Selective Internal Radiation Therapy (SIRT) for Hepatocellular Carcinoma: Real-World Experience from a Tertiary Care Centre

<b>Background:</b> Selective internal radiation therapy (SIRT) with yttrium-90 microspheres has become an established locoregional treatment for hepatocellular carcinoma (HCC). Nevertheless, real-world data on clinical outcomes, including efficacy, safety, and prognostic determinants, remain limited. <b>Methods:</b> This study retrospectively analysed 56 patients with radiologically and/or histologically confirmed HCC who underwent SIRT at a tertiary referral centre. Baseline demographics, clinical information, tumour characteristics, procedural data, and follow-up outcomes were recorded. The primary endpoints were overall survival (OS) and progression-free survival (PFS). Secondary outcomes included radiological response (mRECIST), histological necrosis, and treatment-related toxicity. Prognostic pathways were explored using structural equation modelling (SEM). <b>Results:</b> The mean age at the beginning of SIRT was 65.0 ± 11.6 years; most patients were male (87.5%) and had preserved liver function (mean ALBI -2.9 ± 0.4). BCLC staging distribution was 50% stage A, 32.1% stage B, and 17.9% stage C. According to mRECIST criteria at 6 months, 15.2% achieved complete response (CR), 47.8% partial response (PR), 30% stable disease (SD), and 7% progressive disease (PD). Median OS was 19 months (12-32) for BCLC stage A, 28 months (3-42) for stage B, and 19 months (12-56) for stage C (log-rank <i>p</i> = 0.743). SEM identified diffuse tumour morphology as the most significant predictor of poor prognosis. Radical treatments were performed in 28% of patients, including four liver transplants and ten resections. Adverse events occurred in 11 patients, of which 7 were Clavien-Dindo grade I and 4 were grade II. <b>Conclusions:</b> In this real-world HCC group, SIRT provided durable tumour control and survival with excellent tolerability.