Scholar
  • 38 Lencioni R, Cioni D, Crocetti L , et al. Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology 2005; 234 (3) 961-967
    CrossrefPubMedGoogle Scholar
  • 39 Lu DS, Yu NC, Raman SS , et al. Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation. Hepatology 2005; 41 (5) 1130-1137
    CrossrefPubMedGoogle Scholar
  • 40 Padia SA, Kwan SW, Roudsari B, Monsky WL, Coveler A, Harris WP. Superselective yttrium-90 radioembolization for hepatocellular carcinoma yields high response rates with minimal toxicity. J Vasc Interv Radiol 2014; 25 (7) 1067-1073
    CrossrefPubMedGoogle Scholar
  • 41 Gaba RC, Lewandowski RJ, Kulik LM , et al. Radiation lobectomy: preliminary findings of hepatic volumetric response to lobar yttrium-90 radioembolization. Ann Surg Oncol 2009; 16 (6) 1587-1596
    CrossrefPubMedGoogle Scholar
  • 42 Kubota K, Makuuchi M, Kusaka K , et al. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology 1997; 26 (5) 1176-1181
    PubMedGoogle Scholar
  • 43 Zorzi D, Laurent A, Pawlik TM, Lauwers GY, Vauthey JN, Abdalla EK. Chemotherapy-associated hepatotoxicity and surgery for colorectal liver metastases. Br J Surg 2007; 94 (3) 274-286
    CrossrefPubMedGoogle Scholar
  • 44 Belghiti J, Benhaïm L. Portal vein occlusion prior to extensive resection in colorectal liver metastasis: a necessity rather than an option!. Ann Surg Oncol 2009; 16 (5) 1098-1099
    CrossrefPubMedGoogle Scholar
  • 45 Pamecha V, Glantzounis G, Davies N, Fusai G, Sharma D, Davidson B. Long-term survival and disease recurrence following portal vein embolisation prior to major hepatectomy for colorectal metastases. Ann Surg Oncol 2009; 16 (5) 1202-1207
    CrossrefPubMedGoogle Scholar
  • 46 Pamecha V, Levene A, Grillo F, Woodward N, Dhillon A, Davidson BR. Effect of portal vein embolisation on the growth rate of colorectal liver metastases. Br J Cancer 2009; 100 (4) 617-622
    CrossrefPubMedGoogle Scholar
  • 47 Azoulay D, Castaing D, Smail A , et al. Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization. Ann Surg 2000; 231 (4) 480-486
    CrossrefPubMedGoogle Scholar
  • 48 Hoekstra LT, van Lienden KP, Verheij J, van der Loos CM, Heger M, van Gulik TM. Enhanced tumor growth after portal vein embolization in a rabbit tumor model. J Surg Res 2013; 180 (1) 89-96
    CrossrefPubMedGoogle Scholar
  • 49 Vouche M, Lewandowski RJ, Atassi R , et al. Radiation lobectomy: time-dependent analysis of future liver remnant volume in unresectable liver cancer as a bridge to resection. J Hepatol 2013; 59 (5) 1029-1036
    CrossrefPubMedGoogle Scholar
  • 50 Theysohn JM, Ertle J, Müller S , et al. Hepatic volume changes after lobar selective internal radiation therapy (SIRT) of hepatocellular carcinoma. Clin Radiol 2014; 69 (2) 172-178
    CrossrefPubMedGoogle Scholar
  • 51 Fischman AM, Ward TJ, Horn JC , et al. Portal vein embolization before right hepatectomy or extended right hepatectomy using sodium tetradecyl sulfate foam: technique and initial results. J Vasc Interv Radiol 2014; 25 (7) 1045-1053
    CrossrefPubMedGoogle Scholar
  • 52 Kudo M. Early detection and curative treatment of early-stage hepatocellular carcinoma. Clin Gastroenterol Hepatol 2005; 3 (10) (Suppl. 02) S144-S148
    CrossrefPubMedGoogle Scholar
