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The Clinical Value of Radioembolization in the Treatment of Inoperable Liver Cancer
only one had a fatal event caused by liver failure; however, the cause acceptable levels of toxicity. Early results also suggest potential utility
remained obscure since the liver biopsy before death was inconclusive for treatment of patients on the waiting list for liver transplantation
for radiation-induced liver disease.
6
In 2005, Goin et al. compared TACE and for downstaging patients with disease that is beyond the
(29 patients) and
90
Y microspheres (34 patients) for post-embolization standard Milan criteria and perhaps even beyond the University of
syndrome (PES) manifested by post-treatment abdominal pain, nausea, California, San Francisco (UCSF) criteria for liver transplantation.
vomiting, and fever in the absence of infection. The incidence of PES
was nearly four times higher in the TACE group (p=0.003; 95% There are a number of challenges that remain before
confidence interval [CI] 1.6–16.3), suggesting a favorable toxicity profile radioembolization can be considered a fully validated therapy for
for radioembolization in this tumor type.
7,15,57
HCC. It is important to perform randomized controlled trials of TARE in
comparison with TACE, which has been proven to improve outcomes
Quality of Life of patients with unresectable HCC without PVT. It is also important to
Quality of life for patients with HCC is a difficult subject, since treatment identify predictive variables for those patients who are most likely to
options are limited and the likelihood of cure is low and, as previously develop toxicity and side effects after TARE in order to minimize
mentioned, very often patients are diagnosed at advanced stages of the toxicity. Additional studies to improve our understanding of
disease. Few studies have evaluated patient health-related quality of life the relative perfusion of radioactive microspheres to tumor versus
(HRQoL) in patients with treated HCC. In 2004, Steel et al. evaluated benign liver and the ideal dosimetry techniques to optimize tumor kill
HRQoL in patients with primary HCC who received either hepatic arterial while sparing the surrounding liver are critically needed.
infusion (HAI) of cisplatin or
90
Y. In this study, patients treated with
90
Y Nevertheless, the early results give considerable optimism for the
reported significantly higher scores on scales measuring functional eventual establishment of TARE as a valuable component of our
wellbeing (p<0.001) and overall HRQoL (p<0.001) compared with those armamentarium for effective therapy of HCC. ■
treated with cisplatin. At six-month follow-up, patients treated with
90
Y
reported significantly higher functional wellbeing than patients treated
Laura E Moreno-Luna, MD, is a Professor of Clinical Gastroenterology at the University of
with cisplatin (p<0.04); however, the overall HRQoL was no longer
Guadalajara Medical School. She is a member of several professional societies and
significantly different between the two treatment groups. The results committees, including the Research Fellows Association of Mayo Clinic. Dr Moreno-Luna
of this study were consistent with previous reports that suggest HAI of
has presented at many regional, national, and international meetings, as well as leading
research projects and authoring and co-authoring many scientific papers.
chemotherapy is better tolerated than systemic chemotherapy.
58,59
HAI
of
90
Y microspheres demonstrated a slight advantage over HAI of
James C Andrews, MD, is a Professor of Radiology and a Consultant in the Division of
Vascular and Interventional Radiology at Mayo Clinic Rochester. He is one of the pioneers
cisplatin with regard to HRQoL even when patients with HAI of cisplatin
of hepatic radioembolization with
90
Y microspheres.
reported a significantly higher functional and overall HRQoL at
baseline.
58
A major contributor to the improved quality of life of patients
Lewis R Roberts, MB, ChB, PhD, is an Associate Professor
of Medicine and a Consultant in the Division of
receiving
90
Y microsphere radioembolization is the absence of an
Gastroenterology and Hepatology in the Department of
embolic effect to the hepatic artery distribution. This results in minimal Internal Medicine at Mayo Clinic Rochester. His clinical
abdominal pain or tumor lysis after therapy and consequently the
practice interests focus on hepatocellular carcinoma,
cholangiocarcinoma, and endoscopy. Dr Roberts is actively
therapy is usually accomplished as an outpatient procedure.
involved with numerous professional organizations,
including the American Association for Cancer Research
Conclusions
(AACR), the American College of Gastroenterology (ACG),
the American Gastroenterological Association (AGA), and the American Association for
Intra-arterial radionuclide therapies have recently shown promising
the Study of Liver Diseases, as well as Mayo Clinic committees.
results for the treatment of patients with unresectable HCC, with
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US ONCOLOGY 69
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