الفهرس 
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Abstract
Hepatocellular carcinoma (HCC) is a common cancer that typically occurs in the setting of cirrhosis and chronic hepatitis virus infections. HCC is considered currently as global problem; its incidence is expected to increase dramatically by the next few decades.
More than 90 % of the accidentally diagnosed patients have non resectable tumor. Portal vein thrombosis, diffuse multifocal liver infiltration and large tumor burden are considered to be a great obstacle in front of the modern lines of treatment, even with Child a liver cirrhosis.
Transarterial intrahepatic application of Yttrium-90 microspheres may allow effective local treatment of patients with intrahepatic advanced hepatocellular carcinoma (HCC) with or without portal vein thrombosis.
The aim of this study was to validate evidence on the safety and efficacy of this treatment in an Egyptian cohort of patients with locally advanced HCC such as (large tumor burden, multifocal distribution, portal vein thrombosis). And to assess the response rate according to different approved response assessment guidelines (WHO and RECIST).
Patients and Methods
Starting from May 2013 till May 2015, eighty advanced unresectable HCC patients with and without portal vein thrombosis were included in this prospective study.
Yttrium-90 microspheres radiotherapy was performed and response rate was assessed according to different international response assessment criteria with sequential computed tomography scans till the last clinical visit or death. The safety of this technique was assessed according to the Common Toxicity Criteria version 3.
Results
This prospective study with median observation period of 6 month (min 1 month; max 18 months), the progression free survival after 6.5 months of follow up is 78% (95% CI 64-95%). All of the patients had liver cirrhosis, with ECOG performance status ranges between 0-1, 80% patients have Child A and 20% were early B cirrhosis. 55% of the patient have stage B according to BCLC Classification, while 45% had stage C. 43% of the patients had vascular invasion (portal vein thrombosis or hepatic vein) before therapy.
The mean radiation dose was 115 (+/-23) Gy per treatment. 65 – 70% of the patients had a follow-up of at least six months. The estimated time to progression (TTP) was 10 months. One year survival rate is 59%. The main adverse events were a transient fatigue-syndrome and lymphopenia in almost 60%. Three patients developed Grade 3 to 4 toxicity the bilirubin elevation after therapy.
Conclusion
Yttrium-90 resin microspheres radioemolization is a safe and effective treatment for patients with advanced HCC even with or without portal vein thrombosis, which has been proved by different international assessment guidelines. Since time to progression is comparable to systemic therapy, larger studies against or in combination with Sorafenib and TACE, with longer follow up assessment time are warranted.