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Journal articles on the topic 'Liver radioembolization'

Author: Grafiati

Published: 29 June 2022

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1

Carrion-Martin, L., J. Orcajo Rincón, A. Rotger, M. Gonzalez-Leyte, L. Márquez Pérez, M. Echenagusia, and A. Matilla. "Radioembolization in liver tumors." Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) 38, no. 6 (November 2019): 370–81. http://dx.doi.org/10.1016/j.remnie.2019.06.005.

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Braat, Manon N. G. J. A., Karel J. van Erpecum, Bernard A. Zonnenberg, Maurice A. J. van den Bosch, and Marnix G. E. H. Lam. "Radioembolization-induced liver disease." European Journal of Gastroenterology & Hepatology 29, no. 2 (February 2017): 144–52. http://dx.doi.org/10.1097/meg.0000000000000772.

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3

Braat, A. J. A. T., H. Ahmadzadehfar, S. C. Kappadath, C. L. Stothers, A. Frilling, C. M. Deroose, P. Flamen, et al. "Radioembolization with 90Y Resin Microspheres of Neuroendocrine Liver Metastases After Initial Peptide Receptor Radionuclide Therapy." CardioVascular and Interventional Radiology 43, no. 2 (October 23, 2019): 246–53. http://dx.doi.org/10.1007/s00270-019-02350-2.

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Abstract Purpose Peptide receptor radionuclide therapy (PRRT) and radioembolization are increasingly used in neuroendocrine neoplasms patients. However, concerns have been raised on cumulative hepatotoxicity. The aim of this sub-analysis was to investigate hepatotoxicity of yttrium-90 resin microspheres radioembolization in patients who were previously treated with PRRT. Methods Patients treated with radioembolization after systemic radionuclide treatment were retrospectively analysed. Imaging response according to response evaluation criteria in solid tumours (RECIST) v1.1 and clinical response after 3 months were collected. Clinical, biochemical and haematological toxicities according to common terminology criteria for adverse events (CTCAE) v4.03 were also collected. Specifics on prior PRRT, subsequent radioembolization treatments, treatments after radioembolization and overall survival (OS) were collected. Results Forty-four patients were included, who underwent a total of 58 radioembolization procedures, of which 55% whole liver treatments, at a median of 353 days after prior PRRT. According to RECIST 1.1, an objective response rate of 16% and disease control rate of 91% were found after 3 months. Clinical response was seen in 65% (15/23) of symptomatic patients after 3 months. Within 3 months, clinical toxicities occurred in 26%. Biochemical and haematological toxicities CTCAE grade 3–4 occurred in ≤ 10%, apart from lymphocytopenia (42%). Radioembolization-related complications occurred in 5% and fatal radioembolization-induced liver disease in 2% (one patient). A median OS of 3.5 years [95% confidence interval 1.8–5.1 years] after radioembolization for the entire study population was found. Conclusion Radioembolization after systemic radionuclide treatments is safe, and the occurrence of radioembolization-induced liver disease is rare. Level of Evidence 4, case series.

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Birgin, Emrullah, Erik Rasbach, Steffen Seyfried, Nils Rathmann, Steffen J. Diehl, Stefan O. Schoenberg, Christoph Reissfelder, and Nuh N. Rahbari. "Contralateral Liver Hypertrophy and Oncological Outcome Following Radioembolization with 90Y-Microspheres: A Systematic Review." Cancers 12, no. 2 (January 27, 2020): 294. http://dx.doi.org/10.3390/cancers12020294.

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Radioembolization with 90Y-microspheres has been reported to induce contralateral liver hypertrophy with simultaneous ipsilateral control of tumor growth. The aim of the present systematic review was to summarize the evidence of contralateral liver hypertrophy and oncological outcome following unilateral treatment with radioembolization. A systematic literature search using the MEDLINE, EMBASE, and Cochrane libraries for studies published between 2008 and 2020 was performed. A total of 16 studies, comprising 602 patients, were included. The median kinetic growth rate per week of the contralateral liver lobe was 0.7% and declined slightly over time. The local tumor control was 84%. 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.

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Facciorusso, Antonio, Irene Bargellini, Marina Cela, Ivan Cincione, and Rodolfo Sacco. "Comparison between Y90 Radioembolization Plus Sorafenib and Y90 Radioembolization alone in the Treatment of Hepatocellular Carcinoma: A Propensity Score Analysis." Cancers 12, no. 4 (April 7, 2020): 897. http://dx.doi.org/10.3390/cancers12040897.

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Background: Adjuvant sorafenib may enhance the efficacy of transarterial radioembolization with yttrium-90 in hepatocellular carcinoma patients. The aim of this study is to assess the efficacy and safety of radioembolization plus sorafenib in comparison to radioembolization alone. Methods: Out of 175 hepatocellular carcinoma (HCC) patients treated with radioembolization between 2011 and 2018, after propensity score matching, two groups were compared: a group of 45 patients that underwent radioembolization while being on sorafenib (Group 1) and a second group of 90 patients that underwent radioembolization alone (Group 2). Results: Baseline characteristics of the two groups were well balanced concerning liver function and tumor burden. No significant differences in survival outcomes were identified (median overall survival 10 vs. 10 months; p = 0.711), median progression-free survival 6 vs. 7 months (p = 0.992) in Group 1 and Group 2). The objective response rate in Group 1 vs. Group 2 was 45.5% vs. 42.8% (p = 1) according to mRECIST. No differences in toxicity nor in liver decompensation rates were registered. Conclusions: The association of sorafenib does not prolong survival nor delay progression in patients treated with radioembolization. Liver toxicity does not differ among the two therapeutic schemes.

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De Souza, Andre, Kevin Pelham Daly, James Yoo, and Muhammad Wasif Saif. "Safety and Efficacy of Combined Yttrium 90 Resin Radioembolization with Aflibercept and FOLFIRI in a Patient with Metastatic Colorectal Cancer." Case Reports in Oncological Medicine 2015 (2015): 1–6. http://dx.doi.org/10.1155/2015/461823.

