Survival and Dosimetry in Advanced Hepatocellular Carcinoma with Tumor Sizes Up to 20 cm: A High Tumor Volume Institutional Cohort

Abstract

Objective: Transarterial radioembolization with yttrium-90 (Y-90 TARE) is a well-established locoregional therapy for hepatocellular carcinoma (HCC) in patients who are not candidates for transarterial chemoembolization (TACE); however, its clinical benefit and prognostic determinants in advanced-stage, high-volume, or bilobar disease remain unclear.

Methods: A total of 51 patients with Barcelona Clinic Liver Cancer (BCLC)-B and BCLC-C stage HCC who underwent Y-90 TARE between 2009 and 2018 and were unsuitable for TACE due to diffuse, bilobar, or infiltrative tumor morphology were retrospectively analyzed. Dosimetric data were evaluated in a subgroup treated with glass microspheres. Kaplan–Meier and Cox regression analyses were used to assess overall survival (OS) and its associations with clinical, anatomical, and dosimetric parameters.

Results: The median OS for the cohort was 11.05 months (95% CI: 8.8-18.0), with 12-, 24-, and 36-month survival rates of 46.9%, 23.0%, and 17.9%, respectively. Unilobar disease, albumin–bilirubin grade 1, and absence of portal vein thrombosis were associated with numerically longer survival. Multivariate analysis identified bilobar tumor distribution as the only independent predictor of mortality (hazard ratio: 3.07, P = .039). Tumor absorbed dose >100 Gy, higher tumor volume, and infused activity >40 mCi were not significantly associated with OS.

Conclusion: Transarterial radioembolization with yttrium-90 provides modest survival benefit in advanced HCC patients with large and bilobar tumors, particularly in those with preserved liver function and unilobar involvement. While tumor dose and activity did not independently predict survival, these findings underscore the importance of anatomical disease distribution and the need for refined dosimetric strategies, especially in bilobar disease.

Cite this article as: Bilgiç S, Sayılı U, Sağer S, Sönmezoğlu K. Survival and dosimetry in advanced hepatocellular carcinoma with tumor sizes up to 20 cm: A high tumor volume institutional cohort. Cerrahpaşa Med J 2026, 50, 0029, doi: 10.5152/cjm.2026.26029.