# The Role of TARE for Bridging and Downstaging of HCC Before Resection or Liver Transplant

## TL;DR

This study shows that transarterial radioembolization (TARE) can help make surgery or liver transplants possible for some patients with liver cancer.

## Contribution

The study demonstrates TARE's effectiveness in bridging/downstaging hepatocellular carcinoma (HCC) for curative treatments.

## Key findings

- TARE enabled curative surgery in patients initially ineligible for treatment.
- 76% of patients were alive and disease-free at final follow-up.
- Median overall survival was 33.4 months with favorable outcomes in the liver transplant group.

## Abstract

This paper evaluated transarterial radioembolization (TARE) as bridging/downstaging therapy followed by surgical resection or liver transplantation in patients with hepatocellular carcinoma (HCC). Yttrium-90 TARE was administered to 25 patients, and liver resection was performed on 17 patients and liver transplantation by living donors on 8 patients. TARE was efficient in inducing tumor necrosis and stimulating growth of the subsequent liver remnant, thus permitting surgery in patients who were initially not suitable to receive a definitive treatment. By the final follow-up, 76% of the patients were alive and disease free, and few patients were found to have early recurrence. This evidence indicates that TARE is a potentially useful preoperative strategy in increasing curative treatment in patients with HCC.

Background: Hepatocellular carcinoma (HCC) remains a major cause of cancer-related mortality. Transarterial radioembolization (TARE) has emerged as a locoregional therapy to downstage tumors and expand surgical eligibility. Methods: This retrospective study included patients with HCC who underwent TARE as a bridging treatment. The primary outcomes assessed were the efficacy of TARE in facilitating curative surgery and long-term oncological outcomes, specifically overall survival (OS) and disease-free survival (DFS). Results: This study included 25 patients. 17 patients subsequently underwent surgical resection and eight underwent living-donor liver transplantation (LDLT). At a median follow-up of 33.4 months, the median disease-free survival (DFS) was 11.2 months. Patients with recurrence had a median DFS of 3.65 months, and those without recurrence had a median DFS of 27.1 months. The median overall survival (OS) for the cohort was 33.4 months. At the last follow-up, 76% of patients were alive and disease-free. Kaplan–Meier analysis demonstrated sustained OS in the LDLT group, while resection patients gradually declined within the first two years. Conclusions: TARE is an effective bridging strategy that enables curative-intent surgery in selected patients with HCC and supports favorable long-term oncological outcomes. Careful patient selection and multidisciplinary management remain essential to optimize survival benefits.