Percutaneous transcatheter particle therapies

Abstract

Given that only 20-30% of patients with hepatocellular carcinoma and colorectal liver metastases present with resectable disease, there has been an increasing role for the use of percutaneous transcatheter particle therapies in themanagement of unresectable hepatic malignancies. These therapies involve infusing therapeutic and embolic agents into the hepatic artery, thereby directly targeting tumors while sparing the nontumoral surrounding liver parenchyma. Initiallyonly used for palliation, these therapies are increasingly being used with curative intent. Conventional transarterial chemoembolization (cTACE) has been associated with improved survival in patients with unresectable hepatocellular carcinoma, and preoperative cTACE has been shown to decrease the risk of tumor progression for patients awaiting hepatic transplantation. Chemoembolization with drug-eluting beads (DEB-TACE) offers similar tumor response rates and survival rates as cTACE, while offering potential reduced liver toxicity. Bland transarterial embolization (TAE) also appears to offer improved survival, leading some groups to preferentially utilize TAE in an attempt to avoid chemotherapy-related complications. Radioembolization, or selective internal radiation therapy (SIRT), with Yttrium-90 has been associated with longer time to progression, better tolerability, and improved quality of life over TACE, and resection after SIRT has been shown to be safe and feasible. In this chapter, we provide an evidence-based approach to reviewing the existing data for each of these therapies. Given multiple options and the potential for combining transarterial therapies with other treatment modalities, discussion of treatment choices in multidisciplinary tumor boards and careful patient selection are critical.