Role of SIRT in Patients With Hepatocellular Carcinoma: Current Clinical Indications and Future Perspectives

BACKGROUND/AIM: A retrospective, exploratory study was conducted on patients with hepatocellular carcinoma (HCC) who underwent Selective Internal Radiation Therapy (SIRT) between 2021 and 2024. The aim was to evaluate its efficacy in tumor downsizing prior to surgical resection, downstaging before liver transplantation, and achieving local tumor control. PATIENTS AND METHODS: This is a single-center study conducted at the University Hospital of Naples Federico II. We retrospectively reviewed the medical records of patients with an HCC diagnosis who were subjected to SIRT following discussion within a multidisciplinary tumor board specialized in hepato-biliary diseases. SIRT is a locoregional treatment option for HCC that involves trans-arterial delivery of a therapeutic radioisotope, most frequently the β-emitter yttrium-90 incorporated into glass or resin microspheres. All investigated patients were evaluated by dynamic contrast-enhanced computed tomography and/or magnetic resonance imaging before and after treatment. Radiological tumor response to treatment was evaluated according to modified Response Evaluation Criteria in Solid Tumors. RESULTS: Twenty patients with Child-Pugh A liver function were included. Overall, complete response (CR) was achieved in 6 patients (30%), partial response (PR) in 10 (50%), and progressive disease (PD) in 4 (20%). In the downstaging group (n=5), 1 patient achieved CR, 3 achieved PR, and 1 experienced PD. In the downsizing group (n=4), 3 patients achieved PR and 1 had PD. In the local control group (n=11), 5 patients achieved CR, 4 achieved PR, and 2 experienced PD. No significant post-procedural complications were observed. CONCLUSION: These findings support the role of SIRT as a versatile locoregional therapy in selected patients with HCC, across different therapeutic intents.