Application of yttrium-90 microsphere in conversion therapy for hepatocellular carcinoma

Abstract:

Hepatocellular carcinoma (HCC) is one of the malignancies with high incidence and mortality rates in China. Approximately 64% of patients are diagnosed at intermediate or advanced stages at initial presentation (CNLC stages IIb, IIIa, and IIIb), and most have already lost the opportunity for curative treatment. Conversion therapy aims to enable initially unresectable HCC patients to become eligible for surgical resection or liver transplantation through effective interventions, thereby improving long-term outcomes. Yttrium-90 microsphere selective internal radiation therapy (⁹⁰Y-SIRT) has demonstrated unique advantages in HCC conversion therapy, owing to its potent local tumor control, induction of future liver remnant hypertrophy, promotion of portal vein tumor thrombus regression, and favorable safety profile with preservation of quality of life. This article systematically reviews the application of ⁹⁰Y-SIRT in conversion therapy prior to liver resection and liver transplantation, summarizes its mechanisms of action, clinical evidence, and combination treatment strategies, and discusses current challenges and future directions, with the aim of providing references for clinical decision-making and research in HCC conversion therapy.