الفهرس 
INTRODUCTION AND Aim Of The WorkOnly 14 pages are availabe for public view
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Abstract
The incidence of liver cancer continues to increase. It represents one of the most common and most challenging situations in oncology and the third leading cause of cancer associated deaths in the world.
Radioembolization is a form of brachytherapy in which intra¬arterially injected Y90 -loaded microspheres serve as sources for internal radiation purposes. Radioactive microspheres are infused through minimally invasive transcatheter therapy into the hepatic arteries that supply tumor. Once infused, these microspheres traverse the hepatic vascular plexus and selectively implant within the tumor arterioles. Embedded within the arterioles, the isotope impregnated microspheres emit high energy and low penetrating radiation doses selectively to the tumor.
When radioembolization compared to the standard of care for the intermediate and advanced stages, RE consistently provides similar survival rates. Two indications seem particularly appealing in the boundaries of these stages. First, the treatment of patients straddling between the intermediate and advanced stages (e.g. patients with bulky or bilobar disease that are considered poor candidates for TACE, patients with solitary tumors invading a segmental or lobar branch of the portal vein). Second, the treatment of patients that are slightly above the criteria for resection, ablation or transplantation, for which down staging could open the door for a radical approach. RE can also be used to treat patients progressing to TACE or sorafenib.
Y90 radioembolotherapy is a promising outpatient transarterial therapy for unresectable hepatocellular cancer. It is a unique form of brachytherapy that shares characteristics of radiopharmaceuticals and a radiation therapy source, requiring multidisciplinary involvement. Knowledge of technical aspects of embolization, hepatic artery anatomy, and flow characteristics are essential for safe and effective delivery of this new therapy. Published data from multiple independent sources support enhancement of survival in a distinct subset of patients with hypervascular tumors and intact liver function. Unlike other embolotherapies, portal vein thrombosis is not considered to be a major contraindication.Y90 radioembolotherapy has served as an effective instrument to downstage to resection or as a bridge to transplantation. Compared to historical controls, the postembolization syndrome following Y90 radioembolotherapy is milder than chemoembolization while conferring a similar survival advantage.