An ace in the hole for hepatocellular carcinoma: yttrium-90 radioembolization

Hepatocellular carcinoma (HCC) is currently the second most common cause of cancer related death (1). Assuming that the radical treatment as surgical resection and liver transplantation (LT) achieve better results and are increasingly employed even in HCC patients with intermediate and advanced diseases (2), locoregional treatment (LRT) are successfully applied in patients not candidates to curative therapies (3). In the last 5 years, Yttrium-90 radioembolization (Y90-RE) for HCC has been described as a safe procedure, and appears to be as well-tolerated and effective for the elderly as it is for younger patients with unresectable HCC patients with cirrhosis (4). LRT may be used as well to bridge or downstaging to LT and Y90-RE has been described to be safe as well in this setting (5,6).