Hepatocellular carcinoma patients treated with TARE monotherapy or combination therapy with curative intent: a retrospective, exploratory analysis of two European prospective studies

Abstract Purpose While transarterial radioembolization (TARE) with yttrium-90 (Y90) is an established local treatment option for advanced hepatocellular carcinoma (HCC) and as a curative monotherapy option, its role in curative combination treatment strategies is gaining interest amongst multidisciplinary teams. In this retrospective, exploratory analysis of the prospective observational CIRT studies (NCT02305459 and NCT03256994), we aimed to identify important factors involved in the application of TARE with curative intent. Methods This is a combined analysis of 615 HCC patients treated with TARE between 2015 and 2020. Baseline and treatment-related data were collected, and treating physicians were asked to record the a priori treatment intent. Follow-up data were collected every 3 months for at least 2 years. Patients were allocated to curative-intent and palliative-intent groups based on a posteriori treatment goal assessment. Results Contrary to a priori treatment intent (386/62.7% palliative vs 229/37.3% curative), most patients were treated with TARE with palliative intent as assessed a posteriori (575/93%). In the curative-intent group (40/6.5%), 20 patients underwent transplantation (50%), 7 ablation (17.5%) and 2 resection (5%) following TARE. Additionally, 11 (27.5%) patients did not receive further treatment, likely due to complete response after TARE. ECOG 0 and tumour volume < 150 cc were found to be associated with curative treatment allocation. Conclusion Our analysis of 40 patients successfully treated with TARE with curative intent displays the heterogeneity of treatment algorithms, including transplantation, ablation or resection, and points towards the potential of TARE as a standalone curative-intent treatment in selected cases. Further analyses on specific conversion criteria following TARE are warranted. Trials registration NCT02305459; NCT03256994. Graphical Abstract