Radiation Lobectomy Techniques & Downstaging for HCC w/ Drs. Malone & Toskich | BackTable Ep. 653

How can targeted liver radiation unlock surgical or transplant options for tough hepatocellular carcinoma (HCC) cases? In this episode of 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 Y-90 are creating new surgical and transplant opportunities for patients with limited future liver remnants. They discuss Y-90’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. --- Get the BackTable app https://www.backtable.com/app --- 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 --- More about this episode The discussion features a case of massive right-lobe HCC in a non-cirrhotic patient, with stepwise Y-90 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 Y-90. --- Resources Long-Term Overall Survival After Selective Internal Radiation Therapy for Locally Advanced Hepatocellular Carcinomas: Updated Analysis of DOSISPHERE-01 Trial https://jnm.snmjournals.org/content/e... Downstaging hepatocellular carcinoma before liver transplantation: A multicenter analysis of the ""all-comers"" protocol in the Multicenter Evaluation of Reduction in Tumor Size before Liver Transplantation (MERITS-LT) consortium https://pubmed.ncbi.nlm.nih.gov/37532... --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app #VI653 #interventionalradiology #livercancer #oncology