Episode # 642 • 07 May 2026
Exploring CPN and Radiation Segmentectomy in Liver Cancer
Complete pathologic necrosis (CPN) rates above 90%? This week’s BackTable episode from the 2026 HCC Creator Weekend™ is cracking the code on complete tumor kill in hepatocellular carcinoma (HCC) bridging therapy. Host Dr. Kavi Krishnasamy is joined by Dr. Zach Berman and Dr. Beau Toskich to break down the latest multi-center research from COBRAS (Consortium on Bridging Radiation Segementectomy with Glass Microspheres Before Transplant), setting a new standard for bridging therapy that offers actionable strategies to improve outcomes.
Timestamps
00:00 - Introduction
01:30 - Multiple Rad Segment Case and Treatment Considerations
03:20 - Mapping as Biomarker
04:27 - Angiosome Tumor Ratio
09:13 - Defining CPN Relevance
14:12 - CPN Rates Across Modalities
16:18 - COBRAS Data: Why 400 Gray Varies
19:57 - Four Modifiable Variables
23:35 - From 400 to 440 Gray
26:06 - Stacking Variables Boosts CPN
30:05 - Benchmarks and Future Outcomes
32:48 - Wrap Up and Credits
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More about this episode
The doctors discuss how optimizing radiation segmentectomy can dramatically boost CPN rates before transplant, referencing real-world data from 364 tumors across seven U.S. sites. The episode covers planning with the andiosome-to-tumor concept, challenges of imaging-based biomarkers, and the growing role of tumor-informed ctDNA. The conversation also highlights how precise adjustment of dose, microsphere density, timing, and angiosome-to-tumor ratio can push CPN rates above 90%, with practical recommendations for interventional oncologists.
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