Ep. 653 Radiation Lobectomy Techniques & Downstaging for HCC with Dr. Beau Toskich and Dr. Chris Malone

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 apphttps://www.backtable.com/app --- This podcast is supported by an educational grant from Sirtex and Boston Scientific. --- Timestamps 00:00 - Introduction01:31 - Rad Lobectomy Goals and Case Discussion06:09 - Selective vs Lobar Dosing07:51 - PVE Versus Y9009:35 - Downstaging to Transplant13:03 - Patient Selection Factors19:22 - Radseg vs. Lobar Strategy22:12 - Percent Liver Treated Debate26:38 - Particle Density and Catheter Bias28:04 - Downstaging Evidence MERIT LT36:20 - Operating After Y9041:25 - Hypertrophy Timing and Readiness43:03 - 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 Trialhttps://jnm.snmjournals.org/content/early/2024/01/10/jnumed.123.266211 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) consortiumhttps://pubmed.ncbi.nlm.nih.gov/37532179/ --- 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