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Internal view of patient's torso demonstrating targeted accuracy of TheraSphere Y-90 Glass Microspheres in liver.

TheraSphere™ Y-90 Glass Microspheres

Radiation segmentectomy

Radiation segmentectomy overview

Potential curative therapy for early hepatocellular carcinoma

Radiology, 2018 Jun; 287(3);

Lewandowski RJ, Gabr A, Abouchaleh N, Ali R, Al Asadi A, Mora RA, Kulik L, Ganger D, Desai K, Thornburg B, Mouli S, Hickey R, Caicedo JC, Abecassis M, Riaz A and Salem R

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Curative treatment options for early-stage HCC (BCLC 0 or A) include transplantation, surgical resection and RF ablation with good survival outcomes ranging between 60-80%*1, however many patients are not candidates for these therapies.

  • Radiation segmentectomy is the application of selective ablative radiation doses of Yttrium-90 (Y-90) to tumors, usually delivered to no more than two hepatic segments2
  • The threshold dose of ≥ 190 Gy has been confirmed3 to maximize cytotoxicity and selective delivery minimizes risk of damage to surrounding parenchyma4


  • To report one center’s long-term outcomes of patients with HCC ≤ 5 cm, not amenable to transplantation, resection or RF ablation, who underwent radiation segmentectomy
  • The authors hypothesized radiation segmentectomy could be considered potentially curative based on the same rationale as transplantation, resection and RF ablation


  • Retrospective, single center study looked at 70 patients with solitary HCC ≤ 5 cm, preserved liver function (Child Pugh A) and no vascular invasion or extrahepatic metastases who underwent radiation segmentectomy with Y-90 glass microspheres (target dose ≥ 190 Gy)
  • Patients who had surgical resection or transplant after a radioembolization procedure were excluded
  • A sub-analysis of patients with HCC ≤ 3 cm was also performed (cohort comparable to RF ablation)
  • All patients underwent long-term imaging (contrast material-enhanced magnetic resonance [MR] imaging or computed tomography [CT]) and clinical follow-up (toxicity assessment at 1- and 3-months and response assessment in clinic 1-month post and subsequently at 3-month intervals)


Table describing radiographic response, time to progression (TTP), local tumor control, overall survival (OS).

Results: overall survival for all patients

Graph showing survival probability (%) over time (days) and number at risk.
Table on overall survival rate of one year, three year and five year, with tumor sizes of <=3cm (n=45), >3cm (N=25) and all <=5cm (n=70).
Contrast material–enhanced CT scan before Y-90 of an 87-year-old man with 4 cm hepatocellular carcinoma in right lobe.

Contrast material–enhanced CT scan before Y-90 of an 87-year-old man with 4 cm hepatocellular carcinoma in right lobe.

Contrast-enhanced MR image at subsequent 9-year follow-up (now aged 96 years) shows complete necrosis.

Contrast-enhanced MR image at subsequent 9-year follow-up (now aged 96 years) shows complete necrosis.


  • Liver transplantation, surgical resection and RF ablation are considered curative treatment options based on phase II randomized studies with limited data demonstrating improved survival
  • Data from the present publication suggests a radiation segmentectomy procedure should be considered curative in patients with unablatable BCLC stage 0 or A lesions ≤ 5 cm with preserved liver function (Child Pugh A) as radiation segmentectomy:
    • Provides local tumor control
    • Prolonged time to progression
    • Overall survival outcomes comparable to RF ablation, resection, and transplantation for patients with BCLC stage 0 or A HCC
  • Additionally, radiation segmentectomy is an outpatient, minimally invasive intra-arterial therapy with a low toxicity profile that may be a convenient treatment option for patients
  • Study strengths: homogeneity of patient cohort, >10 years of follow-up, strict patient selection
  • Study limitations: retrospective and nonrandomized analysis, selection bias, comparisons to published literature versus an internal control group

*RF ablation shows similar reported survival outcomes to resection and transplantation for HCC ≤ to 3 cm
BCLC = Barcelona Clinic Liver Cancer; HCC= hepatocellular carcinoma; RF= radiofrequency; EASL= European Association for the Study of the Liver
1. Bruix J, Reig M, Sherman M. Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma. Gastroenterology 2016;150(4):835–853
2. Riaz A, Gates VL, Atassi B et al. Radiation segmentectomy: a novel approach to increase safety and efficacy of radioembolization. Int J Radiat Oncol Biol Phys 2011;79(1):163–171
3. Vouche M, Habib A, Ward TJ et al. Unresectable solitary hepatocellular carcinoma not amenable to radiofrequency ablation: multicenter radiology-pathology correlation and survival of radiation segmentectomy. Hepatology 2014;60(1):192–201
4. Vouche M, Lewandowski RJ, Atassi R et al. Radiation lobectomy: time-dependent analysis of future liver remnant volume in unresectable liver cancer as a bridge to resection. J Hepatol 2013;59(5):1029–1036

TheraSphere is a registered trademark of Theragenics Corporation used under license by Biocompatibles UK Ltd., a wholly owned subsidiary of Boston Scientific Corporation.