; ; ; ;
SIRT does indeed constitute a new therapeutic option for the local treatment of advanced HCC at the intermediate stage. The 2013 guideline from the German Society for Digestive and Metabolic Diseases (Deutsche Gesellschaft für Verdauungs- und Stoffwechselerkrankungen, DGVS) recommended further investigation of this method, especially compared with transarterial chemotherapy (TACE), which is well established and has been evaluated in clinical studies. Currently, only few studies exist that undertook a direct comparison of these methods among themselves or in combination with sorafenib. Salem and colleagues showed that in 291 patients who had been treated with yttrium microspheres, liver function and the presence of portal vein thrombosis were the most important parameters for survival. An advanced study (Salem et al, 2011) showed in a comparison of SIRT and TACE a longer time to progression in the SIRT group (13.3 months vs 8.4 months), however, the difference in median survival between the two groups did not reach significance (20.5 months vs 17.5 months). Furthermore, it became obvious that more than 1000 patients would have had to have been recruited into the study in order to show a significant difference. In future this will be realized only by conducting large multicenter studies. We live in hope that the value of SIRT for the treatment of diffuse tumors and in portal vein thrombosis will be confirmed in appropriate studies. A comparison of the treatment costs for SIRT and for newer medications (sorafenib, avastin, etc.) is currently not the main issue, as palliative drug treatment is employed only in patients who are not eligible for locoregional treatment.
Prof. Dr. med. Nisar P. Malek, Dr. med. Sebastian Schmidt, Petra Huber
Prof. Dr. med. Michael P. Manns, Prof. Dr. med. Tim F. Greten
Medizinische Klinik 1, Universitätsklinikum Tübingen
Conflict of interest statement
Prof. Malek has received payments for lectures from Bayer and consultation fees from Lilly.
Prof. Manns has received payments from Boehringer Ingelheim and BMS for his activities as advisory board member. He has benefited from third-party funding of studies by Bayer, Boehringer Ingelheim, BMS, Novartis, Pfizer, and Transgene.
The remaining authors declare that they have no conflicts of interest.
|1.||Salem R, Lewandowski RJ, Gates VL, et al.; Technology Assessment Committee; Interventional Oncology Task Force of the Society of Interventional Radiology: Research reporting standards for radioembolization of hepatic malignancies. J Vasc Interv Radiol 2011; 22: 265–78 CrossRef MEDLINE|
|2.||Sangro B, Carpanese L, Cianni R, et al.; European Network on Radioembolization with Yttrium-90 Resin Microspheres (ENRY): Survival after yttrium-90 resin microsphere radioembolization of hepatocellular carcinoma across Barcelona clinic liver cancer stages: a European evaluation. Hepatology 2011; 54: 868–78 CrossRef MEDLINE|
|3.||Golfieri R, Bilbao JI, Carpanese L, et al.; European Network on Radioembolization with Yttrium-90 Microspheres (ENRY) study collaborators. Comparison of the survival and tolerability of radioembolization in elderly vs. younger patients with unresectable hepatocellular carcinoma J Hepatol 2013; 59: 753–61 CrossRef MEDLINE|
|4.||Malek NP, Schmidt S, Huber P, et. al.: Clinical practice guideline: The diagnosis and treatment of hepatocellular carcinoma. Dtsch Arztebl Int 2014; 111: 101–6. VOLLTEXT|