***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose To investigate early diffusion-weighted imaging ( DWI ) at 30-days post-yttrium-90 ( Y-90 ) radioembolization as a predictor of treatment response and survival in unresectable infiltrative hepatocellular carcinoma ( HCC ) with portal vein thrombosis ( PVT ) . Material s and methods In a prospect i ve study , 18 consecutive patients with unresectable infiltrative HCC and PVT underwent Y-90 therapy . MR imaging was obtained pre Y-90 , and at 1 and 3 months post-therapy with DWI fat-suppressed tri-directional diffusion gradient ( b = 50 , 400 , 800 s/mm2 ) . Response was evaluated using target mRECIST and EASL . Relative change in apparent diffusion coefficient ( ADC ) value of tumors was evaluated . Statistical analysis using receiver operator characteristic curves was performed . Paired t test and Pearson correlation coefficient ( r ) were used to assess intra- and inter-observer variability . Survival analysis was performed using Kaplan-Meier estimation and log-rank test . Results Mean ADC values of all HCC ’s at baseline and at 30-days post-Y90 therapy was 0.86 × 10−3 and 1.17 × 10−3 mm2/s , respectively ( p < 0.001 ) . Tumors with objective response by mRECIST had significantly increased ADC value when compared to “ non-responders ” ( 1.27 vs. 1.05 × 10−3 mm2/s , p = 0.002 ) . A > 30 % increase in ADC value at 30-days was found to be at least 90 % sensitive in predicting response at 90 days . A > 30 % increase in ADC value at 30-days predicted significantly prolonged survival . Conclusion A 30 % increase in ADC value at 30-days measured post Y90 is a reproducible early imaging response biomarker predicting tumor response and prolonged survival  following Y-90 therapy in infiltrative HCC with PVT UNLABELLED Yttrium-90 radioembolization ( Y90RE ) is a novel approach to radiation therapy for hepatocellular carcinoma ( HCC ) , never tested in phase 2 studies . Fifty-two patients with intermediate ( n.17 ) to advanced ( n.35 ) HCC were prospect ively recruited to assess , as the primary endpoint , efficacy of Y90RE on time-to-progression ( TTP ) . Secondary endpoints were tumor response , safety , and overall survival ( OS ) .  All patients were Eastern Cooperative Oncology Group ( ECOG ) score 0 - 1 , Child-Pugh class A-B7 .  Y90RE treatments aim ed at a lobar delivery of 120 Gy . Retrospective dosimetric correlations were conducted and related to response . Fifty-eight treatments were performed on 52 patients . The median follow-up was 36 months . The median TTP was 11 months with no significant difference between portal vein thrombosis ( PVT ) versus no PVT ( 7 versus 13 months ) . The median OS was 15 months ( 95 % confidence interval [ CI ] , 12 - 18 months ) with a nonsignificant trend in favor of non-PVT versus PVT patients ( 18 versus 13 months ) . Five complete responses occurred ( 9.6 % ) , and the 2 year-progression rate was 62 % . Objective response was 40.4 % , whereas the disease control rate ( 78.8 % ) significantly affected survival ( responders versus nonresponders : 18.4 % versus 9.1 % ; P = 0.009 ) . Tumor response significantly correlated with absorbed dose in target lesions ( r = 0.60 , 95 % CI , 0.41 - 0.74 , P < 0.001 ) and a threshold of 500 Gy predicted response ( area under the curve , 0.78 ) . Mortality at 30 - 90 days was 0%-3.8 % . Various grade s of reduction in liver function occurred within 6 months in 36.5 % of patients , with no differences among stages . On multivariate analysis , tumor response was the sole variable affecting TTP ( P < 0.001 ) and the second affecting survival ( after Child-Pugh class ) . CONCLUSION Y90RE is an effective treatment in intermediate to advanced HCC , particularly in the case of PVT . Further prospect i ve evaluations comparing Y90RE with conventional treatments are warranted Purpose There was no st and ard treatment for hepatocellular carcinoma with portal vein tumour thrombosis ( PVTT ) . This prospect i ve , r and omised , two-arm clinical trial aims to investigate the feasibility , safety and effectiveness of transarterial chemoembolisation ( TACE ) combined with the endovascular implantation of an iodine-125 seed str and for the treatment of hepatocellular carcinoma with portal vein