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Background. When associated with isolated four or fewer liver foci, metastatic colorectal cancer is amenable to surgical resection. Alternative therapeutic methods for isolated liver metastases include radioembolization with yttrium 90 (Y90) and transarterial chemoembolization (TACE). We present here a case of a patient with two sites of liver metastatic disease from colorectal cancer who underwent Y90 radioembolization combined with aflibercept and FOLFIRI.Case Report. A 56-year-old female with history of bilateral breast cancer and metastatic colon cancer with prior hemicolectomy and 4 previous chemotherapy regimens developed liver metastasis. She was started on aflibercept and FOLFIRI and concurrently underwent two treatments of radioembolization with Y90, initially targeting the largest right lobe tumor, and then a subsequent treatment targeting the smaller left lobe tumor with retreatment of the right lobe tumor. Her liver metastases exhibited partial response on imaging utilizing the modified RECIST criteria. Interestingly, the patient CEA levels decreased after the procedure.Discussion. This is the first reported case of a patient managed with radioembolization with Y90 combined with aflibercept, an anti-VEGF treatment, and FOLFIRI. An ongoing randomized clinical trial aims to define the role of combined targeted therapy and chemotherapy with radioembolization with Y90.

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Elsayed, Mohammad, Robert M. Ermentrout, Ila Sethi, Zachary L. Bercu, James R. Galt, Morgan Whitmore, David C. Brandon, David M. Schuster, and Nima Kokabi. "Incidence of Radioembolization-Induced Liver Disease and Liver Toxicity Following Repeat 90Y-Radioembolization." Clinical Nuclear Medicine 45, no. 2 (February 2020): 100–104. http://dx.doi.org/10.1097/rlu.0000000000002828.

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Lebedev, Dmitry Petrovich, Dmitry Nikolaevich Panchenkov, Yuri Viktorovich Ivanov, Dmitry Anatolievich Astakhov, and Elena Alexandrovna Zvezdkina. "RADIOEMBOLIZATION AS A METHOD FOR THE TREATMENT OF UNRESECTABLE PRIMARY AND METASTATIC LIVER CANCER (LITERATURE REVIEW)." Journal of Experimental and Clinical Surgery 13, no. 1 (February 25, 2020): 61–69. http://dx.doi.org/10.18499/2070-478x-2020-13-1-61-69.

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A review of the literature on one of the methods of treatment of unresectable primary and metastatic liver cancer, namely radio embolization, is presented. A detailed description of the procedure for performing radioembolization of the liver vessels, possible complications, indications and contraindications to this method, lists the necessary equipment and tools. Particular attention is paid to the description of the microspheres used in radioembolization. A modern review of clinical studies, including those still unfinished, devoted to the method of radioembolization with unresectable primary and metastatic liver cancer is given.

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Laidlaw, Grace L., and Guy E. Johnson. "Recognizing and Managing Adverse Events in Y-90 Radioembolization." Seminars in Interventional Radiology 38, no. 04 (October 2021): 453–59. http://dx.doi.org/10.1055/s-0041-1735617.

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AbstractTransarterial radioembolization using yttrium-90 (Y-90) microspheres is an important therapy in the management of unresectable primary liver tumors or hepatic metastases. While radioembolization is generally well-tolerated, it is not free from adverse events, and familiarity with the prevention and treatment of radioembolization-specific complications is an important component of patient care. This article aims to review radioembolization-specific toxicities stratified by hepatic, extrahepatic, and systemic effects, with a focus on preventing and mitigating radioembolization-induced morbidity.

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Kiszka, Joanna, and Bożenna Karczmarek-Borowska. "Radioembolization treatment for liver metastases." Współczesna Onkologia 21, no. 4 (2017): 274–78. http://dx.doi.org/10.5114/wo.2017.72153.

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ERDOGAN, Ezgi Basak, Huseyin OZDEMİR, and Mehmet AYDIN. "Radioembolization Treatment for Liver Cancer." Bezmialem Science 4, no. 1 (March 10, 2016): 25–32. http://dx.doi.org/10.14235/bs.2016.624.

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Vente, Maarten A. D., Maurice A. A. J. van den Bosch, Marnix G. E. H. Lam, and Johannes F. W. Nijsen. "Radioembolization for colorectal liver metastases." Nature Reviews Clinical Oncology 7, no. 6 (June 2010): 1. http://dx.doi.org/10.1038/nrclinonc.2009.165-c1.

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13

Kaprin, A. D., S. A. Ivanov, V. V. Kucherov, A. P. Petrosyan, K. V. Mayorov, N. V. Markov, L. O. Petrov, et al. "Liver Radioembolization: a New Chapter in Russian Oncology." Russian Journal of Gastroenterology, Hepatology, Coloproctology 29, no. 5 (December 3, 2019): 7–12. http://dx.doi.org/10.22416/1382-4376-2019-29-5-7-12.

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Recent years have seen an increase in the number of patients with malignant tumours of the liver. In this context, new treatment methods are being actively introduced into practice, one of which is liver radioembolization utilizing microspheres embedded with yttrium-90 (90Y).Aim. To review literature data on the history of radioembolization and its application for liver tumours.Key findings. Annually, over 200 thousand patients with inoperable primary liver cancer and over 270 thousand patients with inoperable metastatic liver cancer are registered globally, for whom radioembolization is considered as the most suitable treatment method. 90Y is a pure beta emitter without its own gamma line, which is characterized by a small average particle path in the tissue of 2.5 mm (the maximum level is 11 mm), a maximum beta particle energy of 2.27 MeV (average energy of 0.937 MeV) and a half-life of 64.1 hours. Clinical research into microspheres containing 90Y has been actively conducted since 1977 all over the world. However, it was only in 2004 that the US FDA authorized the clinical use of glass microspheres containing 90Y for the treatment of hepatocellular cancer and liver colorectal cancer metastases. Until recently, radioembolization has not been applied in Russia. In 2018, the joint efforts of the A. Tsyb Medical Radiological Research Centre (MRRC) — branch of the National Medical Research Radiological Centre and BEBIG LLC resulted in the production of Russian microspheres containing yttrium-90, which were subsequently introduced into routine clinical practice. The first liver embolization in Russia using microspheres containing domestic yttrium-90 (BEBIG LLC) to a patient with hepatocellular cancer was carried out by V.V. Kucherov and A.P. Petrosyan at the A. Tsyb RMMC on April, 25 in 2019.Conclusion. The production of microspheres containing 90Y in Russia, as well as a technical improvement of the procedure, will facilitate the introduction of liver radioembolization into the routine management of patients with malignant liver tumours.

