Transarterial radioembolisation combined with targeted therapy and immune checkpoint inhibitors in advanced hepatocellular carcinoma with portal vein tumour thrombus: efficacy, safety, and dosimetric analysis
- Journal
- European journal of nuclear medicine and molecular imaging (Q1)
- Published
- 21 August 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Weifu Liu, Zhuting Fang, Mingzhi Hao, Yubin Hu, Shiguang Chen, Kongzhi Zhang, et al.
- PMID
- 42625053
- DOI
- 10.1007/s00259-026-08143-3
Why clinicians should know about it
- Picked for Medical Physics (top studies of the week, 23 August 2026): Clinical TARE outcomes, no dosimetry focus
Abstract
PURPOSE: Advanced hepatocellular carcinoma (HCC) with portal vein tumour thrombus (PVTT) carries a dismal prognosis. This study evaluated the efficacy and safety of transarterial radioembolisation (TARE) combined with targeted therapy and immune checkpoint inhibitors (ICIs) in patients with HCC and Vp2-Vp4 PVTT, and explored the tumour absorbed dose (TAD) threshold associated with survival benefit. METHODS: We retrospectively analysed 31 patients with HCC and Vp2-Vp4 PVTT treated with this triplet regimen. Tumour responses were assessed per mRECIST and RECIST 1.1. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. The optimal TAD cutoff was identified through dose-threshold exploration and internally validated by bootstrap resampling. RESULTS: The objective response rate was 77.4% per mRECIST and 54.8% per RECIST 1.1 (P = 0.023), with a disease control rate of 93.5%. Median PFS and OS were 10.0 months (95% CI, 7.9-NR) and 16.4 months (95% CI, 9.1-NR), respectively. Grade ≥ 3 treatment-related adverse events occurred in 22.6% of patients; no treatment-related death occurred. Exploratory analysis identified TAD ≥ 140 Gy as independently associated with improved PFS after multivariable adjustment (HR = 0.33, 95% CI, 0.11-0.95; P = 0.039), with a concordant trend for OS. Bootstrap validation confirmed robustness. CONCLUSION: TARE combined with targeted therapy and ICIs demonstrates encouraging efficacy with an acceptable safety profile in advanced HCC with Vp2-Vp4 PVTT. TAD ≥ 140 Gy was associated with improved survival, providing a hypothesis-generating basis for personalised dosimetric optimisation in future prospective trials.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.