Interpretation of “Expert consensus on the standardized procedure of selective internal radiation therapy with yttrium-90 microspheres for liver malignancies (2024 edition)”_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XIA Dongdong ^1,2 ,  ZHAO Yan ²

1. State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an 710032, P. R. China;
2. Department of Digestive and Peripheral Vascular Interventional Radiology, Digestive Diseases Hospital, Xi’an International Medical Center Hospital, Northwest University, Xi’an 710032, P. R. China;

Corresponding?author：

ZHAO Yan, Email: yanzhao211@163.com

Keywords：

Yttrium-90 microsphere selective internal radiation therapy; liver malignancies; consensus interpretation; standardized procedures

DOI：

10.7507/1007-9424.202511060

Video：

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The “Expert consensus on the standardized procedure of selective internal radiation therapy with yttrium-90 microspheres for liver malignancies (2024 edition)” is China’s first comprehensive technical guideline document on yttrium-90 microsphere selective internal radiation therapy (⁹⁰Y-SIRT), developed collaboratively by domestic experts in interventional radiology, hepatobiliary surgery, nuclear medicine, and other related fields. This consensus systematically outlines the standardized requirements for the entire process of ⁹⁰Y-SIRT, including patient selection, preoperative assessment, dosage calculation, procedural techniques, and postoperative management. This section provides an in-depth interpretation of the consensus's core elements, with a focus on analyzing its innovations and differences compared to international guidelines and previous domestic practices. It highlights the consensus’s guiding value in promoting the safe, standardized, and efficient implementation of this technology in China, offering a reference for clinical practice to physicians across multiple disciplines, including hepatobiliary surgery, interventional radiology, medical oncology, and nuclear medicine, etc.

