TheraSphere (Y-90 glass microspheres) SIRT delivers 21.8-mo real-world OS in HCC, with a clear ≥400Gy dose–survival signal

Yttrium-90 (Y-90) glass microsphere selective internal radiation therapy (SIRT; TheraSphere™) is a catheter-delivered liver-directed radiotherapy that treats HCC by delivering high beta radiation doses to tumor while attempting to spare normal liver. In the prospective, open-label, non-interventional PROACTIF cohort across 34 French centers (Jan 2019–Jan 2024), 989 all-comer HCC patients (13.3%/18.9%/57.9%/5.8% BCLC A/B/C/D; 35.3% with portal-vein tumor thrombosis [PVT]) had median OS 21.8 months (95% CI 20.1–23.3), including 27.0 months in BCLC B and 21.1 months in BCLC C; absorbed dose correlated strongly with OS (index lesion <200Gy vs ≥200Gy: 16.8 vs 26.0 months, p<0.001; <400Gy vs ≥400Gy: 19.7 vs 30.7 months, p<0.001). Post-Y90, 10.7% converted to curative-intent surgery with mOS 48.6 months vs 20.1 months without surgery; QoL time-to-deterioration was 10.6 months, serious AEs were 7.5% and serious treatment-related events 3.7%—noting that for BCLC C, front-line systemic SOC benchmarks are ~19.2-month mOS with atezolizumab+bevacizumab (IMbrave150) and 16.4 months with durvalumab+tremelimumab (HIMALAYA), though those are randomized systemic-therapy populations and not directly comparable to a liver-directed all-comers SIRT cohort.