LAUSR

In recent years, transarterial radioembolization (TARE) with Yttrium-90 (Y90) has emerged as a technique for treating malignant neoplasms in the liver. Compared with other locoregional therapies, such as transarterial chemoembolization (TACE), patients who underwent TARE with Y90 have higher tumor response rates and better outcomes. Moreover, no significant treatment-related complications or treatment-related deaths have been reported [1]. We here review the clinical application of TARE and its associated issues. TARE is most frequently used to treat hepatocellular carcinoma (HCC). Salem et al. [2] performed a study to compare the effects of TACE and TARE in 179 patients with Barcelona Clinic Liver Cancer (BCLC) stages A or B HCC. They found similar tumor response rates in the two groups (74% in the TACE group vs 87% in the TARE group) (P1⁄4 0.433). However, patients in the TARE group had a significantly longer median time to progression (>26 months) than those in the TACE group (6.8 months) (P< 0.001). Furthermore, the occurrence rate of complications was lower in the TARE group. The most recent study by Salem et al. [3] presented overall survival (OS) outcomes in a 1,000-patient cohort acquired over a 15-year period. On the basis of these data, they decided to adopt TARE as the first-line transarterial locoregional therapy for patients with HCC. The only treatment recommended by the BCLC system for patients with advanced HCC and portal vein tumor thrombus (PVTT) or hepatic vein tumor thrombus is Sorafenib [4]. However, the management of advanced HCC is complex and still controversial. Recently, two phase III clinical trials compared TARE and Sorafenib and concluded that the results of TARE are not better than those of Sorafenib in terms of survival benefits [5]. However, this does not mean that TARE should not be used to treat advanced HCC. In fact, the difficulties and potential biases undermining trials that compare an interventional procedure (TARE) with a drug (Sorafenib) should be carefully analysed. Spreafico et al. [6] performed a single-center retrospective study that included 120 patients with advanced HCC and PVTT. These patients were all treated with TARE. Median OS was 14.1 months (95% confidence interval, 10.7–17.5) and 1-year and 3-year OS rates were 53.2% and 18.5%, respectively. These survival results seem to be better than those achieved by Sorafenib. The researchers further developed a prognostic score model to predict response to TARE for patients with HCC and PVTT. They identified three prognostic categories: favorable, intermediate, and dismal prognoses. Median OS in these three categories was 32.2, 14.9, and 7.8 months, respectively (P< 0.001) [6]. This model may help doctors to better identify patients who are suitable for TARE treatment. Liver transplantation (LT) is a curative therapy option for patients with HCC who meet the Milan criteria. However, there is usually a 6-month to 1-year wait for an appropriate donor liver. During this period, interventional procedures are usually required to prevent tumor progression. In addition, the tumor stage of patients with HCC that does not meet the Milan criteria can be reduced by interventional therapy to the point of meeting these criteria. Interventional specialists may prefer TARE because of its better disease-free survival and OS and lower toxicity than with TACE. Ettorre et al. [7] performed TARE before LT in 22 patients with HCC, including 3 who met the Milan criteria prior to treatment with TARE and 19 who did not. Downstaging was observed in 78.9% of cases and bridging was achieved in