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2.	European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of hepatocellular carcinoma. J Hepatol, 2025, 82(2): 315-374.
3.	Cervantes A, Adam R, Roselló S, et al. Metastatic colorectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol, 2023, 34(1): 10-32.
4.	Mertens A, Essing T, Minko P, et al. Selective internal radiotherapy in Germany: a review of indications and hospital mortality from 2012 to 2019. J Clin Transl Res, 2023, 9(2): 123-132.
5.	Lau WY, Leung WT, Ho S, et al. Treatment of inoperable hepatocellular carcinoma with intrahepatic arterial Yttrium-90 microspheres: a phase Ⅰ and Ⅱ study. Br J Cancer, 1994, 70(5): 994-999.
6.	Sangro B, Martínez-Urbistondo D, Bester L, et al. Prevention and treatment of complications of selective internal radiation therapy: expert guidance and systematic review. Hepatology, 2017, 66(3): 969-982.
7.	Camacho JC, Moncayo V, Kokabi N, et al. ⁹⁰Y radioembolization: multimodality imaging pattern approach with angiographic correlation for optimized target therapy delivery. Radiographics, 2015, 35(5): 1602-1618.
8.	中國醫師協會介入醫師分會臨床診療指南專委會, 中國研究型醫院學會肝膽胰外科專業委員會. 釔-90微球選擇性內放射治療肝臟惡性腫瘤規范化操作專家共識(2024版). 中華醫學雜志, 2024, 104(7): 86-498.
9.	Kim E, Sher A, Abboud G, et al. Radiation segmentectomy for curative intent of unresectable very early to early stage hepatocellular carcinoma (RASER): a single-centre, single-arm study. Lancet Gastroenterol Hepatol, 2022, 7(9): 843-850.
10.	Lewandowski RJ, Serhal M, Padia SA, et al. The evolving application of radiation segmentectomy for the treatment of hepatic malignancy. Radiology, 2025, 316(1): e240333.
11.	Lewandowski RJ, Donahue L, Chokechanachaisakul A, et al. ⁹⁰ Y radiation lobectomy: outcomes following surgical resection in patients with hepatic tumors and small future liver remnant volumes. J Surg Oncol, 2016, 114(1): 99-105.
12.	Vouche M, Lewandowski RJ, Atassi R, et al. Radiation lobectomy: time-dependent analysis of future liver remnant volume in unresectable liver cancer as a bridge to resection. J Hepatol, 2013, 59(5): 1029-1036.
13.	Kulik L, Vouche M, Koppe S, et al. Prospective randomized pilot study of Y90+/– sorafenib as bridge to transplantation in hepatocellular carcinoma. J Hepatol, 2014, 61(2): 309-317.
14.	Habib A, Desai K, Hickey R, et al. Transarterial approaches to primary and secondary hepatic malignancies. Nat Rev Clin Oncol, 2015, 12(8): 481-489.
15.	Salem R, Parikh P, Atassi B, et al. Incidence of radiation pneumonitis after hepatic intra-arterial radiotherapy with yttrium-90 microspheres assuming uniform lung distribution. Am J Clin Oncol, 2008, 31(5): 431-438.
16.	Core JM, Frey GT, Sharma A, et al. Increasing yttrium-90 dose conformality using proximal radioembolization enabled by distal angiosomal truncation for the treatment of hepatic malignancy. J Vasc Interv Radiol, 2020, 31(6): 934-942.
17.	Hagspiel KD, Nambiar A, Hagspiel LM, et al. Temporary arterial balloon occlusion as an adjunct to yttrium-90 radioembolization. Cardiovasc Intervent Radiol, 2013, 36(3): 809-813.
18.	Meek J, Fletcher S, Gauss CH, et al. Temporary balloon occlusion for hepatic arterial flow redistribution during yttrium-90 radioembolization. J Vasc Interv Radiol, 2019, 30(8): 1201-1206.
19.	May BJ, Charalel RA. Cone beam computed tomography for the interventional oncologist: a practical approach. Semin Intervent Radiol, 2024, 41(3): 252-257.
20.	Kakeda S, Korogi Y, Ohnari N, et al. Usefulness of cone-beam volume CT with flat panel detectors in conjunction with catheter angiography for transcatheter arterial embolization. J Vasc Interv Radiol, 2007, 18(12): 1508-1516.
21.	Louie JD, Kothary N, Kuo WT, et al. Incorporating cone-beam CT into the treatment planning for yttrium-90 radioembolization. J Vasc Interv Radiol, 2009, 20(5): 606-613.
22.	Hermann AL, Dieudonné A, Ronot M, et al. Relationship of tumor radiation-absorbed dose to survival and response in hepatocellular carcinoma treated with transarterial radioembolization with 90Y in the SARAH study. Radiology, 2020, 296(3): 673-684.
23.	Garin E, Tselikas L, Guiu B, et al. Personalised versus standard dosimetry approach of selective internal radiation therapy in patients with locally advanced hepatocellular carcinoma (DOSISPHERE-01): a randomised, multicentre, open-label phase 2 trial. Lancet Gastroenterol Hepatol, 2021, 6(1): 17-29.
24.	Weber M, Lam M, Chiesa C, et al. EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds. Eur J Nucl Med Mol Imaging, 2022, 49(5): 1682-1699.
25.	Salem R, Johnson GE, Kim E, et al. Yttrium-90 radioembolization for the treatment of solitary, unresectable HCC: The LEGACY study. Hepatology, 2021, 74(5): 2342-2352.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of hepatocellular carcinoma. J Hepatol, 2025, 82(2): 315-374.
