Comparative effectiveness of radioembolization and the standard of care for hepatocellular carcinoma: Is a randomized survival study feasible?

Multimodal treatment of unresectable hepatocellular carcinoma to achieve complete response results in improved survival

“…The current recommendation for BCLC stage C patients is sorafenib, a systemic targeted therapy which provides a median survival of 10.7 months . However, many centres treat patients with limited extrahepatic disease and/or portal vein thrombosis with liver‐directed therapy in light of data from large cohort studies which demonstrate favourable response and survival rates in these selected patients with advanced HCC when compared with historical controls treated with systemic therapy . To address this discrepancy between guidelines and current clinical practice, there are several ongoing multi‐centre randomized trials comparing transarterial radioembolization to systemic treatment for patients with advanced HCC (clinicaltrials.gov).…”

“…Patients with shunts greater than 15% or a calculated Y‐90 dose greater than 30 Gray to the lung were excluded from treatment with Y‐90. Y‐90 dose calculation was based on the body surface area method as described previously . Calculated tissue doses ranged from 80 to 120 Gray.…”

“…Y-90 dose calculation was based on the body surface area method as described previously. 13 Calculated tissue doses ranged from 80 to 120 Gray. Therapeutic Y-90 embolization to the hepatic lobe harbouring the dominant tumour volume was performed 2 weeks after mapping arteriography.…”