  • 53 Hoekstra LT, van Lienden KP, Doets A, Busch OR, Gouma DJ, van Gulik TM. Tumor progression after preoperative portal vein embolization. Ann Surg 2012; 256 (5) 812-817 , discussion 817–818
    CrossrefPubMedGoogle Scholar
  • 54 Garin E, Lenoir L, Rolland Y , et al. Dosimetry based on 99mTc-macroaggregated albumin SPECT/CT accurately predicts tumor response and survival in hepatocellular carcinoma patients treated with 90Y-loaded glass microspheres: preliminary results. J Nucl Med 2012; 53 (2) 255-263
    CrossrefPubMedGoogle Scholar
  • 55 Garin E, Lenoir L, Edeline J , et al. Boosted selective internal radiation therapy with 90Y-loaded glass microspheres (B-SIRT) for hepatocellular carcinoma patients: a new personalized promising concept. Eur J Nucl Med Mol Imaging 2013; 40 (7) 1057-1068
    CrossrefPubMedGoogle Scholar
  • 56 Sato KT, Omary RA, Takehana C , et al. The role of tumor vascularity in predicting survival after yttrium-90 radioembolization for liver metastases. J Vasc Interv Radiol 2009; 20 (12) 1564-1569
    CrossrefPubMedGoogle Scholar
  • 57 Lea WB, Tapp KN, Tann M, Hutchins GD, Fletcher JW, Johnson MS. Microsphere localization and dose quantification using positron emission tomography/CT following hepatic intraarterial radioembolization with yttrium-90 in patients with advanced hepatocellular carcinoma. J Vasc Interv Radiol 2014; 25 (10) 1595-1603
    CrossrefPubMedGoogle Scholar
  • 58 Lhommel R, van Elmbt L, Goffette P , et al. Feasibility of 90Y TOF PET-based dosimetry in liver metastasis therapy using SIR-Spheres. Eur J Nucl Med Mol Imaging 2010; 37 (9) 1654-1662
    CrossrefPubMedGoogle Scholar
  • 59 Gates VL, Esmail AA, Marshall K, Spies S, Salem R. Internal pair production of 90Y permits hepatic localization of microspheres using routine PET: proof of concept. J Nucl Med 2011; 52 (1) 72-76
    CrossrefPubMedGoogle Scholar
  • 60 Padia SA, Alessio A, Kwan SW, Lewis DH, Vaidya S, Minoshima S. Comparison of positron emission tomography and bremsstrahlung imaging to detect particle distribution in patients undergoing yttrium-90 radioembolization for large hepatocellular carcinomas or associated portal vein thrombosis. J Vasc Interv Radiol 2013; 24 (8) 1147-1153
    CrossrefPubMedGoogle Scholar
  • 61 Gates VL, Marshall KG, Salzig K, Williams M, Lewandowski RJ, Salem R. Outpatient single-session yttrium-90 glass microsphere radioembolization. J Vasc Interv Radiol 2014; 25 (2) 266-270
    CrossrefPubMedGoogle Scholar
  • 62 Gaba RC, Zivin SP, Dikopf MS , et al. Characteristics of primary and secondary hepatic malignancies associated with hepatopulmonary shunting. Radiology 2014; 271 (2) 602-612
    Google Scholar
  • 63 Louie JD, Kothary N, Kuo WT , et al. Incorporating cone-beam CT into the treatment planning for yttrium-90 radioembolization. J Vasc Interv Radiol 2009; 20 (5) 606-613
    CrossrefPubMedGoogle Scholar
  • 64 Burgmans MC, Too CW, Kao YH , et al. Computed tomography hepatic arteriography has a hepatic falciform artery detection rate that is much higher than that of digital subtraction angiography and 99mTc-MAA SPECT/CT: implications for planning 90Y radioembolization?. Eur J Radiol 2012; 81 (12) 3979-3984
    CrossrefPubMedGoogle Scholar
  • 65 D'Avola D, Iñarrairaegui M, Pardo F , et al. Prognosis of hepatocellular carcinoma in relation to treatment across BCLC stages. Ann Surg Oncol 2011; 18 (7) 1964-1971
    CrossrefPubMedGoogle Scholar