RL is performed in people with liver cancer, both primary such as hepatocellular carcinoma and metastatic such as from colon adenocarcinoma. Surgical resection is considered the only curative treatment for liver cancer (other than liver transplantation for hepatocellular carcinoma) but it can only be performed in patients with sufficient remnant liver after resection (amongst other criteria). Both PVE and RL are performed in patients who are not surgical candidates due to insufficient future liver remnant (FLR), which is advised to be between 20-30% and 30-40% of the native liver volume in healthy and cirrhotic livers, respectively. Results<unk>  is a relatively new application of radioembolization and results are mainly reported in the form of retrospective chart review studies and case reports, without any prospective validation. Most authors report a comparable future liver remnant hypertrophy between portal vein embolization and RL, ranging between 10 and 47% with cases reaching up to 119% with RL. The main difference between the two is the time interval necessary for appropriate hypertrophy, greater for RL. PVE requires a shorter time frame to achieve comparable results, ranging between 2–6 weeks, while the hypertrophy kinetics of RL are slower but more constant, without significant plateau (some studies report continued hypertrophy up to 9 months). Some authors have even raised concerns regarding PVE and the potential interval disease progression in the embolized and treatment naive lobes while allowing hypertrophy, which is of less concern with RL due to its added tumoricidal effect. Additionally, RL has been demonstrated to aid surgical resection in some cases by inducing a “vascular shift” of tumor masses via necrosis and contraction away from major vascular pedicles, converting patients to resectable status. One study has shown preliminary 600-day survival in 12 out of 13 patients who received RL and subsequent resection. Ultimately, further studies are needed to prospectively compare survival and recurrence outcomes in patients receiving RL versus PVE.
Radiation lobectomy
VATS lobectomy
Selective internal radiation therapy
Chemoradiotherapy
Tomotherapy
Image-guided radiation therapy
Metastasectomy
External beam radiotherapy