Clinical Scorecard: Preoperative Radioembolization Compared with Chemoembolization or Immediate Resection for Resectable Hepatocellular Carcinoma Outside the Milan Criteria

At a Glance

Key Highlights

• The study evaluated preoperative TARE and TACE against upfront resection in technically resectable HCC beyond the Milan criteria.
• Eligible patients had to be suitable for complete liver resection and meet specified liver-function, performance-status, and operative-risk criteria.
• A multidisciplinary tumor board selected treatment based on tumor burden, liver function, technical resectability, and physician discretion.
• Preoperative TARE and TACE were classified as neoadjuvant therapies because all patients were technically resectable at baseline and subsequently underwent resection.
• The supplied article excerpt describes study methods but does not provide comparative outcome results.

Guideline-Based Recommendations

Diagnosis

• The study established HCC radiologically and/or histologically in accordance with updated guidelines.
• Beyond-Milan eligibility was defined as a single tumor >5 cm, 2–3 tumors with at least one >3 cm, or ≥4 tumors regardless of size.

Management

• The study compared preoperative TARE, preoperative TACE, and primary resection; the supplied excerpt does not report a preferred strategy.
• A multidisciplinary tumor board selected treatment based on tumor burden, liver function, technical resectability, and physician discretion.

Monitoring & Follow-up

• TARE planning included hepatic angiography and 99mTc-MAA scintigraphy; lung SPECT assessed pulmonary shunting and extrahepatic tracer uptake.
• TARE was undertaken only in the absence of technical contraindications, including excessive predicted lung radiation.

Risks

• The article introduction states that HCC beyond the Milan criteria carries a substantial risk of early postoperative recurrence.
• TARE planning assessed pulmonary shunting, extrahepatic tracer uptake, and predicted lung radiation before treatment.

Patient & Prescribing Data

Retrospective cohort of adults treated from January 2016 through July 2024 at one hospital. Patients had technically resectable HCC beyond the Milan criteria, Child–Pugh A liver function, ECOG 0–1, adequate residual liver volume, and acceptable operative risk. Patients with extrahepatic metastases, major-vessel invasion, or another malignancy were excluded.

TARE used yttrium-90 glass or resin microspheres, selected by operator preference. TACE was conventional or drug-eluting bead TACE, selected at operator discretion. All patients in the study underwent liver resection; the excerpt provides no comparative efficacy or safety results.

Clinical Best Practices

• The study used multidisciplinary review to select treatment based on tumor burden, liver function, technical resectability, and physician discretion.
• In this study, TARE planning mapped hepatic arterial anatomy and used 99mTc-MAA imaging to assess lung shunting and extrahepatic tracer uptake.
• For TheraSphere, the study proceeded unless predicted lung dose exceeded 30 Gy per session.
• The study used superselective TACE under cone-beam CT guidance.

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