Conversion to resection post radioembolization in patients with HCC: recommendations from a multidisciplinary working group

Background: Transarterial radioembolization (TARE) with yttrium-90 (⁹⁰Y) glass microspheres is an efficacious option for converting appropriately selected patients with borderline-resectable hepatocellular carcinoma (HCC) to surgical candidacy. Methods: In 2018 and 2019, a diverse multidisciplinary group of surgical and interventional experts with experience using ⁹⁰Y for downstaging and bridging to liver transplant convened to review peer-reviewed literature and personal experience in the use of ⁹⁰Y to convert borderline resectable liver cancer patients to surgical candidacy. The working group included surgical oncologists specializing in liver cancer, liver transplant surgeons with experience in complex hepatobiliary surgery, and interventional radiologists with experience using ⁹⁰Y. Results: This document presents expert recommendations based upon the group's experience and consensus. Conclusions: By combining related evidence from the literature with expert experiences with TARE in surgical candidates, these recommendations aim to demonstrate the safety, efficacy, and feasibility of TARE in converting borderline-resectable patients to surgical options. The document also addresses the concerns about potential complications associated with TARE during the surgical intervention.