A novel triple-modality approach overcoming prohibitive hepatopulmonary shunt (HPS): Enabling yttrium-90 selective internal radiation therapy (Y90-SIRT) and subsequent curative resection in massive hepatocellular carcinoma (HCC)
Year: 2025
Type: article
Study design: Case Report
Abstract: Elevated hepatopulmonary shunt exceeding 20% is a strict contraindication for Y90-SIRT due to the risk of fatal radiation pneumonitis, posing a significant clinical challenge in the management of such HCC cases. We report a 45-year-old man with unresectable massive HCC and an initial HPS of 21.8% who was treated with a staged multimodal protocol involving arterioportal fistula embolization, drug-eluting bead transarterial chemoembolization (TACE), and systemic therapy. This strategy successfully reduced the HPS to 7.4%, which permitted curative-intent Y90-SIRT. Subsequent significant tumor regression enabled an R0 resection-defined as complete resection with negative margins. The patient showed no evidence of recurrence or postoperative complications during 6-month surveillance. This case highlights that a strategically sequenced combination of locoregional and systemic therapies can overcome absolute contraindications to Y90-SIRT, enabling conversion to resection in selected patients with advanced HCC.
Source: Radiology Case Reports
Authors: YaDing Luo, YinSheng Lin
Institution: First Affiliated Hospital of Jinan University
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $600
OpenAlex ID: W7114993694