Yttrium-90 microsphere therapy for hepatocellular carcinoma: Clinical efficacy, mechanistic insights, and comparative therapeutic perspectives

Yttrium-90 (Y-90) microsphere therapy, known as radioembolization, has emerged as a pivotal treatment modality for hepatocellular carcinoma (HCC), delivering targeted radiation with minimal collateral damage to healthy liver tissues. This review meticulously synthesizes current evidence regarding the clinical efficacy, underlying therapeutic mechanisms, patient selection criteria, and comparative advantages of Y-90 therapy. Clinical studies consistently demonstrate significant improvements in overall survival and progression-free survival, coupled with robust tumor response rates and manageable adverse events. The therapy’s efficacy is substantially enhanced by advanced dosimetric techniques, enabling precise radiation delivery tailored to individual tumor profiles. Comparative analyses reveal that Y-90 therapy provides superior local tumor control and a preferable safety profile compared to conventional treatments such as transarterial chemoembolization and external beam radiation therapy. Additionally, its clinical outcomes are comparable to those achieved with contemporary systemic therapies. Ongoing research into combination treatments incorporating Y-90 with systemic therapies, including targeted agents and immune checkpoint inhibitors, suggests promising advancements in comprehensive HCC management. Future directions highlight the necessity for continued refinement of dosimetry and patient stratification approaches, aiming to further optimize therapeutic outcomes.