Overview of Yttrium-90 radioembolization for advanced hepatocellular carcinoma: Current status and future perspectives

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.