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Hendlisz, Alain, Marc Van den Eynde, Marc Peeters, Geert Maleux, Bieke Lambert, Jaarke Vannoote, Katrien De Keukeleire, et al. "Phase III Trial Comparing Protracted Intravenous Fluorouracil Infusion Alone or With Yttrium-90 Resin Microspheres Radioembolization for Liver-Limited Metastatic Colorectal Cancer Refractory to Standard Chemotherapy." Journal of Clinical Oncology 28, no. 23 (August 10, 2010): 3687–94. http://dx.doi.org/10.1200/jco.2010.28.5643.

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Purpose Liver dissemination is a major cause of mortality among patients with advanced colorectal cancer. Hepatic intra-arterial injection of the β-emitting isotope yttrium-90 (90Y) bound to resin microspheres (radioembolization) delivers therapeutic radiation doses to liver metastases with minimal damage to adjacent tissues. Patients and Methods We conducted a prospective, multicenter, randomized phase III trial in patients with unresectable, chemotherapy-refractory liver-limited metastatic CRC (mCRC) comparing arm A (fluorouracil [FU] protracted intravenous infusion 300 mg/m2 days 1 through 14 every 3 weeks) and arm B (radioembolization plus intravenous FU 225 mg/m2 days 1 through 14 then 300 mg/m2 days 1 through 14 every 3 weeks) until hepatic progression. The primary end point was time to liver progression (TTLP). Cross-over to radioembolization was permitted after progression in arm A. Results Forty-six patients were randomly assigned and 44 were eligible for analysis (arm A, n = 23; arm B, n = 21). Median follow-up was 24.8 months. Median TTLP was 2.1 and 5.5 months in arms A and B, respectively (hazard ratio [HR] = 0.38; 95% CI, 0.20 to 0.72; P = .003). Median time to tumor progression (TTP) was 2.1 and 4.5 months, respectively (HR = 0.51; 95% CI, 0.28 to 0.94; P = .03). Grade 3 or 4 toxicities were recorded in six patients after FU monotherapy and in one patient after radioembolization plus FU treatment (P = .10). Twenty-five of 44 patients received further treatment after progression, including 10 patients in arm A who received radioembolization. Median overall survival was 7.3 and 10.0 months in arms A and B, respectively (HR = 0.92; 95% CI, 0.47 to 1.78; P = .80). Conclusion Radioembolization with 90Y-resin microspheres plus FU is well tolerated and significantly improves TTLP and TTP compared with FU alone. This procedure is a valid therapeutic option for chemotherapy-refractory liver-limited mCRC.

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Kennedy, Andrew S., Michael Cohn, Douglas M. Coldwell, Alain Drooz, Eduardo Ehrenwald, Adeel Kaiser, Charles W. Nutting, Steven C. Rose, Eric Wang, and Michael Savin. "Unresectable colorectal cancer liver metastases treated with radioembolization: Updated survival analysis of the MORE study." Journal of Clinical Oncology 35, no. 4_suppl (February 1, 2017): 666. http://dx.doi.org/10.1200/jco.2017.35.4_suppl.666.

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666 Background: In December 2011, the Metastatic Colorectal Cancer Liver Metastases Outcomes after Radioembolization (MORE) study retrospectively analyzed 606 patients with unresectable colorectal liver metastases treated with radioembolization using Y-90 resin microspheres. At a median follow-up of 8.6 months, 503 of these patients had died. Here, we summarize survival outcomes from extended follow-up of the remaining patients through September 1, 2016. Methods: Extended survival surveillance was abstracted from patient charts and public records. Survival time was compared for prognostic variables using Kaplan-Meier estimates. Results: Survival data were analyzed for 574 of 606 patients with median follow-up of 9.5 months (IQR 12.9 months). Patients received a median (range) of 2 (0 to 6) lines of chemotherapy. Additional death dates were obtained on 71 patients, and median survival was 10.0 months (95% CI 9.2-11.8) -versus 9.6 (95% CI 9.0-11.1) months originally reported. Data confirm ECOG PS, disease stage, extent of liver involvement, liver function, metachronous metastasis, and prior chemotherapy as predictors of post-radioembolization survival. Conclusions: Long-term follow-up confirms the originally reported prognostic factors for survival and that radioembolization offers a favorable survival benefit for patients with unresectable colorectal cancer liver metastases, even among those who already received 3 or more lines of chemotherapy. [Table: see text]

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Sangro, Bruno, Belen Gil-Alzugaray, Javier Rodriguez, Iosu Sola, Antonio Martinez-Cuesta, Antonio Viudez, Ana Chopitea, Mercedes Iñarrairaegui, Javier Arbizu, and Jose I. Bilbao. "Liver disease induced by radioembolization of liver tumors." Cancer 112, no. 7 (2008): 1538–46. http://dx.doi.org/10.1002/cncr.23339.

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Murali, Nikitha, Samdeep K. Mouli, Ahsun Riaz, Robert J. Lewandowski, and Riad Salem. "Extrahepatic Applications of Yttrium-90 Radioembolization." Seminars in Interventional Radiology 38, no. 04 (October 2021): 479–81. http://dx.doi.org/10.1055/s-0041-1735573.

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AbstractWhile initially described and now accepted as treatment for primary and secondary malignancies in the liver, radioembolization therapy has expanded to include treatment for other disease pathologies and other organ systems. Advantages and limitations for these treatments exist and must be compared against more traditional treatments for these processes. This article provides an overview of the current applications for radioembolization outside of the liver, for both malignant and nonmalignant disease.

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Sivananthan, Gajan, and Nora E. Tabori. "Principles of Radioembolization." Seminars in Interventional Radiology 38, no. 04 (October 2021): 393–96. http://dx.doi.org/10.1055/s-0041-1735606.

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AbstractRadioembolization has become a mainstay therapy in the treatment of primary and secondary liver cancers. This article will specifically discuss a brief history of yttrium treatment as well as an overview of the physical properties of the currently available devices. A discussion of the mechanism of action will be followed by a discussion on patient selection for this treatment.

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Allimant, Carole, Emmanuel Deshayes, Marilyne Kafrouni, Lore Santoro, Delphine de Verbizier, Marjolaine Fourcade, Christophe Cassinotto, et al. "Hepatobiliary Scintigraphy and Glass 90Y Radioembolization with Personalized Dosimetry: Dynamic Changes in Treated and Nontreated Liver." Diagnostics 11, no. 6 (May 21, 2021): 931. http://dx.doi.org/10.3390/diagnostics11060931.

