Background

The incidence of hepatocellular carcinoma (HCC) has been rising, and 80% of HCCs are unresectable at the time of presentation. In recent years, Yttrium-90 (Y90) radioembolization has arisen as a potential tool to treat the primary HCC tumor while also inducing contralateral liver hypertrophy to increase future liver remnant volumes. The goal of this multidisciplinary review is to summarize the contemporary evidence on the safety, efficacy, and utility of Y90 as a bridge to liver resection and transplant in patients with HCC.

Methods

A narrative review was conducted of the recent literature regarding the utilization of Y90 as a therapy prior to liver resection or transplant in patients with HCC. A specific emphasis was placed on articles published in the last 10 years.

Results

Y90 radioembolization has demonstrated a high safety profile and increasing utility in bridging and downstaging patients with HCC who subsequently undergo liver resection or transplant. The continuous advancements in treatment strategies and radiation dosimetry have paved the way for the incorporation of Y90 in all stages of HCC with different intents, including downstaging and bridging.

Conclusions

Y90 radioembolization can be safely used in the HCC population to bridge patients to resection or transplantation, induce future liver remnant growth, and select for less aggressive tumor biology prior to surgery.

中文翻译：

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Y90 用作肝细胞癌肝切除和移植桥梁的综述

背景

肝细胞癌 (HCC) 的发病率一直在上升，80% 的 HCC 在就诊时是不可切除的。近年来，钇 90 (Y90) 放射栓塞已成为治疗原发性 HCC 肿瘤的潜在工具，同时还能诱导对侧肝脏肥大以增加未来的残余肝脏体积。本多学科审查的目的是总结关于 Y90 作为 HCC 患者肝切除和移植桥梁的安全性、有效性和实用性的当代证据。

方法

对最近关于将 Y90 作为 HCC 患者肝切除或移植前治疗的文献进行了叙述性审查。特别强调过去 10 年发表的文章。

结果

Y90 放射栓塞已证明具有较高的安全性，并且在桥接和降期随后接受肝切除术或移植的 HCC 患者中越来越有用。治疗策略和辐射剂量学的不断进步为将 Y90 纳入具有不同意图的 HCC 的所有阶段铺平了道路，包括降期和桥接。

结论

Y90 放射栓塞可以安全地用于 HCC 人群，为患者提供切除或移植的桥梁，诱导未来的肝脏残余生长，并在手术前选择侵袭性较低的肿瘤生物学。