tumour thrombosis versus conventional TACE . Patients and methods Eighty-five patients who met the eligibility requirements were r and omly assigned to receive the treatment of TACE combined with the endovascular implantation of an iodine-125 seed str and ( 43 cases ) or conventional TACE ( 42 cases ) . The end points were survival time , complications related to the procedure and adverse events . Results No significant differences in baseline characteristics were observed between groups . The mean and median survival times were 221.7 ± 16.3 days [ 95 % confidence interval ( CI ) 189.8–253.6 days ] and 210.0 ± 17.5 days ( 95 % CI 175.8–244.2 days ) in group A and 155.1 ± 7.9 days ( 95 % CI 139.6–170.5 days ) and 154.0 ± 11.2 days ( 95 % CI 133.2–176.0 days ) in group B ( P = 0.000 ) . The 90- , 180- and 360-day cumulative survival rates were 97.6 , 58.9 and 12.3 % in group A and 92.5 , 30.7 and 0 % in group B ( P = 0.000 ) . Conclusion Transarterial chemoembolisation combined with the endovascular implantation of an iodine-125 seed str and is feasible , safe and effective in the treatment for hepatocellular carcinoma with PVTT BACKGROUND The goal of this study was to examine the safety and efficacy of selective internal radioembolization ( SIR ) for hepatocellular carcinoma ( HCC ) with portal vein or caval thrombosis ( VT ) , or both . Recent reports have demonstrated that SIR is safe for patients with HCC , but the impact on efficacy of venous thrombosis is unknown . STUDY DESIGN Prospect i ve single-arm study of the use of Therasphere in patients with unresectable HCC enrolled from January 2004 to June 2007 . Patients were categorized into three groups based on VT status and therapy . RESULTS Fifty-two patients were enrolled : 20 patients without VT who received SIR , 15 patients with VT who were treated , and 17 patients ( 10 with VT ) who were not treated because of preprocedure screening failure . Fifty-eight treatments were administered , with a median of two treatments per patient ( range of one to three treatments ) . Child 's score was different between groups . Of the VT patients treated , 67 % had portal VT , 7 % had cava VT , and 26 % had both . There were no treatment-related deaths . There was no difference in complications among groups ( p = 0.34 ) . Treated patients without thrombosis had a median overall survival of 13.9 months versus 2.7 months for those treated with thrombosis and 5.2 months for the untreated group given best supportive care only ( p = 0.01 ) . CONCLUSIONS SIR is safe in patients with HCC . Although SIR can be delivered with minimal morbidity , there might be no benefit for patients with VT . Continued emphasis on multimodality therapy in this population is needed to improve survival Disease Control Rate ( DCR ) and Clinical Benefit Rate ( CBR ) are defined as the percentage of patients with advanced or metastatic cancer who have achieved complete response , partial response and stable disease to a therapeutic intervention in clinical trials of anticancer agents .  DCR and CBR are commonly reported in many clinical trials in abstract s , papers , meeting presentations and media releases . The frequent use of these measures of drug activity presents the question of whether DCR and CBR are useful additional endpoints in early clinical trials , and if they can reasonably predict the success of an agent in subsequent , adequately powered , r and omized trials . There are no comprehensive analyses to demonstrate that CBR and DCR add to the value of traditional response/activity endpoints in early clinical trials . Data from phase II clinical trials in which the DCR or CBR are reported suggest that DCR or CBR provides ambiguous information that likely exaggerates the anticancer activity of the therapy . The terms ' disease control ' and ' clinical benefit ' in the context of non-r and omized trials are themselves disingenuous because neither tumor regression nor stable disease , defined without any consideration of duration of effect or reduction of symptoms appropriate for the specific patient population , are evidence of these endpoints in an individual patient UNLABELLED Radioembolization has been demonstrated to allow locoregional therapy of patients with hepatocellular carcinoma not eligible for transarterial chemoembolization or other local therapies . The aim of this study was to vali date evidence of the safety and efficacy of this treatment in a European sample of patients with advanced hepatocellular carcinoma ( HCC ) . Therefore , 108 consecutive patients with advanced HCC and liver cirrhosis were included .  