Radioembolization in Hepatocellular Carcinoma: Indications and Outcomes

Area of Science:

• Hepatobiliary medicine
• Interventional oncology
• Nuclear medicine

Background:

• Hepatocellular carcinoma (HCC) is a leading cause of cancer mortality, with many patients ineligible for curative resection or transplantation.
• Transarterial radioembolization (TARE) using Yttrium-90 (Y-90) microspheres is an emerging, versatile treatment for HCC.

Purpose of the Study:

• To review the evolving role and expanding applications of TARE in managing hepatocellular carcinoma.
• To highlight TARE's efficacy as a curative-intent treatment, bridge to transplant, downstaging strategy, and palliative intervention.

Main Methods:

• Review of current literature on TARE for HCC.
• Discussion of TARE applications including radiation segmentectomy and lobectomy.
• Exploration of advanced treatment planning with personalized dosimetry and combination therapies.

Main Results:

• TARE is effective for early-stage HCC (radiation segmentectomy), comparable to thermal ablation.
• Radiation lobectomy addresses tumor control and liver remnant hypertrophy in specific patient groups.
• TARE provides long-term disease control and preserves liver function in intermediate/advanced HCC, often combined with systemic therapy.

Conclusions:

• TARE has evolved from a palliative measure to a disease-modifying treatment for HCC across multiple stages.
• Personalized dosimetry and combination with immunotherapy represent promising future directions for TARE in HCC management.
• TARE offers improved outcomes and greater applicability in the contemporary treatment landscape of hepatocellular carcinoma.