Internal Radiation Therapy for Hepatocellular Carcinomas With Therasphere: Optimized Dosimetry Versus Standard Dosimetry

Inclusion Criteria: * Age ≥ 18, * Written free and informed consent, * Histologically demonstrated Hepatocellular Carcinoma (HCC), not a candidate for surgery or local ablative treatment (radio frequency, etc.) * Barcelona Clinic Liver Cancer (BCLC) classification A, B or C, * At least one lesion ≥ 7 cm, * Hepatic reserve (hepatic parenchyma not treated) after the first SIRT ≥ 30%, * Unilateral involvement, minimal bilateral involvement allowed only with a hepatic reserve ≥ 30% after SIRT * Child A classification only, or B but with bilirubinemia \<35 micromol/L, * Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1, * Patients whose biological parameters meet the following criteria: * Hemoglobin ≥ 8.5 g/dL, * Granulocytes ≥ 1500/mm3, * Platelets ≥ 50,000/mm3, * Bilirubinemia \<35 micromol per liter, * Transaminases ≤ five times the upper limit of normal, * Creatininemia ≤ 1.5 times the normal upper limit, * Expected survival over 12 weeks, * Negative pregnancy test for women of childbearing age, * If sorafenib has been taken the diagnostic angiogram must follow it by at least four weeks after its stop. Exclusion Criteria: * HCC operable or accessible to a local ablative treatment (radio frequency), * Hepatectomy history unless a segmental treatment is considered, with a hepatic reserve ≥ 30% after SIRT, * Prior treatment with sorafenib unless stopped at least four weeks earlier, * History of chemo-embolization of the principal lesion, except in case of nodular residual lesion measuring at least 7 cm or in case of progression after initial response, * Bilateral disease requiring a whole liver injection or with a hepatic reserve \< 30% after SIRT * Treatment of another cancer less than one year earlier, * Extra-hepatic metastases other than adenopathies of the hilum smaller than 2 cm, * \>70% tumor invasion of the liver, * Bilirubinemia ≥ 35 µmol/L, * A Severe underlying biliary pathology: * Bile duct anomaly (stent, dilation) Cirrhosis of biliary origin, * Women of childbearing age without contraception * Pregnant or nursing women