Efficacy of Transarterial Y90 Radioembolization in Management for Unresectable-Intermediate and Locally Advanced-HCC

Abstract
Background: Egypt has the highest prevalence of HCV worldwide and has rising rates of hepatocellular carcinoma (HCC). Many have adopted the Barcelona Clinic Liver Cancer (BCLC) staging classification, which links the stage of the disease to a specific treatment strategy. More controversial than the prognostic scoring system is the treatment algorithm that is a part of the BCLC. TACE is usually recommended as the standard treatment of BCLC-B patients, yet it is a relatively contraindicated in BCLC-C1 patients. Radioembolization with yttrium-90 (Y90) is a recently introduced liver-directed therapy, it is a is a sort of internal brachytherapy by arterially injected yttrium-90 (Y90) microspheres for the treatment of HCC. Growing data suggest that (Y90) radioembolization has a potent anticancer effect with negligible adverse events if appropriate pretreatment evaluations. It can be used in BCLC-B and BCLC-C1 in an unselective manner. In contrast to
TACE, the rate of adverse effects after such "unselective" application, as performed over a lobar branch of the hepatic
artery, is not significantly increased as compared to segmental or even subsegmental microsphere application, although the tumor response rate may vary.
Aim of Study: This study aims to present and discuss the efficacy and clinical outcome of Y90 radioembolization using Y90 microsphere for management of patients with intermediate and locally advanced (BCLC-B and BCLC-C1) Hepato-Cellular Carcinoma (HCC).
Patients and Methods: This is a prospective study carried out between June 2014 and May 2016 for patients with hepatocellular carcinoma and liver restricted disease. All patients underwent treatment by Y90 microsphere radioem-bolization (SIR-Tex). A total number of 20 patients with intermediate and locally hepatocellular carcinoma and liver restricted disease, not eligible for curative treatment.
Results: Assessment was done according to RECIST and mRECIST guidelines. We found good therapeutic response in patients treated with Y90 radioembolization. The complete response, partial response, stable disease and disease progres-sion rates for the study sample after 3 months using the conventional RECIST criteria was 0%, 55%, 30% and 10%, while after 6 months it became 0, 50%, 20% and 25% respec-tively.
Conclusion: Y90 microspheres radioembolization for patients with intermediate and advanced HCC is an effective treatment which can be utilized even in patients with compro-mised liver function.