Complications of transarterial radioembolization in hepatic malignancies: Pathophysiological insights and management paradigms

Mengdi Qi; Zijia Tao; Duo Yu; Yang Zuo; Hongshan Zhong

doi:10.1016/j.ejrad.2025.112224

Complications of transarterial radioembolization in hepatic malignancies: Pathophysiological insights and management paradigms

Eur J Radiol. 2025 Jun 12:190:112224. doi: 10.1016/j.ejrad.2025.112224. Online ahead of print.

Authors

Mengdi Qi¹, Zijia Tao², Duo Yu³, Yang Zuo⁴, Hongshan Zhong⁵

Affiliations

¹ Department of Interventional Radiology, the First Hospital of China Medical University, Shenyang 110000, China. Electronic address: qimengdi@cmu.edu.cn.
² Department of Interventional Radiology, the First Hospital of China Medical University, Shenyang 110000, China. Electronic address: zjtao@cmu.edu.cn.
³ Department of Interventional Radiology, the First Hospital of China Medical University, Shenyang 110000, China. Electronic address: yud4088@126.com.
⁴ Department of Interventional Radiology, the First Hospital of China Medical University, Shenyang 110000, China. Electronic address: zuo13980763176@163.com.
⁵ Department of Interventional Radiology, the First Hospital of China Medical University, Shenyang 110000, China. Electronic address: hszhong@cmu.edu.cn.

PMID: 40532593
DOI: 10.1016/j.ejrad.2025.112224

Abstract

Hepatic malignancies remain among the most prevalent and lethal oncologic entities worldwide, characterized by aggressive biological behavior and dismal prognosis. Hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM) represent the predominant hepatic neoplasms, for which conventional therapies demonstrate limited efficacy in unresectable advanced-stage disease. Transarterial radioembolization (TARE), alternatively termed selective internal radiation therapy (SIRT) using yttrium-90 (⁹⁰Y) labeled microspheres, has emerged as an innovative hybrid modality integrating interventional radiology with intratumoral radiotherapy. While offering distinct advantages including minimally invasive implementation, demonstrated tumor response, and abbreviated hospitalization, postprocedural complications may substantially compromise therapeutic outcomes and quality of life. Consequently, prevention and management of TARE-associated complications have become critical components of perioperative care. This comprehensive review systematically analyzes the spectrum of potential post-TARE complications while elucidating contemporary prevention strategies and therapeutic algorithms grounded in pathophysiological mechanisms.

Keywords: Colorectal liver metastases (CRLM); Hepatic malignancies; Hepatocellular carcinoma (HCC); Postprocedural complications; Transarterial radioembolization (TARE); Yttrium-90 ((90)Y) microspheres; Yttrium-90 selective internal radiation therapy ((90)Y-SIRT).

Publication types

Review