Locoregional therapy for hepatocellular carcinoma: radioembolization with yttrium-90 microspheres

Compared with other malignant tumours, hepatocellular carcinoma (HCC) exhibits particular characteristics regarding its supplying vessels and tumour biology. If a potentially curative surgical approach, such as resection or liver transplantation, is due to technical or prognostical reasons no option, these characteristics are a fundamental prerequisite for the possibility to effectively treat this tumour by local ablation methods. Microsphere and particle technology with selective transport of tumoricidal substances or radiation represents a new generation of therapeutics in interventional oncology. With the intrahepatic application of radioactive microspheres via the hepatic artery (radioembolization) local ablation can be performed even of diffuse and multifocal liver tumours, which hitherto, could only be approached with systemic therapy. The present standard for radioembolization, is the use of yttrium-90 glass or resin microspheres. The indications, technique and current results of radioembolization with yttrium-90 microspheres for the treatment of HCC are discussed in this review.