# Selective Internal Radiation Therapy (SIRT) for Hepatocellular Carcinoma: Real-World Experience from a Tertiary Care Centre

## TL;DR

This study examines the real-world effectiveness and safety of SIRT for treating liver cancer, showing good outcomes and minimal side effects.

## Contribution

The study provides real-world data on SIRT for HCC, including survival rates and prognostic factors from a tertiary care center.

## Key findings

- SIRT achieved durable tumor control with median survival of 19-28 months across different stages of HCC.
- Diffuse tumor morphology was identified as a significant predictor of poor prognosis using structural equation modeling.
- Treatment was well-tolerated, with most adverse events being mild (Clavien–Dindo grade I or II).

## Abstract

Background: Selective internal radiation therapy (SIRT) with yttrium-90 microspheres has become an established locoregional treatment for hepatocellular carcinoma (HCC). Nevertheless, real-world data on clinical outcomes, including efficacy, safety, and prognostic determinants, remain limited. Methods: This study retrospectively analysed 56 patients with radiologically and/or histologically confirmed HCC who underwent SIRT at a tertiary referral centre. Baseline demographics, clinical information, tumour characteristics, procedural data, and follow-up outcomes were recorded. The primary endpoints were overall survival (OS) and progression-free survival (PFS). Secondary outcomes included radiological response (mRECIST), histological necrosis, and treatment-related toxicity. Prognostic pathways were explored using structural equation modelling (SEM). Results: The mean age at the beginning of SIRT was 65.0 ± 11.6 years; most patients were male (87.5%) and had preserved liver function (mean ALBI −2.9 ± 0.4). BCLC staging distribution was 50% stage A, 32.1% stage B, and 17.9% stage C. According to mRECIST criteria at 6 months, 15.2% achieved complete response (CR), 47.8% partial response (PR), 30% stable disease (SD), and 7% progressive disease (PD). Median OS was 19 months (12–32) for BCLC stage A, 28 months (3–42) for stage B, and 19 months (12–56) for stage C (log-rank p = 0.743). SEM identified diffuse tumour morphology as the most significant predictor of poor prognosis. Radical treatments were performed in 28% of patients, including four liver transplants and ten resections. Adverse events occurred in 11 patients, of which 7 were Clavien–Dindo grade I and 4 were grade II. Conclusions: In this real-world HCC group, SIRT provided durable tumour control and survival with excellent tolerability.