General selection criteria of patients for radioembolization of liver tumors: an international working group report.

A combined treatment approach that incorporates surgical resection, ablation, chemotherapy, targeted agents, and radiotherapy has augmented the management of liver tumors (both primary and metastatic). The challenge that remains is how to reduce the burden of liver disease and thus enable greater patient eligibility for resection as well as lengthened survival for those who remain unsuitable for surgery. Radioembolization can deliver high doses of radiation preferentially to liver tumors and is a valuable treatment option that should be considered as part of a multimodal treatment approach for the management of patients in whom the liver is the sole or dominant site of disease. Essential in this consideration is a careful assessment by a multidisciplinary team of the individuals most likely to benefit from this treatment modality. Along with the clinical benefits, integration of radioembolization into the treatment paradigm can provide added options of using systemic chemotherapy synergistically as a radiosensitizer and to control extrahepatic metastases, permitting a reduction in hepatic disease and conserving remaining liver function. If successful, the possibility of improved patient survival and quality of life is increased.