Radioembolization in Hepatocellular Carcinoma: Indications and Outcomes

Hepatocellular carcinoma (HCC) continues to rank among the most common causes of cancer-associated deaths, especially since a large number of patients cannot undergo curative resection or transplantation. For HCC patients, transarterial radioembolization (TARE) with yttrium-90 microspheres has become a rapidly emerging multipurpose treatment. For patients with early-stage disease, radiation segmentectomy, which is frequently used as a bridge or downstaging strategy to transplant, is a curative-intent treatment comparable to thermal ablation. For patients with inadequate future liver remnant, radiation lobectomy is a two-fold solution to local tumor control and hypertrophy of the resectable contralateral liver. TARE, in the intermediate and advanced stages of HCC, provides long-term disease control and maintains liver function, and is frequently used as an alternative or in combination with systemic treatment. Personalized dosimetry is an advancement in treatment planning, and the combination of TARE with immunotherapy is a promising area of exploration. Overall, the evolution of radio-embolization from a purely palliative to a disease-modifying curative option, greater use in more stages of the disease, and more positive outcomes than in the past, marks a significant achievement in the treatment of HCC.