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).

YaDing Luo, YinSheng Lin

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Article in Radiology case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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YaDing LuoDepartment of Interventional Vascular Surgery, First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue, Tianhe District, Guangzhou, Guangdong Province, China.

YinSheng LinDepartment of Interventional Vascular Surgery, First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue, Tianhe District, Guangzhou, Guangdong Province, China.

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6 · The paper itself

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.

Indexed as

Conversion therapyHepatocellular carcinomaHepatopulmonary shuntMultimodal therapyYttrium-90 selective internal radiation therapy

Identifiers

PMID41492347

DOI10.1016/j.radcr.2025.11.007

PMCPMC12765385

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