Phase 2 Yttrium-90 TARE beta-radiation embolization versus SBRT photon radiation for HCC

Henry Ford Health System is running REVERT, a single-site, prospective, randomized, open-label Phase 2 trial comparing two definitive local radiation strategies for hepatocellular carcinoma (HCC): transarterial radioembolization (TARE) using Yttrium-90 microspheres and stereotactic body radiation therapy (SBRT) delivered in 3–5 fractions. TARE’s mechanism is catheter-based selective arterial delivery of Y-90, a beta emitter that deposits high-dose radiation within the perfused tumor territory while simultaneously embolizing tumor-feeding arteries; SBRT’s mechanism is highly conformal external-beam photon radiation targeting the tumor with steep dose falloff. Patients must be considered eligible for either approach at a multidisciplinary tumor board (e.g., limited number of lesions, preserved liver function, no macrovascular invasion), making this a pragmatic “either treatment is reasonable” comparison. The primary endpoint—index-lesion re-treatment rate at 12 months—aims to capture durable local control and resource utilization rather than radiographic response alone. Today’s care for nonresectable, liver-limited HCC commonly uses local/regional therapies (ablation when feasible; TACE/TARE) and/or SBRT in selected cases, with systemic therapy (immunotherapy-based regimens and TKIs) used when disease is more advanced or not amenable to definitive local treatment; this trial tests whether an intra-arterial Y-90 approach reduces subsequent local retreatment versus modern SBRT.