摘要
Transarterial radioembolization(TARE) is a form of brachytherapy in which intra-arterially injected yttrium-90-loaded microspheres serve as a source for internal radiation purposes.On the average,it produces disease control rates exceeding 80% and it is a consolidated therapy for hepatocellular carcinoma(HCC);however,current data are all based on retrospective series or non-controlled prospective studies since randomized controlled trials comparing it with the other liver-directed therapies for intermediate and locally advanced stage HCC are still underway.The data available show that TARE provides similar or even better survival rates when compared to transarterial chemoembolization(TACE).First-line TARE is best indicated for both intermediatestage patients(staged according to the barcelona clinic liver cancer staging classification) who have lesions which respond poorly to TACE due to multiple tumors or a large tumor burden,and for locally advanced-stage patients with solitary tumors,and segmental or lobar portal vein tumor thrombosis.In addition,emerging data have suggested the use of TARE in patients who are classified slightly beyond the Milan criteria regarding radical treatment for downstaging purposes.As a secondline treatment,TARE can also be applied in patients progressing to TACE or sorafenib;a large number of phase Ⅱ/Ⅲ trials are ongoing with the purpose of evaluating the best association with systemic therapies.Transarterial radioembolization is very well tolerated and has a low rate of complications which are mainly related to unintended non-target tissue irradiation,including the surrounding liver parenchyma.The complications can be additionally reduced by accurate patient selection and a strict pre-treatment evaluation including dosimetry and assessment of the vascular anatomy.Since a correct treatment algorithm for potential TARE candidates is not clear and standardized,this comprehensive review analyzes the best selection criteria for patients who really benefit from TARE and also the new advances of this therapy,which can be a very important weapon against HCC.
Transarterial radioembolization （TARE） is a form ofbrachytherapy in which intra-arterially injected yttrium-90-loaded microspheres serve as a source for internalradiation purposes. On the average, it produces diseasecontrol rates exceeding 80% and it is a consolidatedtherapy for hepatocellular carcinoma （HCC）; however,current data are all based on retrospective series ornon-controlled prospective studies since randomizedcontrolled trials comparing it with the other liver-directedtherapies for intermediate and locally advanced stageHCC are still underway. The data available show thatTARE provides similar or even better survival rates whencompared to transarterial chemoembolization （TACE）.First-line TARE is best indicated for both intermediatestagepatients （staged according to the barcelona clinicliver cancer staging classification） who have lesionswhich respond poorly to TACE due to multiple tumorsor a large tumor burden, and for locally advanced-stagepatients with solitary tumors, and segmental or lobarportal vein tumor thrombosis. In addition, emergingdata have suggested the use of TARE in patients whoare classified slightly beyond the Milan criteria regardingradical treatment for downstaging purposes. As a secondlinetreatment, TARE can also be applied in patientsprogressing to TACE or sorafenib; a large number ofphase Ⅱ/Ⅲ trials are ongoing with the purpose ofevaluating the best association with systemic therapies.Transarterial radioembolization is very well tolerated andhas a low rate of complications which are mainly relatedto unintended non-target tissue irradiation, including thesurrounding liver parenchyma. The complications can beadditionally reduced by accurate patient selection and astrict pre-treatment evaluation including dosimetry andassessment of the vascular anatomy. Since a correcttreatment algorithm for potential TARE candidates isnot clear and standardized, this comprehensive reviewanalyzes the best selection criteria for patients who reallybenefit from TARE and also the new advances of thistherapy, which can be a very important weapon againstHCC.
