***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: 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 Intraarterial injection of yttrium 90 microspheres ( TheraSpheres ) is used in the treatment of hepatocellular carcinoma ( HCC ) . This article presents an analysis of the incidence of liver toxicities ( liver-related events ) and pretreatment factors associated with liver toxicities after TheraSphere treatment . PATIENTS AND METHODS Eighty-eight TheraSphere-treated patients with low 90-day mortality risk were selected for analysis , with liver toxicities coded with use of st and ard oncology criteria . Descriptive and inferential statistical methods were applied to estimate the incidence of liver toxicities and to evaluate the influence of liver radiation dose and various pretreatment factors on the risk of their occurrence . RESULTS Sixty-eight liver toxicities occurred in 37 of the 88 patients ( 42 % ) . Thirty-two patients ( 36 % ) experienced 50 liver toxicities after the first treatment and nine of 23 patients ( 39 % ) who received a second treatment experienced 18 liver toxicities . Pretreatment total bilirubin and liver radiation dose were found to be associated with the risk of at least one liver toxicity and with the time to first occurrence of a liver toxicity after first treatment . Pretreatment total bilirubin also was associated with liver toxicities after the second treatment . Most of the toxicities resolved ; however , those that did not resolve were attributed to tumor progression or advancing cirrhosis . CONCLUSIONS The risk of liver toxicities in patients with unresectable HCC treated with TheraSpheres increases with increasing pretreatment total bilirubin level and liver radiation dose to a maximum of 150 Gy for a single administration . The toxicities attributed to treatment resolved over time , and none of the patients studied had confirmed radiation-induced liver disease . Consequently , doses as high as 150 Gy on a single administration and as high as 268 Gy on repeated administrations were well tolerated Unresectable hepatocellular carcinoma is extremely difficult to treat . TheraSphere consists of yttrium-90 ( a pure beta emitter ) microspheres , which are injected into the hepatic arteries . This article review s the safety and survival of patients with hepatocellular carcinoma who were treated with yttrium-90 microspheres . Eighty patients were selected from a data base of 108 yttrium-90 microsphere-treated patients and were staged by using Child-Pugh , Okuda , and Cancer of the Liver Italian Program scoring systems . Patients were treated with local , regional , and whole-liver approaches . Survival from first treatment was analyzed with Kaplan-Meier and Cox regression methods . Adverse events and complications of treatment were coded by using the Southwest Oncology Group toxicity scoring system . Patients received liver doses ranging from 47 to 270 Gy . Thirty-two patients ( 40 % ) received more than 1 treatment . Survival correlated with pretreatment Cancer of the Liver Italian Program scores ( P = .002 ) , as well as with the individual Cancer of the Liver Italian Program components , Child-Pugh class , alpha-fetoprotein levels , and percentage of tumor replacement . Patients classified as Okuda stage I ( n = 54 ) and II ( n = 26 ) had median survival duration s and 1-year survival rates of 628 days and 63 % , and 384 days and 51 % , respectively ( P = .02 ) . One patient died of liver failure judged as possibly related to treatment . Thus , in selected patients with hepatocellular carcinoma , yttrium-90 microsphere treatment is safe and well tolerated . On the basis of these results , a r and omized controlled trial is warranted comparing yttrium-90 microsphere treatment with transarterial chemoembolization by using the Cancer of the Liver Italian Program system for prospect i ve stratified r and omization 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 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 portal flow received segmental , lobar , or whole-liver infusion of (90)Y resin microspheres . For the analysis of tumor response , changes in target lesions , appearance of new lesions , and changes in portal vein thrombus were studied . Controlled disease was defined by absence of progression in all these components . RESULTS Globally , controlled disease was achieved in 66.7 % of patients at 2 months and 50 % of patients at 6 months . No significant changes were observed in liver-related toxicities according to Common Toxicity Criteria ( version 3.0 ) at 1 and 2 months after treatment . Median survival time was 10 months ( 95 % CI , 6.6 - 13.3 months ) . CONCLUSIONS Radioembolization of unresectable HCC and branch or main PVT with (90)Y resin microspheres was associated with minimal toxicity and a favorable median survival time . Further prospect i ve studies are warranted to vali date the findings in this clinical ly challenging patient population BACKGROUND & AIMS Chemoembolization is one of several st and ards of care treatment for hepatocellular carcinoma ( HCC ) . Radioembolization with Yttrium-90 microspheres is a novel , transarterial approach to radiation therapy . We performed a comparative effectiveness analysis of these therapies in patients with HCC . METHODS We collected data from 463 patients who were treated with transarterial locoregional therapies ( chemoembolization or radioembolization ) over a 9-year period . We excluded patients who were not appropriate for comparison and analyzed data from 245 ( 122 who received chemoembolization and 123 who received radioembolization ) . Patients were followed for signs of toxicity ; all underwent imaging analysis at baseline and follow-up time points . Overall survival was the primary outcome measure . Secondary outcomes included safety , response rate , and time-to-progression . Uni- and multivariate analyses were performed . RESULTS Abdominal pain and increased transaminase activity were more frequent following chemoembolization ( P < .05 ) . There was a trend that patients treated with radioembolization had a higher response rate than with chemoembolization ( 49 % vs 36 % , respectively , P = .104 ) . Although time-to-progression was longer following radioembolization than chemoembolization ( 13.3 months vs 8.4 months , respectively , P = .046 ) , median survival times were not statistically different ( 20.5 months vs 17.4 months , respectively , P = .232 ) . Among patients with intermediate-stage disease , survival was similar between groups that received chemoembolization ( 17.5 months ) and radioembolization ( 17.2 months , P = .42 ) . CONCLUSIONS Patients with HCC treated by chemoembolization or radioembolization with Yttrium-90 microspheres had similar survival times .  Radioembolization result ed in longer time-to-progression and less toxicity than chemoembolization . Post hoc analyses of sample size indicated that a r and omized study with > 1000 patients would be required to establish equivalence of survival times between patients treated with these two therapies PURPOSE The short- and long-term effects of (90)Yttrium microspheres therapy for hepatocellular carcinoma ( HCC ) on peripheral blood lymphocytes are unknown and were therefore examined . METHODS AND MATERIAL S Ninety-two HCC patients were enrolled in a (90)Yttrium therapy  study and routine blood counts were examined as part of st and ard clinical monitoring . RESULTS We found an early , profound , and prolonged lymphopenia . In a subsequent cohort of 25 additional HCC patients , prospect i ve flow cytometric immune-monitoring analysis was performed to identify specific changes on distinct lymphocyte subsets ( i.e. , CD3 , CD4 , CD8 T , and CD19 B lymphocytes ) and NK cells absolute numbers , in addition to the granulocytes and platelets subsets . We found that the pretreatment lymphocyte subset absolute numbers ( with the exception of NK cells ) had a tendency to be lower compared with healthy control values , but no significant differences were detected between groups . Posttherapy follow-up revealed that overall , all lymphocyte subsets , except for NK cells , were significantly ( > 50 % from pretherapy values ) , promptly ( as early as 24 h ) and persistently ( up to 30 months ) depleted post-(90)Yttrium microspheres therapy . In contrast , granulocytes increased rapidly ( 24 h ) to compensate for lymphocyte depletion , and remained increased at 
    Output:
    
In the events related to post-embolization syndrome , glass microspheres exhibited a similar safety profile compared to resin microspheres .
Ascites and nausea grade 3 or higher were recorded more frequently with glass microsphere treatment .
Based on this review of the published literature , glass microspheres exhibit a safety profile with fewer gastrointestinal and pulmonary adverse events compared to resin microspheres in the treatment of hepatocellular carcinoma