CURRENT ROLE OF SELECTIVE INTERNAL IRRADIATION WITH YTTRIUM-90 MICROSPHERES IN THE MANAGEMENT OF HEPATOCELLULAR CARCINOMA: A SYSTEMATIC REVIEW

Purpose: This article reviews the role of selective internal irradiation (SIR) with yttrium-90 ((90)Y) microspheres for hepatocellular carcinoma (HCC). Methods and Materials: Studies were identified by searching Medline and PubMed databases for articles from 1990 to 2009 using the keywords selective internal irradiation, hepatocellular carcinoma, therapeutic embolization, and yttrium-90. Results: 90Y microspheres are a safe and well-tolerated therapy for unresectable HCC (median survival range, 7 -21.6 months). The evidence was limited to cohort studies and comparative studies with historical control. (90)Y microspheres have been reported to downstage unresectable HCC to allow for salvage treatments with curative intent, act as a bridging therapy before liver transplantation, and treat HCC with curative intent for patients who are not surgical candidates because of comorbidities. Conclusions: (90)Y microsphere is recommended as an option of palliative therapy for large or multifocal HCC without major portal vein invasion or extrahepatic spread. It can also be used for recurrent unresectable HCC, as a bridging therapy before liver transplantation, as a tumor downstaging treatment, and as a curative treatment for patients with associated comorbidities who are not candidates for surgery. (C) 2011 Elsevier Inc.