The American Brachytherapy Society consensus statement for permanent implant brachytherapy using Yttrium-90 microsphere radioembolization for liver tumors

PURPOSE: To develop a multidisciplinary consensus for high quality multidisciplinary imple-mentation of brachytherapy using Yttrium-90 ( 90 Y) microspheres transarterial radioembolization ( 90 Y TARE) for primary and metastatic cancers in the liver.METHODS AND MATERIALS: Members of the American Brachytherapy Society (ABS) and colleagues with multidisciplinary expertise in liver tumor therapy formulated guidelines for 90 Y TARE for unresectable primary liver malignancies and unresectable metastatic cancer to the liver. The consensus is provided on the most recent literature and clinical experience.RESULTS: The ABS strongly recommends the use of 90 Y microsphere brachytherapy for the definitive/palliative treatment of unresectable liver cancer when recommended by the multidisci-plinary team. A quality management program must be implemented at the start of 90 Y TARE program development and follow-up data should be tracked for efficacy and toxicity. Patient -specific dosimetry optimized for treatment intent is recommended when conducting 90 Y TARE. Implementation in patients on systemic therapy should account for factors that may enhance treat-ment related toxicity without delaying treatment inappropriately. Further management and salvage therapy options including retreatment with 90 Y TARE should be carefully considered.CONCLUSIONS: ABS consensus for implementing a safe 90 Y TARE program for liver cancer in the multidisciplinary setting is presented. It builds on previous guidelines to include recommen-dations for appropriate implementation based on current literature and practices in experienced centers. Practitioners and cooperative groups are encouraged to use this document as a guide to formulate their clinical practices and to adopt the most recent dose reporting policies that are criti-cal for a unified outcome analysis of future effectiveness studies.(c) 2022 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Automated summary

This article aims to develop a multidisciplinary consensus for the high-quality implementation of Yttrium-90 (90Y) microsphere brachytherapy for primary and metastatic liver cancer using transarterial radioembolization (90Y TARE). The guidelines are based on the most recent literature and clinical experience, covering indications for 90Y TARE, quality management, treatment dosimetry, and follow-up management.