Learning objectives
To review the current and emerging literature surrounding selective internal radiation therapy (SIRT) for hepatocellular carcinoma (HCC), with a focus on recent technical refinements and expanding applications to summarise its role in the current era of HCC treatment following the 2022 Barcelona Clinic Liver Cancer (BCLC) staging system update.
Background
Background
Primary liver malignancy, of which HCC is the most common type is the sixth most common cancer worldwide [1, 2].
SIRT, also known as radioembolisation, is a locoregional treatment option for HCC that involves transarterial delivery of the β-emitter Yttrium-90 (90Y) via resin or glass microspheres to arterialised tumour vasculature, delivering a tumouricidal dose to the tumour.
Historically, the precise role for SIRT was not consistently defined in international HCC treatment guidelines as initially there was failure of earlier RCTs (SARAH, SIRveNIB, SORAMIC) to...
Imaging findings OR Procedure details
Conventional SIRT
Infusion of radioactive substances, typically 90Y resin or glass microspheres, into the hepatic artery to selectively target liver tumours forms the basis of radioembolisation.
The 3 landmark RCTs based on90Y resin spheres mainly used an older dosimetry technique:
SARAH - Body Surface Area (BSA) dosimetry method and both lobar and segmental delivery [8].
SIRveNIB - Mix of BSA and partition dosimetry [9].
SORAMIC - BSA and lobar delivery [10].
- Another older dosimetry approach is the Medical Internal Radiation Dosimetry (MIRD) method for...
Conclusion
SIRT is an established and integral part of HCC treatment.
Althoughinitial RCTs (SARAH, SIRveNIB, SORAMIC) have not shown superiority over sorafenib, subgroup analyses and lessons gained from these trials have guided more recent studies with contemporary data showing survival benefit driven by advances in patient selection, ablative techniques and personalised dosimetry.
Incorporation of SIRT into the 2022 BCLC algorithm marks substantial progress from the early failures of landmark SIRT trials.
However, recently published findings are likely to have further impact on the BCLC treatment algorithm...
Personal information
D. Duong:
Nothing to disclose
H. Briody:
Nothing to disclose
A. Hannah:
Nothing to disclose
S. Leong:
Nothing to disclose
M. J. Lee:
Nothing to disclose
J. Maingard:
Nothing to disclose
H. Asadi:
Nothing to disclose
H. K. Kok:
Nothing to disclose
References
1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87-108.
2. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359-86.
3. Bruix J, Reig M, Sherman M. Evidence-Based Diagnosis, Staging, and Treatment of Patients With Hepatocellular Carcinoma. Gastroenterology. 2016;150(4):835-53.
4. Forner A, Reig M, Bruix J. Hepatocellular carcinoma. Lancet. 2018;391(10127):1301-14.
5.Garin...
