Screening the advantageous population for liver cancer undergoing yttrium-90 microsphere selective internal radiation therapy

Abstract

Yttrium-90 microsphere selective internal radiation therapy (SIRT), also known as transarterial radioembolization, has become one of the pivotal treatments for liver cancer, particularly for selected advantageous patient groups. This review summarizes the characteristics of different patients with liver cancer that could obtain maximum benefit from SIRT and discusses key factors affecting efficacy and safety, including tumor characteristics, liver function, patient performance status, and treatment intent. In evaluating appropriate candidates, mapping serves as a crucial simulation procedure to assess tumor vascular anatomy, predict lung shunting, and guide catheter positioning and dose planning. This procedure substantially enhances therapeutic precision while minimizing the risk of nontarget radiation-related adverse events, such as radiation-induced pneumonitis and gastrointestinal toxicity. Several studies have suggested that SIRT is not only suitable for patients with early or limited hepatocellular carcinoma but can also be used as a bridging therapy for liver transplantation and conversion therapy for unresectable liver cancers. In combination with systemic treatments, SIRT has demonstrated survival benefits in patients with unresectable liver cancer. This review also highlights the importance of further optimizing patient screening through personalized dosimetry and mapping to ensure the precision and safety of treatment. A thorough review of relevant literature and clinical practice offers clinicians comprehensive suggestions on patient screening and clarifies the promise of SIRT in the liver cancer population.

Keywords

Liver cancer / Selective internal radiation therapy (SIRT) / Transarterial radioembolization (TARE) / Yttrium-90 / Advantageous population

Authors’ contributions

Licong Liang: Conceptualization, Writing-original draft, Writing-review & editing. Yuchan Liang: Writing - original draft. Wensou Huang: Writing - original draft. Yongjian Guo: Writing - original draft. Jingjun Huang: Writing - original draft. Jingwen Zhou: Writing - original draft. Liteng Lin: Writing - review & editing. Xinxin Nie: Writing - original draft. Mingyue Cai: Su-pervision, Writing-original draft. Kangshun Zhu: Conceptualiza-tion, Project administration, Writing-original draft, Writing- review & editing, Funding acquisition.

Declaration of competing interest

The authors declare that there is no conflicts of interest.

Acknowledgements

This work was funded by the Innovative Clinical Technique of Guangzhou (No. 2024C-GX08).

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