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Advances in Radiotherapy
& Nuclear Medicine SIR-spheres Y-90 resin microspheres for HCC treatment

1. Introduction The objective of this study was to determine the clinical
effectiveness and safety of using SIRT to treat HCC in
Worldwide, liver cancer is one of the most commonly Vietnamese patients. Effectiveness was assessed by the
diagnosed cancers and is the second-leading cause of response rate of the targeted lesions and the percentage
cancer-related deaths in men . In Vietnam, the incidence of patients alive 6 months after SIRT. Safety was assessed
[1]
rate of liver cancer (15.4%) was higher than that of lung by changes in liver function parameters and the frequency
cancer (14.4%), and the mortality rate for liver cancer was of nonspecific and radiation-specific adverse events (AEs)
22% in 2018 . Many patients present with unresectable and serious AEs (SAEs).
[2]
hepatocellular carcinoma (HCC) or are otherwise not
candidates for curative treatment. A recent study of patients 2. Methods
with HCC treated at Cho Ray Hospital, the largest tertiary
care center in South Central Vietnam, reported that 40.8% 2.1. Ethics and compliance
of the patients presented with advanced HCC amenable This study was a single-arm, prospective, multicenter
[3]
only to palliative care . For these patients, locoregional observational study of patients receiving yttrium-90 resin
therapies can improve survival and quality of life . microspheres to treat unresectable HCC. The study was
[4]
Selective internal radiation therapy (SIRT), a approved by the Ethics Committee of the Ministry of Health
sophisticated treatment, is available at specialized centers of Vietnam (certificate of approval No. 59/CN-BDGĐĐ).
and requires a multidisciplinary team to review candidacy All patients provided written informed consent before
and management decisions . SIRT delivers yttrium-90 enrollment. In the case that any patient declined to
[5]
microspheres through the hepatic artery to treat hepatic participate in the study, they still received standard of care,
tumors directly. The 2017 Asia-Pacific clinical practice as did the patients who agreed to participate in the study.
guidelines on the management of HCC suggest that SIRT 2.2. Patient selection and assessments
may be considered an alternative for patients who are not
candidates for transarterial chemoembolization (TACE) . Between May 2017 and November 2018, 46 patients were
[6]
screened at Military Central Hospital or Bach Mai Hospital
Even though SIRT has been used for 10 years in in Vietnam for inclusion in this observational study up to
Vietnam, no prospective studies have been reported to 4 weeks before the day of their scheduled SIRT procedure.
support its use there. Data have been limited from Asian Which study group patients were assigned to was decided
countries where the prevalence of HCC and hepatitis is by physicians who treated them, with the consent of
high. SIRT versus sorafenib was a phase 3, randomized, the professional board, based on the patients’ specific
multicenter trial that found SIRT comparable in overall conditions.
survival (OS) but superior in toxicity profile to sorafenib
for treating locally advanced HCC . Kim et al. reported Eligible patients were at least 18 years of age with
[7]
that SIRT was safe and efficacious in treating 40 Korean clinically diagnosed HCC that was unresectable or
patients with HCC . unsuitable for an immediate liver transplant, with total
[8]
bilirubin ≤2 mg/dL, tumor burden ≤50%, Child-Pugh
Several retrospective studies have provided data on score class A or ≤B7, Barcelona Clinic Liver Cancer stage
the use of SIRT to treat unresectable HCC. The ENRY A–C, and Eastern Cooperative Oncology Group (ECOG)
(The European Network on Radioembolization with performance status ≤1.
Yttrium-90 resin microspheres study group) study
comprised a retrospective review of 325 patients with Exclusion criteria included extrahepatic disease,
HCC and demonstrated that survival was extended in a history of previous external beam radiation to the liver,
subset of patients with intermediate HCC who were poor intractable clinical ascites, any clinical sign of liver
candidates for chemoembolization as well as those for failure, upper gastrointestinal (GI) bleeding due to portal
whom chemoembolization had failed . However, only a hypertension within 1 month, or presence of main portal
[9]
few studies documented real-world experience in Asian vein thrombosis.
countries regarding the treatment of patients with HCC Medical histories were documented, and prior surgeries
using SIRT. Khor et al. retrospectively reviewed the use of were self-reported because electronic medical records were
SIRT in Singapore for 103 patients of varied ethnicity , not in use at the time of the study. Child-Pugh classification
[10]
and Woo et al. retrospectively analyzed the clinical was assessed at screening and 6 months. ECOG
outcomes in 50 Korean patients with HCC, many of whom performance status was assessed on the day of SIRT and
had chronic hepatitis infection, who were treated with 1 week and 6 months after SIRT. If participants prematurely
SIRT . Neither study included Vietnamese patients. left the study, their ECOG status was assessed on their
[11]

Volume 1 Issue 1 (2023) 2 https://doi.org/10.36922/arnm.0385