Effectiveness and Safety of Transarterial Radioembolization Following Inferior Phrenic Artery Glue Embolization for...

To assess the effectiveness and safety of transarterial radioembolization (TARE) following inferior phrenic artery (IPA) glue embolization for flow redistribution in hepatocellular carcinoma (HCC).

This study included 37 consecutive patients with HCC who underwent TARE following IPA glue embolization for flow redistribution between November 2021 and January 2026. Tumor response, local tumor progression-free survival (LTPFS), progression-free survival (PFS), overall survival (OS), and adverse events were retrospectively analyzed.

The best responses of the index tumor were complete response in 15 patients (40.5%), partial response in 18 (48.6%), and stable disease in 4 (10.8%), resulting in an objective response rate of 89.2%. The median LTPFS, PFS, and OS were 31.7, 12.5, and 31.7 months, respectively. The 12-, 24-, and 36-month LTPFS rates were 77.4%, 51.6%, and 25.8%; PFS rates were 52.0%, 29.3%, and 19.6%; and OS rates were 71.9%, 68.3%, and 48.8%, respectively. Furthermore, severe adverse events included cholecystitis (n = 2, 5.4%), prolonged prothrombin time (n = 1, 2.7%), acute kidney injury (n = 1, 2.7%), infection (n = 1, 2.7%), and radiation pneumonitis (n = 1, 2.7%). All severe adverse events were reversible with appropriate treatment, including steroid therapy for radiation pneumonitis. However, 1 additional patient experienced a fatal treatment-related death due to a procedure-related complication, specifically radiation pneumonitis.

TARE following IPA glue embolization for flow redistribution in HCC appears to be an effective treatment and is generally well tolerated. However, meticulous lung dosimetry is critical to ensure patient safety and minimize the risk of severe complications.