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SIR 2026

Scientific Session

Interventional Oncology

Session: Radioembolization 1

Transarterial Radioembolization (TARE) with Yttrium-90 (Y90) Glass Microspheres in Patients with Hepatocellular Carcinoma and Portal Vein Thrombosis (PVT): Real-World Data from the PROACTIF Study

Sunday, April 12, 2026
3:54 PM - 4:03 PM ET
Location: 717
Purpose: Presence of PVT and the degree or extent of thrombosis are prognostic factors for HCC patients. Whether locoregional treatments are still appropriate in patients with PVT is an open debate and most treatment guidelines recommend systemic therapies as the first treatment option in patients with PVT. Herein, we evaluated the effectiveness of Y90 in patients with and without PVT.

Materials and Methods: All patients treated with Y90 glass microspheres (TheraSphere™) across 34 French institutions who not opposed to data collection, were included in the PROACTIF study. Duration of follow-up and overall survival (OS) were assessed by reverse Kaplan-Meier (KM) and KM analysis, respectively.

Results: Among the 989 HCC patients, 349 (35·3%) had PVT determined by central read. Key baseline and treatment characteristics and median OS by portal vein invasion (Vp) categories are reported in Table 1. The baseline characteristics were similar for patients with Vp0 to 3, whereas Vp4 patients had larger tumors and impaired liver function. Median OS [95% confidence interval (CI)] in patients without and with PVT were 23.1 [95% CI, 21.6,27.0] and 18.3 months (M) [15.4 – 22.2] respectively. By multivariate analysis, the HR for survival was 1.02 [0.64, 1.64] for Vp1-2, 2.01 [1.21 – 3.34]) for Vp3 and 4.8 [2.10 – 10.93] for Vp4. Similar to patients with no PVT, 13.6% of patients with Vp1-3 were downstaged to surgery and subsequent treatment (excluding surgery) was given to 38.9% of patients.

Conclusion: While a number of factors limit cross-study comparisons, median OS in PROACTIF patients with PVT compares favorably with results reported in pivotal immunotherapy combination studies, corroborating that TARE is an appropriate treatment in patients with PVT and allows subsequent resection. Y90 administration for patients with PVT should be considered in multidisciplinary tumor board discussions.