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Background: The functional changes that occur over time in the liver following 90Y-radioembolization (RE) using personalized dosimetry (PD) remain to be investigated. Methods: November 2016–October 2019: we retrospectively included hepatocellular carcinoma (HCC) patients treated by 90Y-glass RE using PD, who underwent hepatobiliary scintigraphy (HBS) at baseline and at 15 days, 1, 2, 3, and 6 months after RE. Results: There were 16 patients with unilobar disease (100%) included, and 64 HBS were performed. Whole liver function significantly decreased over time. The loss was maximal at 2 weeks: −32% (p = 0.002) and remained below baseline at 1 (−15%; p = 0.002), 2 (−25%; p < 0.001), and 3 months (−16%; p = 0.027). No radioembolization-induced liver disease was observed. Treated liver function strongly decreased to reach −64% (p < 0.001) at 2 months. Nontreated liver function decreased at 2 weeks (−21%; p = 0.027) and remained below baseline before reaching +20% (p = 0.002) and +59% (p < 0.001) at 3 and 6 months, respectively. Volumetric and functional changes exhibited parallel evolutions in the treated livers (p = 0.01) but independent evolutions in the nontreated livers (p = 0.08). Conclusion: RE using PD induces significant regional changes in liver function over time. As early as 15 days following RE, both the treated and nontreated livers showed a decreased function. Nontreated liver function recovered after 3 months and greatly increased afterwards.

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Laroia, Sandeep T. "90Yttrium Microsphere Radioembolization for Liver Malignancies: A Technical Overview." Journal of Postgraduate Medicine, Education and Research 47, no. 1 (2013): 61–64. http://dx.doi.org/10.5005/jp-journals-10028-1057.

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ABSTRACT The incidence of the liver tumors is increasing worldwide; concurrently liver directed therapies are also evolving rapidly. Management of these complex disease processes involves a multidisciplinary approach, hence it is imperative to understand the underlying management principles thoroughly. This overview is intended to provide an easy, step by step approach to transcatheter brachytherapy, also known as radioembolization (RE). A brief overview of the anatomical issues, transcatheter technique and intraarterial RE will be provided. How to cite this article Laroia ST. 90Yttrium Microsphere Radioembolization for Liver Malignancies: A Technical Overview. J Postgrad Med Edu Res 2013;47(1):61-64.

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Spa, Silvia J., Mick M. Welling, Matthias N. van Oosterom, Daphne D. D. Rietbergen, Mark C. Burgmans, Willem Verboom, Jurriaan Huskens, Tessa Buckle, and Fijs W. B. van Leeuwen. "A Supramolecular Approach for Liver Radioembolization." Theranostics 8, no. 9 (2018): 2377–86. http://dx.doi.org/10.7150/thno.23567.

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Masthoff, Max, Philipp Schindler, Fabian Harders, Walter Heindel, Christian Wilms, Hartmut H. Schmidt, Andreas Pascher, et al. "Repeated radioembolization in advanced liver cancer." Annals of Translational Medicine 8, no. 17 (September 2020): 1055. http://dx.doi.org/10.21037/atm-20-2658.

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Vente, Maarten AD, Bernard A. Zonnenberg, and J. Frank W. Nijsen. "Microspheres for radioembolization of liver malignancies." Expert Review of Medical Devices 7, no. 5 (September 2010): 581–83. http://dx.doi.org/10.1586/erd.10.48.

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Saini, Aman, Alex Wallace, Sadeer Alzubaidi, M. Grace Knuttinen, Sailendra Naidu, Rahul Sheth, Hassan Albadawi, and Rahmi Oklu. "History and Evolution of Yttrium-90 Radioembolization for Hepatocellular Carcinoma." Journal of Clinical Medicine 8, no. 1 (January 7, 2019): 55. http://dx.doi.org/10.3390/jcm8010055.

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Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer and affects millions worldwide. Due to the lack of effective systemic therapies for HCC, researchers have been investigating the use of locoregional tumor control with Yttrium-90 (Y90) radioembolization since the 1960s. Following the development of glass and resin Y90 microspheres in the early 1990s, Y90 radioembolization has been shown to be a safe and efficacious treatment for patients with HCC across Barcelona Clinic Liver Cancer (BCLC) stages. By demonstrating durable local control, good long term outcomes, and equivalent if not superior tumor responses and tolerability when compared to alternative therapies including transarterial chemoembolization (TACE) and sorafenib, Y90 radioembolization is being increasingly used in HCC treatment. More recently, investigations into variations in Y90 radioembolization technique including radiation segmentectomy and radiation lobectomy have further expanded its clinical utility. Here, we discuss the history and evolution of Y90 use in HCC. We outline key clinical trials that have established the safety and efficacy of Y90 radioembolization, and also summarize trials comparing its efficacy to existing HCC treatments. We conclude by reviewing the techniques of radiation segmentectomy and lobectomy, and by discussing dosimetry.

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Niekamp, Andrew S., Govindarajan Narayanan, Brian J. Schiro, Constantino Pena, Alex Powell, and Ripal T. Gandhi. "Radioembolization for Rare Metastatic Disease." Digestive Disease Interventions 05, no. 02 (May 20, 2021): 118–22. http://dx.doi.org/10.1055/s-0041-1729875.

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AbstractRadioembolization has become a widespread treatment modality for both primary and metastatic hepatic malignancies. Although the majority of data and indication for yttrium-90 radioembolization have been for hepatocellular carcinoma and metastatic colorectal cancer, radioembolization with yttrium-90 has rapidly expanded into the treatment options for multiple tumor types with metastases to the liver. This article reviews the clinical data and expanding utilization of radioembolization for rare metastatic diseases with an emphasis on efficacy and safety.

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Manchec, Barbara, Nima Kokabi, Govindarajan Narayanan, Andrew Niekamp, Constantino Peña, Alex Powell, Brian Schiro, and Ripal Gandhi. "Radioembolization of Secondary Hepatic Malignancies." Seminars in Interventional Radiology 38, no. 04 (October 2021): 445–52. http://dx.doi.org/10.1055/s-0041-1732318.

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AbstractCancer has become the leading cause of mortality in America, and the majority of patients eventually develop hepatic metastasis. As liver metastases are frequently unresectable, the value of liver-directed therapies, such as transarterial radioembolization (TARE), has become increasingly recognized as an integral component of patient management. Outcomes after radioembolization of hepatic malignancies vary not only by location of primary malignancy but also by tumor histopathology. This article reviews the outcomes of TARE for the treatment of metastatic colorectal cancer, metastatic breast cancer, and metastatic neuroendocrine tumors, as well as special considerations when treating metastatic disease with TARE.

