Single-system outcomes after adopting yttrium-90 radioembolization with personalized dosimetry as the primary treatment approach for unresectable, solitary hepatocellular carcinoma

<h3>Background</h3> Yittrium-90 (⁹⁰Y) radioembolization has emerged as a secondary treatment option for early- to intermediate-stage hepatocellular carcinoma (HCC) in the Barcelona Clinic Liver Cancer (BCLC) Staging and Treatment Algorithm. Several trials have recently shown that ⁹⁰Y is a safe and effective primary treatment option for BCLC stages A and B. In this study, the outcomes for three treatment centers within a single health system with experience utilizing ⁹⁰Y as a definitive treatment option for early-stage HCC (BCLC-A) were analyzed in the context of results reported by the DOSISPHERE-01 and TARGET clinical trials. <h3>Materials and methods</h3> The cohort was derived from multiple treatment centers within a single health system that utilized ⁹⁰Y as the primary option for BCLC-A solitary, unresectable HCC >3 cm and as a secondary option for HCC <3 cm, both with an Eastern Cooperative Oncology Group score of 0-1 and Child–Pugh A5-B9 (<i>n</i> = 171, 2018-2024). The study outcomes included first-cycle objective response (OR) and complete response (CR) rates, target time to retreatment (tTTR), time to BCLC-C progression, progression-free survival (PFS), and overall survival (OS). <h3>Results</h3> Patients were enrolled between 2018 and 2024 (<i>n</i> = 171). OS rates at 1 and 3 years were 94% and 73%, with 1- and 3-year PFS rates of 89% and 61%, respectively. Response to first-cycle ⁹⁰Y could be assessed in 166 patients. The overall OR rate was 98% (163/166), with 71% (118/166) achieving a target CR. Patients who obtained a target CR had reduced progression rates at 1 year (2% versus 16%) and 3 years (21% versus 62%) compared with incomplete responders. The median tTTR in patients who achieved a target CR was 48 months, with 1- and 2-year retreatment rates of 9% and 24%, respectively. <h3>Conclusion</h3> First-cycle ⁹⁰Y radioembolization with personalized dosimetry is an effective treatment option for early-stage, solitary HCC that yields high, sustained response rates.