Advancements in selective internal radiotherapy: Efficacy, safety, and future directions

Selective internal radiotherapy (SIRT) has emerged as a viable treatment for both primary and secondary liver neoplasms, exhibiting favorable efficacy and low toxicity in clinical applications. This review synthesizes key studies that investigate the safety and efficacy of SIRT, particularly in hepatocellular carcinoma and intrahepatic cholangiocarcinoma, along with its application in treating liver metastatic malignancies. SIRT demonstrates superior time to progression, enhanced quality of life, and reduced toxicity compared with conventional therapies, including tyrosine kinase inhibitors and transarterial chemoembolization, despite comparable overall survival benefits. Notwithstanding these gains, additional study is warranted to enhance combination therapy, improving dosimetry models. Further investigation is also needed to explore the use of SIRT in extrahepatic cancers. Personalized dosimetry holds significant potential for improving patient outcomes and warrants further exploration in several key areas, including biodistribution simulation, dosimetry calculation method refinement, intraprocedural visualization advancement, and posttreatment dosimetry evaluation technique improvement. Furthermore, the integration of SIRT with systemic therapies has demonstrated potential for synergistic effects, thereby enhancing tumor response and survival outcomes. SIRT is a significant enhancement to the treatment repertoire for liver neoplasms, with ongoing research further broadening its clinical applicability and improving patient outcomes.