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Marsala, Andrew, Edward Lee, and Siddharth Padia. "Yttrium-90 Radioembolization for Metastatic Colorectal Cancer: Outcomes by Number of Lines of Therapy." Seminars in Interventional Radiology 34, no. 02 (June 2017): 116–20. http://dx.doi.org/10.1055/s-0037-1602711.

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AbstractMetastatic colorectal cancer represents the most common liver malignancy, and imparts a very poor prognosis for those who develop this disease. Unlike primary liver tumors such as hepatocellular carcinoma, which largely develops in patients with underlying cirrhosis, most metastatic liver tumor patients have normal underlying liver function. Owing to this, most will succumb to tumoral replacement of the liver rather than from underlying liver dysfunction. Radioembolization represents a treatment modality that can be used in multiple fashions to treat one or both lobes of the liver. Techniques depend on whether the procedure is used as first-line, second/third-line, or as salvage therapy. Outcomes and complications of radioembolization are presented in this article, as well as background information on colorectal cancer and systemic therapies.

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Helmberger, Thomas, Dirk Arnold, José I. Bilbao, Niels de Jong, Geert Maleux, Anders Nordlund, Bora Peynircioglu, Bruno Sangro, Ricky A. Sharma, and Agnes Walk. "Clinical Application of Radioembolization in Hepatic Malignancies: Protocol for a Prospective Multicenter Observational Study." JMIR Research Protocols 9, no. 4 (April 22, 2020): e16296. http://dx.doi.org/10.2196/16296.

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Background Radioembolization, also known as transarterial radioembolization or selective internal radiation therapy with yttrium-90 (90Y) resin microspheres, is an established treatment modality for patients with primary and secondary liver tumors. However, large-scale prospective observational data on the application of this treatment in a real-life clinical setting is lacking. Objective The main objective is to collect data on the clinical application of radioembolization with 90Y resin microspheres to improve the understanding of the impact of this treatment modality in its routine practice setting. Methods Eligible patients are 18 years or older and receiving radioembolization for primary and secondary liver tumors as part of routine practice, as well as have signed informed consent. Data is collected at baseline, directly after treatment, and at every 3-month follow-up until 24 months or study exit. The primary objective of the Cardiovascular and Interventional Radiological Society of Europe Registry for SIR-Spheres Therapy (CIRT) is to observe the clinical application of radioembolization. Secondary objectives include safety, effectiveness in terms of overall survival, progression-free survival (PFS), liver-specific PFS, imaging response, and change in quality of life. Results Between January 2015 and December 2017, 1047 patients were included in the study. The 24-month follow-up period ended in December 2019. The first results are expected in the third quarter of 2020. Conclusions The CIRT is the largest observational study on radioembolization to date and will provide valuable insights to the clinical application of this treatment modality and its real-life outcomes. Trial Registration ClinicalTrials.gov NCT02305459; https://clinicaltrials.gov/ct2/show/NCT02305459 International Registered Report Identifier (IRRID) DERR1-10.2196/16296

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Aurélie Louvet, Cédric van Marcke, Philippe D'Abadie, and Emmanuel Seront. "Successful treatment with yttrium-90 microspheres in a metastatic breast cancer patient and sclerosing cholangitis." Future Science OA 7, no. 7 (August 2021): FSO716. http://dx.doi.org/10.2144/fsoa-2021-0015.

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Breast cancer is the most common malignancy occurring in women worldwide. More than 90% of patients present with localized disease are treated with curative intent; however, recurrence can occur with development of metastatic lesions. Frequently associated with extra-hepatic lesions, localized treatments (surgery or stereotaxic body radiotherapy) are rarely proposed in liver lesions. 90Y radioembolization has extensively been evaluated in colorectal cancer, but its role in breast cancer with isolated liver metastases remains largely unknown. Pre-existing liver diseases are known risk factors for 90Y induced liver toxicity. Not considered as an excluding factor for this treatment, data are limited regarding its safe use with cholangitis. We report a successful control of liver metastases by 90Y radioembolization in a breast cancer patient.

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Avkshtol, Vladimir, Iavor Veltchev, Jian Qin Yu, Mohan Doss, Gary S. Cohen, Joseph N. Panaro, Crystal S. Denlinger, et al. "Measuring liver radioembolization dose with positron emission tomography." Journal of Clinical Oncology 37, no. 4_suppl (February 1, 2019): 290. http://dx.doi.org/10.1200/jco.2019.37.4_suppl.290.

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290 Background: There is no established way to measure radiation dose deposition during liver radioembolization to help quantify the shortcomings of prescription calculations, which do not consider size, shape, and location of tumors. We aimed to establish a standardized method of radioembolization dose measurement though a novel technique using Positron Emission Tomography and Computed Tomography (PET-CT). Methods: Patients who were recommended for liver radioembolization treatment were enrolled in a prospective single-arm registry study. Index lesions were contoured on the patients’ CT simulation scans. Immediate post-treatment PET/CTs were used to measure the deposited radiation dose by capturing the positron emission from the Yttrium-90’s daughter nuclei. The CT simulation scans were fused to the post-treatment PET/CT scans using rigid registration around the index lesions. The primary dosimetric outcomes were mean dose and dose to 70% of the tumor volume (D70). The optimal mean dose and D70 were > 100 Gy and > 70 Gy, respectively. Results: From November 2014 to November 2015, fifteen consecutive patients with either hepatocellular carcinoma (n = 4) or liver metastases (n = 11) were enrolled in the study. A total of 43 index lesions were contoured with a mean and median size of 18.2 cc and 5.4 cc, respectively. The average mean dose to the index lesions was 99.9 Gy (mean dose range: 2 – 298 Gy; Table). The mean and median D70 were 66.9 Gy and 71 Gy, respectively (range: 1.4 – 211 Gy; standard deviation [SD]: 40.3 Gy). The mean and median D90s were 43 Gy and 41 Gy, respectively. A total of 20 (46.5%) lesions received optimal mean dose and 23 (53.5%) lesions received optimal D70 dose. Conclusions: We established a successful standardized procedure utilizing PET/CT scans to measure the radiation dose delivered during liver radioembolization. The range of the doses received by the tumors underlines the need to collect dosimetric data for future treatment optimization. Dosimetric parameters. Clinical trial information: NCT02088775. [Table: see text]

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Hanin, F. K., N. A. Yussof, and J. Sabirin. "Selective Internal Radiation Therapy Using Yttrium-90 Radioembolization for Hepatocellular Carcinoma." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 81s. http://dx.doi.org/10.1200/jgo.18.13200.

