Sumary of Is radioembolization appropriate for patients with limited extrahepatic spread?:
- There are four scenarios in which patients with HCC and extrahepatic disease (EHD) should be considered for locoregional therapy (LRT) in the form of radioembolization or other options (eg, ablation, external radiotherapy)..
- Riad Salem The second scenario relates to the patient with EHD who develops new, localized HCC in the liver, despite other disease being controlled with systemic therapy (ST)..
- The third scenario relates to the application of LRT among patients with advanced disease and EHD at initial presentation..
- In this setting, it is possible for 99% of the disease to be hepatic, with 1% manifested as EHD (eg, lung nodule)..
- We must recognize that there is a wide spectrum of disease and, rather than simply labeling both patients as advanced and dogmatically applying ST, individualized and personalized care is warranted..
- Although also advanced stage, only the LRTs have consistently downstaged patients to cure via resection or transplantation..
- In properly selected patients, LRT in the form of radioembolization should be considered, with or without ST, with the intent of achieving a curative outcome..
- It also highlights the limited granular data presented in ST trials relating to index lesion size, tumor burden, tumor distribution, location of disease and pattern of progression….