Yttrium-90 Radioembolization for Hepatocellular Carcinoma: Clinical Evidence, Evolving Indications, and Research-Frontier Mapping

Yttrium-90 (Y-90) radioembolization, also termed selective internal radiation therapy (SIRT) or transarterial radioembolization (TARE), is used across the hepatocellular carcinoma (HCC) treatment spectrum as locoregional therapy, bridging or downstaging treatment, radiation segmentectomy, and an emerging partner for systemic therapy. SARAH and SIRveNIB did not show overall survival superiority over sorafenib; DOSISPHERE-01 supported personalized dosimetry; and LEGACY/RASER strengthened radiation segmentectomy in selected solitary HCC. Recent 2025-2026 studies have updated comparative TARE/TACE evidence and combination strategies. We synthesize clinical evidence by indication and integrate a bibliometric analysis of 1,472 high-specificity WoSCC-SCIE records through June 2026 as a triangulation tool, comparing research-frontier signals with unresolved clinical evidence gaps. These signals do not establish efficacy, but they help prioritize trials of Y-90 plus immunotherapy, standardized personalized dosimetry, and contemporary comparisons against TACE or current systemic therapy.