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Background: Hepatocellular carcinoma (HCC) is a primary malignant tumor of the liver that accounts for an important health problem worldwide. It is the sixth most common cancer worldwide with an incidence of 626,000 new patients a year, and the third most common cause of cancer related death. Secondary or metastatic liver are more common than primary tumor. The most common sites of primary tumor are breast, lung, and colorectal cancer with the majority of secondary liver cancers are metastases from colorectal cancer. Several locoregional catheter-based therapies options are available such as transarterial chemoembolism (TACE), drug eluting bead chemo-embolism and 90Y radioembolization for treatment of choice for unresectable HCC. Aim: To assess the effectiveness, safety and cost-effectiveness of selective internal radiation therapy (SIRT) using 90Y microspheres for the treatment of hepatocellular carcinoma. Methods: Electronic databases searched through the Ovid interface using MEDLINE (R) In-Process and Other Non-Indexed Citations and Ovid MEDLINE (R) 1946 to present. Additional articles were identified from reviewing the references of retrieved articles. Last search was conducted on 25th February 2016. Results: Seventeen articles related to SIRT using 90Y microspheres for HCC were included in this report in term of safety and effectiveness. For primary HCC, limited fair level of retrievable evidence to demonstrate that yttrium-90 radioembolization increased clinical response rates, improve survival and downstaging tumor for resection or transplant in unresectable primary HCC. For liver metastatic disease in colorectal cancer, limited fair level of retrievable evidence to demonstrate improvement in clinical response rates, longer median time to liver progression and overall survival when used in combination with first, second or third line chemotherapy as well as salvage treatment of chemotherapy refractory disease. For liver metastasis in neuroendocrine tumor, limited low level of retrievable evidence to suggest the use of 90Y radioembolization improved clinical response rates and median overall survival. Sufficient fair level of retrievable to suggest that 90Y radioembolization is a safe and well-tolerated procedure with some radioembolization specific complications. No retrievable evidence on cost-effectiveness. Conclusion: SIRT using 90Y microspheres may be used for unresectable primary hepatocellular carcinoma (HCC) and liver metastasis from colorectal cancer (mCRC). Strict criteria should be applied for patient selection and treatment shall be delivered through multidisciplinary team approach. However, SIRT is not recommended for unresectable metastatic liver disease of neuroendocrine tumor (mNET).

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Chamarthy, Murthy R., Terence W. Hughes, Mohit Gupta, Josephina A. Vossen, Noel B. Velasco, and Kenneth M. Zinn. "Celiac Artery Stenting to Facilitate Hepatic Yttrium-90 Radioembolization Therapy." Case Reports in Radiology 2012 (2012): 1–5. http://dx.doi.org/10.1155/2012/236732.

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Radioembolization offers a novel way to treat the nonresectable, liver predominant hepatic malignancies with better tumor response and overall progression-free survival rates. Transarterial catheter-based radioembolization procedure involves the hepatic arterial administration of glass- or resin-based beta emitting Yttirum-90 microspheres. Safe delivery of the tumoricidal radiation dose requires careful angiogram planning and coil embolization to quantify lung shunting and prevent systemic toxicity, respectively. Diagnostic pretreatment angiogram also serves to identify the hepatic arterial variant anatomy and other coexisting pathologies that might require a different or alternative approach. We describe a complex case of celiac artery stenosis with tortuous pancreaticoduodenal arterial arcade precluding access to the right hepatic artery for performing radioembolization. Celiac artery stenting of the stenosis was performed to facilitate subsequent safe and successful Yttrium-90 microsphere radioembolization.

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Rodríguez-Fraile, M., and M. Iñarrairaegui. "Radioembolization with 90Y-microspheres for liver tumors." Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) 34, no. 4 (July 2015): 244–57. http://dx.doi.org/10.1016/j.remnie.2015.05.001.

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Memon, Khairuddin, Robert J. Lewandowski, Laura Kulik, Ahsun Riaz, Mary F. Mulcahy, and Riad Salem. "Radioembolization for Primary and Metastatic Liver Cancer." Seminars in Radiation Oncology 21, no. 4 (October 2011): 294–302. http://dx.doi.org/10.1016/j.semradonc.2011.05.004.

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Rhee, Thomas K., Robert J. Lewandowski, David M. Liu, Mary F. Mulcahy, Gary Takahashi, Paul D. Hansen, Al B. Benson, Andrew S. Kennedy, Reed A. Omary, and Riad Salem. "90Y Radioembolization for Metastatic Neuroendocrine Liver Tumors." Annals of Surgery 247, no. 6 (June 2008): 1029–35. http://dx.doi.org/10.1097/sla.0b013e3181728a45.

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Gundavaram, Pawan, and Ron C. Gaba. "Thrombocytopenia Following 90Yttrium Glass Microsphere Liver Radioembolization." Southern Medical Journal 104, no. 4 (April 2011): 286. http://dx.doi.org/10.1097/smj.0b013e31820c0148.

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Nicolay, Nils H., David P. Berry, and Ricky A. Sharma. "Author reply: Radioembolization for colorectal liver metastases." Nature Reviews Clinical Oncology 7, no. 6 (June 2010): 1. http://dx.doi.org/10.1038/nrclinonc.2009.165-c2.

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Kennedy, Andrew, Douglas Coldwell, Bruno Sangro, Harpreet Wasan, and Riad Salem. "Radioembolization for the Treatment of Liver Tumors." American Journal of Clinical Oncology 35, no. 1 (February 2012): 91–99. http://dx.doi.org/10.1097/coc.0b013e3181f47583.

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&NA;. "Radioembolization for the Treatment of Liver Tumors." American Journal of Clinical Oncology 36, no. 4 (August 2013): 422. http://dx.doi.org/10.1097/coc.0b013e31829e97fe.

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Bohle, W., and W. Zoller. "Ultrasound in radioembolization induced liver disease (REILD)." Zeitschrift für Gastroenterologie 53, no. 08 (August 18, 2015): 798–801. http://dx.doi.org/10.1055/s-0035-1553197.

