Recent Advances in the Treatment of Hepatocellular Carcinoma

Amit G. Singal; Jorge A. Marrero

Disclosures

Curr Opin Gastroenterol. 2010;26(3):189-195. 

In This Article

90Y Radiotherapy (TheraSphere)

HCC has long been considered to be a radioresistant tumor. Despite improvements in external beam radiation techniques, persisting technical limitations limit delivery of sufficient doses of radiation to induce tumor necrosis. Radioembolization with yttrium-90 (90Y) microspheres was recently introduced as a way to target radiation therapy to the tumor and limit exposure to surrounding normal parenchyma. Radiolabeled particles are injected through the hepatic artery, become trapped at the precapillary level, and emit internal radiation.

A large single-center prospective cohort study evaluating 90Y microspheres in 291 patients was recently reported.[40•] Tumor response rate was 57% per EASL guidelines, with 23% of patients having a complete response and 34% having a partial response. Median survival was 17.2 months in patients with Child–Pugh A and 7.7 months in those with Child–Pugh B. Other significant prognostic factors in this cohort included age, sex, performance status, presence of portal hypertension, multifocal disease, bilirubin levels, albumin, alpha-fetoprotein, and response rates. Patient safety was acceptable, with the most common side-effects being fatigue (57%), abdominal pain (23%), nausea (20%), and grade 3–4 hyperbilirubinemia (19%). Although data from this single-center cohort study are promising, these results must be externally validated.

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