Roberts_subbed_EU Onc.qxp

Hepatocellular carcinoma (HCC) is the sixth most common malignancy and the third most common cause of death from cancer worldwide.1 The incidence of HCC in the US is increasing because of the rise in the prevalence of hepatitis C virus infection.2,3 HCC-related mortality is high because most cases are diagnosed at an advanced stage, when potentially curative therapies such as liver transplantation, surgical resection and local ablation are not feasible.4–7 The majority of patients are therefore candidates for palliative therapies only.8 Due to the capacity of liver cells to detoxify and excrete drugs, HCCs are relatively resistant to chemotherapy; in addition, the splenomegaly and cytopenias associated with cirrhosis with portal hypertension render patients prone to systemic chemotherapy-related toxicity.9 Transarterial chemoembolisation (TACE) is a loco-regional therapy that delivers high doses of chemotherapy to HCCs through the hepatic artery, with limited systemic effect. TACE has been proved to improve survival of patients with unresectable HCC without portal vein thrombosis (PVT).10–12 Recently, a number of devices for transarterial radioembolisation (TARE) have been tested for treatment of HCC in early-phase studies. This article will summarise the results thus far, with an emphasis on yttrium-90 (90Y) radioactive glass microspheres, which are the only modality currently approved for use in the US.