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Ibrahim, Saad M., Ahsun Riaz, Robert J. Lewandowski, Mary F. Mulcahy, Al B. Benson, and Riad Salem. "Internal radioembolization for colorectal carcinoma liver metastases." Current Colorectal Cancer Reports 5, no. 2 (April 2009): 93–98. http://dx.doi.org/10.1007/s11888-009-0014-9.

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42

Heckman, Patrick, Brandon Martinez, and Ruemu E. Birhiray. "Yttrium-90 radioembolization for breast cancer with liver metastases: A focus on mortality, adverse reactions, and radiological response." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e13065-e13065. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e13065.

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e13065 Background: Breast cancer associated with liver metastases (BCLM) occurs later in the progression of metastatic breast cancer and carries a poorer prognosis than bone or soft tissue metastases (Pagani). As systemic therapy begins to prolong progression, there is an inherent necessity for localized therapy directed at distant metastases. Further, there is some evidence to suggest that interventional techniques can prolong survival and palliate symptoms although data is lacking in this area (Hoe). Here we present findings describing the mortality benefit, adverse effects, and radiological response to Yttrium-90 (Y-90) radioembolization in BCLM patients. Methods: All patients with BCLM who received Y-90 radioembolization at St. Vincent Hospital from 2013-2018 were included in data collection. Digital chart review was utilized for data collection. To be eligible for the study, patients must have image or biopsy proven metastatic breast cancer to the liver, active unresectable disease not appropriate for ablation, ECOG performance status of 0-2, Bilirubin < 2.0 mg/dL, and no other evidence of liver disease. Patients with a life expectancy less than 2 months were excluded. Results: Twenty-five patients with BCLM underwent Y-90 radioembolization of hepatic metastases. Median survival after therapy was 495 days, or 16 months compared to the median survival rate of 4 months for BCLM patients reported by previous studies (Hoe). At 3 month follow up CT, 48% of patients experienced significant reduction in hepatic tumor burden, only 20% had worsening disease. 16% of patients reported abdominal pain. Median increase in bilirubin was 0.1. Median post procedural AST was 47, and ALT 40. Six patients experienced ascites requiring paracentesis, which occurred on average 14.3 months after Y-90 therapy. There were zero cases of pancreatitis and Radioembolization Induced Liver Disease (REILD). Conclusions: In patients with BCLM who undergo Y-90 radioembolization there seems to be a mortality benefit compared to traditional therapies. Further, there is a radiological reduction in tumor burden, and only minimal adverse effects.

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van Roekel, Caren, Maarten L. J. Smits, Jip F. Prince, Rutger C. G. Bruijnen, Maurice A. A. J. van den Bosch, and Marnix G. E. H. Lam. "Quality of life in patients with liver tumors treated with holmium-166 radioembolization." Clinical & Experimental Metastasis 37, no. 1 (November 15, 2019): 95–105. http://dx.doi.org/10.1007/s10585-019-10006-1.

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AbstractHolmium-166 radioembolization is a palliative treatment option for patients with unresectable hepatic malignancies. Its influence on quality of life has not been evaluated yet. Since quality of life is very important in the final stages of disease, the aim of this study was to evaluate the effect of holmium-166 radioembolization on quality of life. Patients with hepatic malignancies were treated with holmium-166 radioembolization in the HEPAR I and II studies. The European Organization for Research and Treatment of Cancer QLQ-C30 and LMC21 questionnaires were used to evaluate quality of life at baseline, 1 week, 6 weeks and at 6, 9 and 12 months after treatment. The course of the global health status and symptom and functioning scales were analyzed using a linear mixed model. Quality of life was studied in a total of 53 patients with a compliance of 94%. Role functioning was the most affected functioning scale. Fatigue and pain were the most affected symptom scales. Changes in almost all categories were most notable at 1 week after treatment. A higher WHO performance score at baseline decreased global health status, physical functioning, role functioning and social functioning and it increased symptoms of fatigue, dyspnea and diarrhea. Quality of life in salvage patients with liver metastases treated with holmium-166 radioembolization was not significantly affected over time, although a striking decline was seen during the first week post-treatment. A WHO performance score > 0 at baseline significantly influenced quality of life.

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Schacht, Michael, Douglas M. Coldwell, and Vivek Sharma. "The impact of KRAS mutation on radioembolization in the treatment of unresectable liver predominant metastatic colorectal cancer." Journal of Clinical Oncology 32, no. 3_suppl (January 20, 2014): 664. http://dx.doi.org/10.1200/jco.2014.32.3_suppl.664.

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664 Background: Radioembolization with either Yttrium-90 labeled resin or glass microspheres is an FDA approved treatment for hepatic metastases from primary colorectal cancer. Y-90 therapy is used almost exclusively in unresectable liver metastases. However, radioembolization is only an optional part of the treatment process along with first-line, second-line, and salvage chemotherapy. KRAS is a known proto-onco gene that has typically been studied as a negative prognostic factor in the chemotherapeutic treatment of metastatic colorectal cancer (mCRC). KRAS is a known marker for resistance to anti-EGFR antibodies and generally have a poorer prognosis. The aim of this study is to begin to shed light on the impact of KRAS status on the outcome of patients undergoing radioembolization for the treatment of unresectable liver predominant metastatic CRC, regardless of their chemotherapy regimens. Methods: This is a retrospective analysis of 18 subjects treated with radioembolization for liver predominant metastatic CRC. KRAS status and treatment outcomes were followed for each patient up to the study close date of 9/15/13. Statistical analysis was performed using the Mann-Whitney U test. Results: Of the 18 subjects included in the study, 5 were found to have KRAS mutant oncogene. The remaining 13 were found to have the KRAS wildtype. Overall, those subjects with KRAS mutant were found to have a statistically significant difference in median time to progression of intrahepatic metastatic disease burden when compared to KRAS wildtype even when liver-directed therapy was utilized (2.0 vs. 6.4 months). Differences in median time to progression of extrahepatic metastatic disease burden and overall survival were not found to be statistically significant at this time. Conclusions: KRAS mutant patients are exceedingly difficult to treat due to both intrahepatic and extrahepatic disease recurrence/progression.

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Rayar, Michel, Giovanni Battista Levi Sandri, Pauline Houssel-Debry, Christophe Camus, Laurent Sulpice, and Karim Boudjema. "Multimodal Therapy including Yttrium-90 Radioembolization as a Bridging Therapy to Liver Transplantation for a Huge and Locally Advanced Intrahepatic Cholangiocarcinoma." Journal of Gastrointestinal and Liver Diseases 25, no. 3 (September 1, 2016): 401–4. http://dx.doi.org/10.15403/jgld.2014.1121.253.y90.

