title: Transarterial radioembolization for hepatocellular carcinoma: An update and perspectives.
abstract: In the last decade trans-arterial radioembolization has given promising results in the treatment of patients with intermediate or advanced stage hepatocellular carcinoma (HCC), both in terms of disease control and tolerability profile. This technique consists of the selective intra-arterial administration of microspheres loaded with a radioactive compound (usually Yttrium(90)), and exerts its therapeutic effect through the radiation carried by these microspheres. A careful and meticulous selection of patients is crucial before performing the radioembolization to correctly perform the procedure and reduce the incidence of complications. Radioembolization is a technically complex and expensive technique, which has only recently entered clinical practice and is supported by scant results from phase III clinical trials. Nevertheless, it may represent a valid alternative to transarterial chemoembolization (TACE) in the treatment of intermediate-stage HCC patients, as shown by a comparative retrospective assessment that reported a longer time to progression, but not of overall survival, and a more favorable safety profile for radioembolization. In addition, this treatment has reported a higher percentage of tumor shrinkage, if compared to TACE, for pre-transplant downsizing and it represents a promising therapeutic option in patients with large extent of disease and insufficient residual liver volume who are not immediately eligible for surgery. Radioembolization might also be a suitable companion to sorafenib in advanced HCC or it can be used as a potential alternative to this treatment in patients who are not responding or do not tolerate sorafenib.
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Luca Giacomelli, Marco Bertini, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Ambra Corti, Department of Gastroenterology, Pisa University Hospital, 56124 Pisa, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Sacco
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Luca Giacomelli, Marco Bertini, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Ambra Corti, Department of Gastroenterology, Pisa University Hospital, 56124 Pisa, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Mismas
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Luca Giacomelli, Marco Bertini, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Ambra Corti, Department of Gastroenterology, Pisa University Hospital, 56124 Pisa, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Marceglia
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Luca Giacomelli, Marco Bertini, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Ambra Corti, Department of Gastroenterology, Pisa University Hospital, 56124 Pisa, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Romano
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Luca Giacomelli, Marco Bertini, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Ambra Corti, Department of Gastroenterology, Pisa University Hospital, 56124 Pisa, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Giacomelli
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Luca Giacomelli, Marco Bertini, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Ambra Corti, Department of Gastroenterology, Pisa University Hospital, 56124 Pisa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bertini
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Luca Giacomelli, Marco Bertini, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Ambra Corti, Department of Gastroenterology, Pisa University Hospital, 56124 Pisa, Italy.
authors.forename: Graziana
authors.initials: G
authors.lastname: Federici
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Luca Giacomelli, Marco Bertini, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Ambra Corti, Department of Gastroenterology, Pisa University Hospital, 56124 Pisa, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Metrangolo
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Luca Giacomelli, Marco Bertini, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Ambra Corti, Department of Gastroenterology, Pisa University Hospital, 56124 Pisa, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Parisi
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Luca Giacomelli, Marco Bertini, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Ambra Corti, Department of Gastroenterology, Pisa University Hospital, 56124 Pisa, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Tumino
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Luca Giacomelli, Marco Bertini, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Ambra Corti, Department of Gastroenterology, Pisa University Hospital, 56124 Pisa, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Bresci
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Luca Giacomelli, Marco Bertini, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Ambra Corti, Department of Gastroenterology, Pisa University Hospital, 56124 Pisa, Italy.
authors.forename: Ambra
authors.initials: A
authors.lastname: Corti
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Luca Giacomelli, Marco Bertini, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Ambra Corti, Department of Gastroenterology, Pisa University Hospital, 56124 Pisa, Italy.
authors.forename: Manuel
authors.initials: M
authors.lastname: Tredici
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Luca Giacomelli, Marco Bertini, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Ambra Corti, Department of Gastroenterology, Pisa University Hospital, 56124 Pisa, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Piccinno
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Luca Giacomelli, Marco Bertini, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Ambra Corti, Department of Gastroenterology, Pisa University Hospital, 56124 Pisa, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Giorgi
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Luca Giacomelli, Marco Bertini, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Ambra Corti, Department of Gastroenterology, Pisa University Hospital, 56124 Pisa, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Bartolozzi
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Luca Giacomelli, Marco Bertini, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Ambra Corti, Department of Gastroenterology, Pisa University Hospital, 56124 Pisa, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Bargellini
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000473:pathology / Q000532:radiotherapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000473:pathology / Q000532:radiotherapy*; D008863:Microspheres; D009367:Neoplasm Staging; D019275:Radiopharmaceuticals / Q000008:administration & dosage* / Q000009:adverse effects; D011879:Radiotherapy Dosage; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals
keywords: Clinical trial; Downsizing; Hepatocellular carcinoma; RECIST, Modified RECIST; Radioembolization; Sorafenib; Staging; Transarterial chemoembolization