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

Abstract
Background: Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide. However, most patients present with either unresectable (intermediate or advanced) tumors, cirrhosis, or both, eliminating these surgical treatment choices. Many institutions have adopted the Barcelona Clinic Liver Cancer (BCLC) staging classification, which links the stage of the disease to a specific treatment strategy. Current guidelines recommend transarterial chemoembolization (TA-CE) as the standard treatment of Barcelona-Clinic Liver Cancer (BCLC)-B patients, however, the long-term survival outcomes of patients managed with this technique do not appear fully satisfactory. In addition, HCC has traditionally been regarded as a radioresistant tumor due to the limited ability to deliver lethal doses using external beam tech-niques.Radioembolization with yttrium-90 (Y90) is a recently introduced liver-directed therapy. It is brachy therapy by arterially injected Y90 microspheres for the treatment of malignancies. Growing data suggest that Y90 radioembolization has a potent anticancer effect with negligible adverse events.
Aim of Study: This study aims to present and discuss the safety and adverse effects of Y90 radioembolization 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: Follow-up was done using laboratory tests and clinical assessment. We found accepted toxicity profile in patients treated with Y90 radioembolization. The most frequent symptoms we encountered were the transient fatigue, abdom-inal pain and post embolization syndrome. The sever adverse effects (pneumonitis and GI ulceration) were not encountered in our study due to careful selection and pretreatment diagnostic preparation angiograph.
Conclusion: Y90 microspheres radioembolization is safe therapeutic option for patients with intermediate and advanced HCC which can be utilized even in patients with compromised liver function.