3. Cervantes A, Adam R, Roselló S, et al. Metastatic colorectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol, 2023, 34(1): 10-32.
4. Mertens A, Essing T, Minko P, et al. Selective internal radiotherapy in Germany: a review of indications and hospital mortality from 2012 to 2019. J Clin Transl Res, 2023, 9(2): 123-132.
5. Lau WY, Leung WT, Ho S, et al. Treatment of inoperable hepatocellular carcinoma with intrahepatic arterial Yttrium-90 microspheres: a phase Ⅰ and Ⅱ study. Br J Cancer, 1994, 70(5): 994-999.
6. Sangro B, Martínez-Urbistondo D, Bester L, et al. Prevention and treatment of complications of selective internal radiation therapy: expert guidance and systematic review. Hepatology, 2017, 66(3): 969-982.
7. Camacho JC, Moncayo V, Kokabi N, et al. ⁹⁰Y radioembolization: multimodality imaging pattern approach with angiographic correlation for optimized target therapy delivery. Radiographics, 2015, 35(5): 1602-1618.
8. 中國醫師協會介入醫師分會臨床診療指南專委會, 中國研究型醫院學會肝膽胰外科專業委員會. 釔-90微球選擇性內放射治療肝臟惡性腫瘤規范化操作專家共識(2024版). 中華醫學雜志, 2024, 104(7): 86-498.
9. Kim E, Sher A, Abboud G, et al. Radiation segmentectomy for curative intent of unresectable very early to early stage hepatocellular carcinoma (RASER): a single-centre, single-arm study. Lancet Gastroenterol Hepatol, 2022, 7(9): 843-850.
10. Lewandowski RJ, Serhal M, Padia SA, et al. The evolving application of radiation segmentectomy for the treatment of hepatic malignancy. Radiology, 2025, 316(1): e240333.
11. Lewandowski RJ, Donahue L, Chokechanachaisakul A, et al. ⁹⁰ Y radiation lobectomy: outcomes following surgical resection in patients with hepatic tumors and small future liver remnant volumes. J Surg Oncol, 2016, 114(1): 99-105.
12. Vouche M, Lewandowski RJ, Atassi R, et al. Radiation lobectomy: time-dependent analysis of future liver remnant volume in unresectable liver cancer as a bridge to resection. J Hepatol, 2013, 59(5): 1029-1036.
13. Kulik L, Vouche M, Koppe S, et al. Prospective randomized pilot study of Y90+/– sorafenib as bridge to transplantation in hepatocellular carcinoma. J Hepatol, 2014, 61(2): 309-317.
14. Habib A, Desai K, Hickey R, et al. Transarterial approaches to primary and secondary hepatic malignancies. Nat Rev Clin Oncol, 2015, 12(8): 481-489.
15. Salem R, Parikh P, Atassi B, et al. Incidence of radiation pneumonitis after hepatic intra-arterial radiotherapy with yttrium-90 microspheres assuming uniform lung distribution. Am J Clin Oncol, 2008, 31(5): 431-438.
16. Core JM, Frey GT, Sharma A, et al. Increasing yttrium-90 dose conformality using proximal radioembolization enabled by distal angiosomal truncation for the treatment of hepatic malignancy. J Vasc Interv Radiol, 2020, 31(6): 934-942.
17. Hagspiel KD, Nambiar A, Hagspiel LM, et al. Temporary arterial balloon occlusion as an adjunct to yttrium-90 radioembolization. Cardiovasc Intervent Radiol, 2013, 36(3): 809-813.
18. Meek J, Fletcher S, Gauss CH, et al. Temporary balloon occlusion for hepatic arterial flow redistribution during yttrium-90 radioembolization. J Vasc Interv Radiol, 2019, 30(8): 1201-1206.
19. May BJ, Charalel RA. Cone beam computed tomography for the interventional oncologist: a practical approach. Semin Intervent Radiol, 2024, 41(3): 252-257.
20. Kakeda S, Korogi Y, Ohnari N, et al. Usefulness of cone-beam volume CT with flat panel detectors in conjunction with catheter angiography for transcatheter arterial embolization. J Vasc Interv Radiol, 2007, 18(12): 1508-1516.
21. Louie JD, Kothary N, Kuo WT, et al. Incorporating cone-beam CT into the treatment planning for yttrium-90 radioembolization. J Vasc Interv Radiol, 2009, 20(5): 606-613.
22. Hermann AL, Dieudonné A, Ronot M, et al. Relationship of tumor radiation-absorbed dose to survival and response in hepatocellular carcinoma treated with transarterial radioembolization with 90Y in the SARAH study. Radiology, 2020, 296(3): 673-684.
23. Garin E, Tselikas L, Guiu B, et al. Personalised versus standard dosimetry approach of selective internal radiation therapy in patients with locally advanced hepatocellular carcinoma (DOSISPHERE-01): a randomised, multicentre, open-label phase 2 trial. Lancet Gastroenterol Hepatol, 2021, 6(1): 17-29.
24. Weber M, Lam M, Chiesa C, et al. EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds. Eur J Nucl Med Mol Imaging, 2022, 49(5): 1682-1699.
25. Salem R, Johnson GE, Kim E, et al. Yttrium-90 radioembolization for the treatment of solitary, unresectable HCC: The LEGACY study. Hepatology, 2021, 74(5): 2342-2352.

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