Current status of transarterial radioembolization

Table 1 Characteristics of commercially available ⁹⁰Y-particles

Feature	SIR-Spheres®	TheraSphere®
Isotope	90Y	90Y
Half life (h)	64.2	64.2
Material	Resin	Glass
Diameter (μm)	20-60	20-30
Activity per particle (Bq)	50	2500
Spheres per 3 GBq	40-80 × 106	1.2 × 106
Specific Gravity (g/mL)	1.6	3.2
Embolic effect	Mild	Negligible
Contrast injection	During infusion	No
FDA approved indication	CRC liver metastases with intrahepatic floxuridine	HCC

FDA: Food and Drug Administration; CRC: Colorectal cancer; HCC: Hepatocellular carcinoma.

Table 2 Summary of studies on ⁹⁰Y-transarterial radioembolization in hepatocellular carcinoma with more than 50 patients

Ref.	Patients (n)	Particle type	Stage	Design	Response (%)					Median survival (mo)
					CR	PR	SD	AR	PD
Lau et al[73]	71	Resin	CHILD A/B	Retrospective	0	27	65	92	8	9.4
Carr[74]	65	Glass	Okuda I/II	Prospective	3	28	40	71	29	Okuda I = 21.6; Okuda II = 10
Geschwind et al[75]	80	Glass	CHILD A/B	Retrospective	NA	NA	NA	NA	NA	CHILD A = 18.9; CHILD B = 8.2
Hilgard et al[34]	108	Glass	CHILD A/B	Retrospective	3	37	53	94	6	16.4 (CHILD A = 17.4; CHILD B = 6)
Salem et al[33]	291	Glass	CHILD A/B	Prospective	23	34	NA	NA	NA	CHILD A = 17.2; CHILD B = 7.7
Sangro et al[39]	325	Resin	BCLC A-D	Retrospective						12.8 (BCLC A = 24.4; BCLC B = 16.9; BCLC C = 10)
Mazzaferro et al[35]	52	Glass	CHILD A/B	Prospective	9.6	30.8	38.4	78.8	21.2	15

CR: Complete response; PR: Partial response; SD: Stable disease; AR: Any response; PD: Progressive disease; NA: Not available; BCLC: Barcelona Clinic Liver Cancer.

Table 3 Summary of studies comparing different treatments to ⁹⁰Y-transarterial radioembolization in hepatocellular carcinoma

Ref.	Patients (n)	Particle type	Stage	Design	Response (%)					Median survival (mo)
					CR	PR	SD	AR	PD
D'Avola et al[32]	35	Resin	CHILD A/B	Retrospective	NA	NA	NA	NA	NA	16
	43	Control			NA	NA	NA	NA	NA	8
Lewandowski et al[43]	43	Glass	UNOS T3	Retrospective	47	39	14	100	0	18.7
	43	TACE			17	54	26	97	3	35.7
Kooby et al[76]	27	Resin	Okuda I-III	Retrospective	0	11	56	87	33	6
	44	TACE			0	4	60	64	36	6
Salem et al[41]	123	Glass	BCLC A-D	Retrospective	NA	NA	NA	72	NA	20.5
	122	TACE			NA	NA	NA	69	NA	17.4
Lance et al[77]	38	Glass	CHILD A/B	Retrospective	NA	NA	NA	NA	NA	8
	35	TACE			NA	NA	NA	NA	NA	10.3
Moreno-Luna et al[26]	55	Glass	CHILD A/B	Retrospective	12	39	39	91	9	15
	61	TACE			4	47	34	85	15	14.4
Gramenzi et al[47]	63	Resin	BCLC B/C	Retrospective	14	54	14	72	28	13.2
	74	Sorafenib			0	10	42	52	48	14.4

CR: Complete response; PR: Partial response; SD: Stable disease; AR: Any response; PD: Progressive disease; NA: Not available; TACE: Transarterial chemoembolization; BCLC: Barcelona Clinic Liver Cancer; UNOS: United Network for Organ Sharing.

Table 4 Summary of randomized controlled clinical trials comparing different treatments to ⁹⁰Y-transarterial radioembolization using resin spheres in colorectal liver metastases

Ref.	Patients (n)	Protocol	Design	Setting	Response (%)					Progression free survival (mo)	Median survival (mo)
					CR	PR	SD	AR	PD
Gray et al[19]	36	TARE + HAI FUDR	RCT - Phase III	Early line	6	44	28	78	14	15.9 (liver)	17
	34	TARE - HAI FUDR			0	22	48	70	30	9.7 (liver)	15.9
Van Hazel et al[21]	11	TARE + 5-FU/LV	RCT - Phase II	1. line	0	91	9	100	0	18.6	29.4
	10	5-FU/LV			0	0	60	60	40	3.6	12.8
Hendlisz et al[20]	21	TARE + 5-FU	RCT - Phase III	Salvage	0	10	80	90	10	4.5	10
	23	5-FU			0	0	36	36	64	2.1	7.3
Gibbs et al[24]	267	TARE + FOLFOX ± Bevacizumab	RCT - Phase III	1. line	4.5	71.9	NA	NA	NA	10.7/20.5 (liver)	NA
	263	FOLFOX ± Bevacizumab			1.5	66.5	NA	NA	NA	10.2/12.6 (liver)	NA

CR: Complete response; PR: Partial response; SD: Stable disease; AR: Any response; PD: Progressive disease; NA: Not available; RCT: Randomized controlled clinical trial; HAI: Hepatic artery infusion; FUDR: Floxuridine; TARE: Transarterial radioembolization; 5-FU: 5-fluoruracil; LV: Leucoverin.

Table 5 Summary of studies on ⁹⁰Y-transarterial radioembolization in liver metastases from various tumor types with more than 10 patients published within the last 5 years

Ref.	Patients (n)	Particle type	Entity	Setting	Design	Response (%)					Median survival (mo)
						CR	PR	SD	AR	PD
Saxena et al[78]	48	Resin	NET	Salvage	Retrospective	15	40	23	78	22	35
Cao et al[79]	58	Resin	NET	Mixed	Retrospective	11.7	27.5	27.5	66.7	33.3	36
Paprottka et al[80]	42	Resin	NET	Mixed	Retrospective	0	22.5	75	97.5	2.5	NA
Memon et al[81]	40	Glass	NET	Mixed	Retrospective	1.2	62.7	32.5	96.4	3.6	34.4
Peker et al[82]	30	Resin	NET	Mixed	Retrospective	3	37	43	83	17	39
Haug et al[83]	58	Resin	Breast	Salvage	Retrospective	0	25	63	88	12	10.8
Cianni et al[84]	52	Resin	Breast	Salvage	Retrospective	0	56	35	91	9	11.5
Saxena et al[85]	40	Resin	Breast	≥ 1.line CTX	Retrospective	5	26	39	70	30	13.6
Gonsalves et al[86]	32	Resin	Uveal Melanoma	Salvage	Retrospective	3	3	56	62	38	10
Michl et al[87]	19	Resin	Pancreas	mixed	Retrospective	0	64.3	0	64.3	45.7	9

CR: Complete response; PR: Partial response; SD: Stable disease; AR: Any response; PD: Progressive disease; NA: Not available; CTX: Chemotherapy; NET: Neuroendocrine tumor.