Li ZY, Xie C, Cai HQ. Overview of Yttrium-90 radioembolization for advanced hepatocellular carcinoma: Current status and future perspectives. World J Clin Oncol 2025; 16(9): 109730 [PMID: 41024843 DOI: 10.5306/wjco.v16.i9.109730]
Corresponding Author of This Article
Hong-Qiao Cai, MD, PhD, Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun 130021, Jilin Province, China. hongqiaocai@jlu.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Oncol. Sep 24, 2025; 16(9): 109730 Published online Sep 24, 2025. doi: 10.5306/wjco.v16.i9.109730
Overview of Yttrium-90 radioembolization for advanced hepatocellular carcinoma: Current status and future perspectives
Zong-Yang Li, Cheng Xie, Hong-Qiao Cai
Zong-Yang Li, Cheng Xie, Hong-Qiao Cai, Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Author contributions: Cai HQ designed the overall concept and outline of the manuscript; Li ZY contributed to the discussion and design of the manuscript; Xie X contributed to the writing, and editing the manuscript, illustrations, and review of literature.
Conflict-of-interest statement: The authors have claimed no conflicts of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Qiao Cai, MD, PhD, Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun 130021, Jilin Province, China. hongqiaocai@jlu.edu.cn
Received: May 20, 2025 Revised: May 27, 2025 Accepted: July 10, 2025 Published online: September 24, 2025 Processing time: 126 Days and 21.7 Hours
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality, with a majority of patients presenting at intermediate or advanced stages, precluding curative interventions. Radioembolization, also known as selective internal radiation therapy, has emerged as a promising locoregional therapy that delivers high-dose yttrium-90 microspheres directly to hepatic tumors while sparing healthy parenchyma. This technique is especially beneficial for patients with portal vein tumor thrombosis or impaired liver function. This editorial provides a comprehensive overview of the mechanism, technical considerations, and clinical efficacy of radioembolization in advanced HCC. Landmark trials such as SARAH, SIRveNIB, and DOSISPHERE-01 demonstrate comparable or superior outcomes to systemic therapies like sorafenib, particularly when personalized dosimetry is applied. Radioembolization contributes to tumor downstaging, transplant bridging, and improved disease control rates. The integration of radioembolization with systemic therapies, including immune checkpoint inhibitors and tyrosine kinase inhibitors, represents a key area of ongoing research. Despite current challenges such as microsphere heterogeneity, dosimetry standardization, and limited accessibility, emerging innovations in imaging, isotopes, and personalized treatment strategies are expected to refine its application. Overall, radioembolization is poised to play an increasingly central role in the multidisciplinary management of advanced HCC.
Core Tip: Radioembolization with yttrium-90 microspheres represents a pivotal locoregional treatment option for patients with advanced hepatocellular carcinoma (HCC), especially those with portal vein tumor thrombosis or limited tolerance to systemic therapies. Landmark trials confirm its favorable safety profile and potential for tumor downstaging. Emerging strategies such as personalized dosimetry and combination with immunotherapy are poised to enhance efficacy. Radioembolization continues to evolve as a core component of multimodal therapy in advanced HCC management.
