Evolution of Personalized Dosimetry for Radioembolization of Hepatocellular Carcinoma

Yttrium-90 transarterial radioembolization (TARE) has progressed from a salvage or palliative lobar or sequential bilobar regional liver therapy for patients with advanced disease to a versatile, potentially curative, and often highly selective local treatment for patients across Barcelona Clinic Liver Cancer stages. With this shift, radiation dosimetry has evolved to become more tailored to patients and target lesion(s), with treatment dose and distributions adapted for specific clinical goals (ie, palliation, bridging or downstaging to liver transplantation, converting to surgical resection candidacy, or ablative/ curative intent). Data have confirmed that personalizing dosimetry yields real-world improvements in tumor response and overall survival while maintaining a favorable adverse event profile. In this review, imaging techniques used before, during, and after TARE have been reviewed. Historical algorithms and contemporary image-based dosimetry methods have been reviewed and compared. Finally, recent and upcoming developments in TARE methodologies and tools have been discussed.

Automated summary

Yttrium-90 transarterial radioembolization (TARE) has evolved from a salvage or palliative therapy to a versatile and potentially curative treatment for liver cancer patients. Personalized radiation dosimetry has been proven to improve tumor response and overall survival while ensuring patient safety. This review covers the imaging techniques, dosimetry methods, and future developments in TARE.