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Treatment of intrahepatic cholangiocarcinoma remains a major challenge. For an unresectable lesion without extrahepatic spread, liver transplantation could be a potential solution but it is still associated with poor oncologic results owing to the absence of effective neoadjuvant treatment. We report the case of a young man with locally advanced intrahepatic cholangiocarcinoma presenting with multiple intrahepatic metastases and vascular structure involvement. The lesion was significantly downstaged by a multimodal therapy including intra-arterial Yttrium-90 radioembolization, systemic chemotherapy and external radiotherapy, allowing liver transplantation. Three years after the procedure, oncologic outcome is excellent with no sign of recurrence.Multimodal therapy including Yttrium-90 radioembolization could be relevant as neoadjuvant treatment before liver transplantation for unresectable intrahepatic cholangiocarcinoma. Abbrevations: CA 19-9: carbohydrate antigen 19-9; FDG-PET: fluorodeoxyglucose positron emission tomography; HCC: hepatocellular carcinoma; ICC: intrahepatic cholangiocarcinoma; LT: liver transplantation; MRI: magnetic resonance imaging; PHC: perihilar cholangiocarcinoma; Ytt-90: Yttrium-90.

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Holt, Alicia, Lawrence D. Wagman, Maheswari Senthil, Shaun Mckenzie, Howard Marx, Yi-Jen Chen, Nayana Vora, and Joseph Kim. "Transarterial Radioembolization with Yttrium-90 for Regional Management of Hepatocellular Cancer: The Early Results of a Nontransplant Center." American Surgeon 76, no. 10 (October 2010): 1079–83. http://dx.doi.org/10.1177/000313481007601012.

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Selective arterial radioembolization with Yttrium-90 (Y-90) microspheres has shown promise for regional management of hepatocellular cancer (HCC). Our objective was to report our early experience with this treatment modality from a nontransplant center. Treatment of patients with HCC was discussed in a multidisciplinary tumor board. Patients with unresectable disease resulting from high lesion number, ill location of the tumor, poor hepatic reserve, or medical comorbidities were offered Y-90 treatment. Liver treatment was either lobar or tumor-targeted. Response to therapy was assessed by CT scan obtained within 3 months using Response Evaluation Criteria in Solid Tumors criteria. During 2007 to 2009, 40 Y-90 radioembolizations were performed in 20 patients with age that ranged from 16 to 87 years; four patients were 80 years old or older. After the first therapy, CT assessment of the treated area showed stable disease (n = 15), partial response (n = 3), and progression (n = 2). Of the two patients who progressed, one was retreated with a subsequent complete response. The other patient died of progressive disease. The most common side effects were mild fatigue, anorexia, and nausea. In summary, our nontransplant center experience shows that Y-90 radioembolization is a well-tolerated treatment in select patients with unresectable HCC with an associated high rate of local tumor control.

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Mabud, Tarub S., and Ryan Hickey. "Radioembolization in the Setting of Systemic Therapies." Seminars in Interventional Radiology 38, no. 04 (October 2021): 472–78. http://dx.doi.org/10.1055/s-0041-1735572.

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Abstract 90Yttrium (Y90) radioembolization has been shown to improve outcomes for primary and metastatic liver cancers, but there is limited understanding of the optimal timing and safety of combining systemic therapies with Y90 treatment. Both therapeutic effects and toxicities could be synergistic depending on the timing and dosing of different coadministration paradigms. In particular, patients with liver-only or liver-dominant metastatic disease progression are often on systemic therapy when referred to interventional radiology for consideration of Y90 treatment. Interventional radiologists are frequently asked to offer insight into whether or not to hold systemic therapy, and for how long, prior to and following transarterial therapy. This study reviews the current evidence regarding the timing and safety of systemic therapy with Y90 treatment for hepatocellular carcinoma, metastatic colorectal carcinoma, intrahepatic cholangiocarcinoma, metastatic neuroendocrine tumors, and other hepatic metastases. A particular focus is placed on the timing, dosing, and toxicities of combined therapy.

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Mahvash, Armeen, David Madoff, Bruno Odisio, Joshua Kuban, Rony Avritscher, Ravi Murthy, and Mohamed Abdelsalam. "Radioembolization in Colorectal Metastases: A Review." Digestive Disease Interventions 01, no. 03 (September 2017): 208–17. http://dx.doi.org/10.1055/s-0037-1607965.

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AbstractRadioembolization has gained wide acceptance as a safe and efficient treatment for unresectable liver-dominant metastatic colorectal cancer. In this comprehensive article, we focus on clinical outcomes and dosimetry models in the era of personalized medicine.

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Bouvry, C., X. Palard, J. Edeline, V. Ardisson, P. Loyer, E. Garin, and N. Lepareur. "Transarterial Radioembolization (TARE) Agents beyond 90Y-Microspheres." BioMed Research International 2018 (December 31, 2018): 1–14. http://dx.doi.org/10.1155/2018/1435302.

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Liver malignancies, either primary tumours (mainly hepatocellular carcinoma and cholangiocarcinoma) or secondary hepatic metastases, are a major cause of death, with an increasing incidence. Among them, hepatocellular carcinoma (HCC) presents with a dark prognosis because of underlying liver diseases and an often late diagnosis. A curative surgical treatment can therefore only be proposed in 20 to 30% of the patients. However, new treatment options for intermediate to advanced stages, such as internal radionuclide therapy, seem particularly attractive. Transarterial radioembolization (TARE), which consists in the use of intra-arterial injection of a radiolabelled embolising agent, has led to very promising results. TARE with 90Y-loaded microspheres is now becoming an established procedure to treat liver tumours, with two commercially available products (namely, SIR-Sphere® and TheraSphere®). However, this technology remains expensive and is thus not available everywhere. The aim of this review is to describe TARE alternative technologies currently developed and investigated in clinical trials, with special emphasis on HCC.

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Küçük, Nuriye Özlem, and Pınar Akkuş. "Radioembolization in the Treatment of Metastatic Liver Cancer." Nuclear Medicine Seminars 5, no. 2 (July 11, 2019): 146–51. http://dx.doi.org/10.4274/nts.galenos.2019.0019.

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