Primary liver
tumor with
hepatocellular carcinoma accounting for 75-80% of all such
tumors, is one of the global leading causes of
cancer-related death, especially in cirrhotic patients. Liver
tumors are highly hypervascularized via the hepatic artery, while normal liver tissues are mainly supplied by the portal vein; consequently, intra-arterially delivered treatment, which includes transarterial chemoembolization (TACE) and transarterial radioembolization (TARE), is deemed as a
palliative treatment. With the development of nuclear technology and radiochemistry, TARE has become an alternative for patients with
hepatic cancer, especially for patients who failed other
therapies, or for patients who need
tumor downstaging treatment. In practice, some
radionuclides have suitable physicochemical characteristics to act as radioactive
embolism agents. Among them, 90Y emits β rays only and is suitable for bremsstrahlung single photon emission computed tomography (BS SPECT) and positron emission tomography (PET); meanwhile, some others, such as 131I, 153Sm, 166Ho, 177Lu, 186Re, and 188Re, emit both β and γ rays, enabling
embolism beads to play a role in both
therapy and single photon emission computed tomography (SPECT) imaging. During TARE, concomitant imaging provide additive diagnostic information and help to guide the course of
liver cancer treatment. Therefore, we review the
theranostic radionuclides that have been used or could potentially be used in TARE for
liver cancer and focus on the clinical benefits of diagnostic applications, including real-time monitoring of
embolism beads, evaluating irradiation dose, predicting
therapy effects, and corresponding adjustments to TARE.