Yttrium-90 Radioembolization for High-Risk Hepatocellular Adenomas: A Single-Institution Experience

To evaluate the safety and efficacy of Yttrium-90 (Y-90) transarterial radioembolization (TARE) for the treatment of high-risk hepatocellular adenomas (HCAs) at a single tertiary care center.

A retrospective review was performed of all patients who underwent TARE for HCAs at a tertiary care center between 2010 and 2025. Clinical, laboratory, imaging, and safety data were collected for twelve patients with 22 HCAs included in the study. The primary endpoint was treatment-related adverse events (AEs) graded by CTCAE and SIR AE classification. The secondary endpoints included target and overall radiologic response assessed by mRECIST.1 Patients were followed up with MRI at 6 weeks, 3 months, 6 months, 9 months, 12 months, 18 months, and 24 months. Median follow-up between Y-90 and latest imaging was 17.7 months, with an IQR of 12.9 [8.0-20.9] months.

Indications for treatment included symptomatic adenoma (5%, 1/22), risk of malignant transformation (100%, 22/22) and hemorrhage risk (50%, 11/22). Grade 1 AEs (nausea, fatigue, anorexia, diarrhea, abdominal and shoulder pain) occurred in 75% (9/12) of patients. No grade 2 or greater AEs occurred. The objective response rate (ORR) was 100% (20/20) (complete target lesion response [CR]: 85% (17/20), partial target lesion response [PR]: 15% (3/20)). No lesions ruptured, progressed, or recurred during follow-up.

In this single-institution experience, TARE was safe and demonstrated high short to intermediate-term ORRs in the treatment of high-risk hepatocellular adenomas. Larger prospective studies with longer duration of follow up are needed to confirm these findings.