Radioembolization (yttrium-90 microspheres) for primary and metastatic hepatic malignancies.

Radioembolization using radioactive yttrium-90-labeled microspheres is gaining a stronger foothold in the management of primary and metastatic hepatic cancers. The expanding literature reveals good and encouraging results in both retrospective and prospective reports as demonstrated by low acute or late toxicity and high response rates. This treatment modality, which is most beneficial in patients with good liver reserve and low Eastern Cooperative Oncology Group performance status, has led to improved time to liver progression and extended overall patient survival. Although the phase III trials of radioembolization are ongoing as a first-line treatment of patients with metastatic colorectal cancer, there are sufficient phase II and retrospective clinical data supporting its use in salvage therapy for most patients. Patients with hepatocellular cancer, neuroendocrine tumors, and other primary sites, including breast and lung, have also shown promising response and survival increases in multi-institutional experiences.