Feasibility of Single-Session Whole-Liver Yttrium-90 Radioembolization for Multifocal Hepatocellular Carcinoma

To evaluate the feasibility, safety, and treatment outcomes of single-session whole-liver yttrium-90 (Y90) transarterial radioembolization (TARE) in patients with multifocal hepatocellular carcinoma (HCC).

This retrospective study included 37 patients (age, 23-86 years; median age, 60 years) with multifocal HCC (2-21 tumors; median, 9) and preserved liver function (Child-Pugh A) who underwent planned single-session whole-liver Y90 TARE between 2017 and 2024. Treatment was performed when no substantial liver parenchyma could be spared on pretreatment imaging and angiographic evaluation. Treatment planning was based on the findings of technetium-99m macroaggregated albumin single-photon emission computed tomography and partition-model dosimetry. Tumor response was assessed using the modified Response Evaluation Criteria in Solid Tumors. Overall survival, progression-free survival, and hepatic toxicity were also evaluated, with toxicity assessed on the basis of the occurrence of adverse events, Child-Pugh class change, and the development of ascites within 3-6 months.

Patients were followed up for 1.4-49.0 months (median, 17.8 months). At 3 months, the objective response rate was 78.4%; the disease control rate was 94.6%; and complete response was noted in 11 patients (29.7%). Successful downstaging was achieved in 19 (51.4%) patients. The median overall survival was not reached, and the median progression-free survival was 23.5 months. The 2-year overall and progression-free survival rates were 78.3% and 46.8%, respectively. Eleven patients (29.7%) subsequently underwent surgery, including one resection and 10 living-donor liver transplantations. None of the patients showed grade 3 or 4 adverse events or radioembolization-induced liver disease. One patient with cirrhosis showed worsening of the Child-Pugh class with ascites.

Single-session whole-liver Y90 TARE was feasible and showed acceptable hepatic safety in carefully selected patients with multifocal HCC and preserved liver function. It achieved high response and downstaging rates and may serve as a bridge to curative surgery in selected patients.