Yttrium-90 Transarterial Radioembolization: An Effective Primary or Salvage Therapy to Bridge the Patients with Hepatocellular Carcinoma to Liver Transplantation

In 2020, an estimated 905,700 people were diagnosed with liver cancer, and 830,200 people died from this disease globally. Liver cancer was among the top three causes of cancer death in 46 countries and was among the top five causes of cancer death in 90 countries ( 1 Rumgay H. Arnold M. Ferlay J. et al. Global burden of primary liver cancer in 2020 and predictions to 2040. J Hepatol. 2022; 77: 1598-1606 Abstract Full Text Full Text PDF PubMed Scopus (296) Google Scholar ). Hepatocellular carcinoma (HCC) is increasing in the western world being mainly attributed to cirrhosis due to chronic HBV or HCV infection, alcohol abuse or steatohepatitis ( 2 Kirchner T. Marquardt S. Werncke T. et al. Comparison of health-related quality of life after transarterial chemoembolization and transarterial radioembolization in patients with unresectable hepatocellular carcinoma. Abdom Radiol (NY). 2019; 44: 1554-1561 Crossref Scopus (17) Google Scholar , 3 Makary M.S. Bozer J. Miller E.D. et al. Long-term clinical outcomes of Yttrium-90 transarterial radioembolization for hepatocellular carcinoma: a 5-year institutional experience. Acad Radiol. 2023; Abstract Full Text Full Text PDF Scopus (1) Google Scholar ). Unfortunately, HCC is diagnosed at intermediate or advanced stages in approximately 70% of cases, when most potentially curative therapies are precluded ( 2 Kirchner T. Marquardt S. Werncke T. et al. Comparison of health-related quality of life after transarterial chemoembolization and transarterial radioembolization in patients with unresectable hepatocellular carcinoma. Abdom Radiol (NY). 2019; 44: 1554-1561 Crossref Scopus (17) Google Scholar , 4 Ludwig J.M. Zhang D. Xing M. et al. Meta-analysis: adjusted indirect comparison of drug-eluting bead transarterial chemoembolization versus (90)Y-radioembolization for hepatocellular carcinoma. Eur Radiol. 2017; 27: 2031-2041 Crossref Scopus (19) Google Scholar ). Despite an improvement in imaging modalities and surveillance programs, the overall five-year survival for patients with HCC is still only 20% ( 5 Hamad A. Aziz H. Kamel I.R. et al. Yttrium-90 radioembolization: current indications and outcomes. J Gastrointest Surg. 2023; 27: 604-614 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar ). Patients with HCC are often treated based on comprehensive pretreatment evaluations using the Barcelona Clinic Liver Cancer (BCLC) staging system. For patients with early-stage HCC (BCLC A), the standard of care includes surgical resection, liver transplantation (LT), or ablations with the intent of cure. In patients with intermediate stage HCC (BCLC B), transarterial chemoembolization (TACE), drug-eluting bead (DEB)-TACE or transarterial radioembolization (TARE) is the treatment option. Patients with advanced HCC (BCLC C) are candidates for systemic therapy such as sorafenib or targeted/immunotherapy agents; supportive therapy may be appropriate for those patients with significant comorbidities ( 4 Ludwig J.M. Zhang D. Xing M. et al. Meta-analysis: adjusted indirect comparison of drug-eluting bead transarterial chemoembolization versus (90)Y-radioembolization for hepatocellular carcinoma. Eur Radiol. 2017; 27: 2031-2041 Crossref Scopus (19) Google Scholar , 5 Hamad A. Aziz H. Kamel I.R. et al. Yttrium-90 radioembolization: current indications and outcomes. J Gastrointest Surg. 2023; 27: 604-614 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar , 6 European Association For The Study Of The L European Organisation For R Treatment Of C EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012; 56: 908-943 Abstract Full Text Full Text PDF PubMed Scopus (4849) Google Scholar ).