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Updated: Sep 12, 2025
Y-90 Radioembolization and PD-1 Inhibitor as Neoadjuvant Treatment in Hepatocellular Carcinoma
Published on: May 24, 2024
Histopathologic outcomes of hepatocellular carcinoma treated with transarterial radioembolization with yttrium-90
Ammar Sarwar1, Imad Nasser2, Jeffrey L Weinstein3
1Division of Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Road Rosenberg 3, Boston, MA, 02215, USA. asarwar@bidmc.harvard.edu.
Purpose:
To evaluate the pathologic outcomes of 90Y-TARE of HCC with resin microspheres prescribed using the single-compartment model and to correlate posttreatment dose with outcomes.
Methods:
This retrospective single-center study included adult patients with HCC who underwent 90Y-TARE with resin microspheres before liver transplantation or surgery. Histopathologic evaluation of liver tissue was performed. Complete pathologic necrosis (CPN) was defined as 100% tumor necrosis, extensive necrosis as 50-99%, and partial necrosis as < 50%. Posttreatment voxel-based dosimetry was conducted. Additional subgroup analysis was done to compare tumors with complete and incomplete necrosis.
Results:
Among 28 patients (median age, 64 years [IQR, 57-69 years]); 86% males,75% BCLC 0-A) with 37 HCC tumors, complete, extensive and partial pathologic necrosis were achieved in 27/37(73%), 8/37(22%) and 2/37(5%) tumors, respectively. Tumors with CPN were significantly smaller than those without CPN (2.2 vs. 3.4 cm, P = 0.03), with longer interval between the 90Y-TARE and liver surgery (274 vs. 143 days, P = 0.048). All tumors with a mean tumor absorbed dose ≥ 433 Gy had CPN. Conversely, all tumors in which 4% or more of the tumor volume received a dose less than 100 Gy had incomplete necrosis. ROC analysis identified D95 ≥ 133 Gy (AUC 0.96 [95%CI: 0.9-1]) and V0-100 (%) < 5% (AUC 0.9 [95%CI: 0.75-0.97]) as predictors of CPN with 100% and 78% specificity, respectively.
Conclusion:
Among HCC patients who underwent 90Y-TARE with resin microspheres, 73% achieved complete pathologic necrosis. All tumors with a mean tumor absorbed dose ≥ 433 Gy achieved CPN.
Clinical Trial Number:
not applicable.
