Abstract
Purpose
To describe clinical outcomes after transarterial radioembolization (TARE) for hepatocellular carcinoma (HCC) beyond the Up-to-Seven criteria.Materials and methods
This retrospective study included 94 treatment-naïve patients with HCC beyond the Up-to-Seven criteria who underwent TARE between November 2021 and December 2025. Outcomes included tumor response, local tumor progression-free survival (LTPFS), progression-free survival (PFS), overall survival (OS), and adverse events.Results
The median maximum tumor diameter was 9.5 cm (interquartile range, 7.1-11.4 cm). A single lesion was observed in 55 (58.5%) patients, 30 (31.9%) had oligonodular disease, and 9 (9.6%) had ≥5 lesions. Index-lesion complete response (CR) and objective response rate (ORR) were 38.3% and 83.0%, respectively; at the patient level, CR and ORR were 38.3% and 81.9%, respectively. Median index-lesion LTPFS, patient-level LTPFS, PFS, and OS were 19.6, 15.7, 11.1, and 30.5 months, respectively. Low tumor-absorbed dose (TAD) was independently associated with worse OS (adjusted hazard ratio, 2.70; p = 0.016). Twenty-one patients (22.3%) subsequently underwent curative-intent surgery after TARE, with a more favorable OS pattern observed in the postsurgery state in an exploratory time-varying analysis (p = 0.004). Three fatal adverse events occurred.Conclusion
In this single-center retrospective cohort of patients with HCC beyond the Up-to-Seven criteria, favorable tumor control and survival outcomes were observed after TARE, and 22.3% of patients subsequently underwent curative-intent surgery. Higher TAD was associated with longer OS, although this finding should be interpreted cautiously given the potential for confounding. Careful dosimetric planning is warranted given the observed fatal radiation pneumonitis events.