Yttrium-90 ( Y-90 ) microspheres were administered in a lobar fashion over the right or left branch of the hepatic artery . The response to treatment was evaluated by computed tomography ( CT ) imaging applying Response Evaluation Criteria in Solid Tumors ( RECIST ) and World Health Organization ( WHO ) criteria with recent European Association for the Study of the Liver / National Cancer Institute ( EASL/NCI ) amendments . Time to progression ( TTP ) and overall survival were estimated by the Kaplan-Meier method . In all , 159 treatment sessions were performed ranging between one to three treatments per patient . The mean radiation dose per treatment was 120 ( ± 18 ) Gy . According to EASL criteria , complete responses were determined in 3 % of patients , partial responses in 37 % , stable disease 53 % , and primary progression in 6 % of patients . TTP was 10.0 months , whereas the median overall survival was 16.4 months . No lung or visceral toxicity was observed . The most frequently observed adverse events was a transient fatigue-syndrome . CONCLUSION Radioembolization with Y-90 glass microspheres for patients with advanced HCC is a safe and effective treatment which can be utilized even in patients with compromised liver function . Because TTP and survival appear to be comparable to systemic therapy in selected patients with advanced HCC , r and omized controlled trials in combination with systemic therapy are warranted This is a retrospective study on the safety and efficacy of gamma knife radiosurgery ( GKR ) in treating hepatocellular carcinoma ( HCC ) with portal vein tumor thrombosis ( PVTT ) . Patients with confirmed HCC and PVTT were allocated into two groups based on the treatments they received ( palliative or GKR ) . A total of 138 patients were included ( 74 in the palliative group , 64 in GKR group ) . No significant differences in baseline characteristics existed between the two groups . Treatment-related adverse events ( AEs ) were recorded and compared between groups . The majority of AEs were mild to moderate and subsided naturally or after medication . There was no AE-induced death . The influences of baseline characteristics and treatment options on patients ' OS were analyzed . The median OS of patients in the palliative and GKR group were 3.0 months ( 95 % CI : 2.719 - 3.281 ) and 6.1 months ( 95 % CI : 4.706 - 7.494 ) respectively ( p = 0.003 ) . Multivariate analysis revealed that GKR treatment , performance status 0 - 1 , Child A , smaller tumor diameter and monolobar distribution were significant favorable prognosticators . Subgroup analyses showed OS benefit of GKR regardless of PVTT location ( main or branch of PVTT ) . In conclusion , GKR is well tolerated in selected HCC-PVTT patients and can confer OS benefit , which needs validation in future prospect i ve studies PURPOSE Intraarterial delivery of yttrium-90 ( (90)Y)-bound microspheres ( ie , radioembolization ) is a promising treatment for hepatocellular carcinoma ( HCC ) . An early concern was the " embolic " nature of the microspheres , and their potential to reduce hepatic arterial blood flow in patients with compromised portal blood flow secondary to portal vein thrombosis/occlusion ( PVT ) . In this situation , the risk of liver failure could be enhanced , particularly in patients with cirrhosis who have increased hepatic arterial blood flow . This retrospective analysis was undertaken to assess the safety and clinical benefits of radioembolization with (90)Y resin microspheres in HCC with branch or main PVT . MATERIAL S AND METHODS A total of 25 patients presenting with unresectable HCC and compromised 
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The common toxicities were fatigue , nausea/vomiting , abdominal pain , mostly not requiring medical intervention needed no medication intervention .
90 Y radioembolization is a safe and effective treatment for HCC and PVTT