Episode # 653 • 09 Jun 2026
Radiation Lobectomy Techniques & Downstaging for HCC
How can targeted liver radiation unlock surgical or transplant options for tough hepatocellular carcinoma (HCC) cases? In this episode of the BackTable 2026 HCC Creator Weekend™, host Dr. Kavi Krishnasamy is joined by interventional radiologists Dr. Beau Toskich and Dr. Chris Malone to explore how downstaging and radiation lobectomy with Y90 are creating new surgical and transplant opportunities for patients with limited future liver remnants. They discuss Y90’s role as a “test of time” for tumor biology, strategies to prevent post-hepatectomy liver failure, and the ongoing challenge of recurrence even after R0 resection in cirrhotic livers.
This podcast is supported by an educational grant from Sirtex and Boston Scientific.
Timestamps
00:00 - Introduction
01:31 - Rad Lobectomy Goals and Case Discussion
06:09 - Selective vs Lobar Dosing
07:51 - PVE Versus Y90
09:35 - Downstaging to Transplant
13:03 - Patient Selection Factors
19:22 - Radseg vs. Lobar Strategy
22:12 - Percent Liver Treated Debate
26:38 - Particle Density and Catheter Bias
28:04 - Downstaging Evidence MERIT LT
36:20 - Operating After Y90
41:25 - Hypertrophy Timing and Readiness
43:03 - Wrap Up
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More about this episode
The discussion features a case of massive right-lobe HCC in a non-cirrhotic patient, with stepwise Y90 dosing and selective retreatment leading to complete response and marked liver hypertrophy. The doctors compare radiation lobectomy with portal vein embolization (PVE), explore dosimetry advances from studies like DOSISPHERE and MERITS-LT, and stress the importance of careful mapping and patient selection. Additional topics include the pros and cons of different downstaging methods, functional imaging to assess risk, the impact of lab values and portal hypertension, and the practicalities of timing surgery after Y90.
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