What clinical parameters determine when you treat a large HCC lesion with ablative radiation vs Y-90?

Based on 3 negative randomized trials that have compared Y-90 to relatively inactive targeted therapy (Sorafenib), Y-90 has no evidence-based role in the treatment of HCC. In fact, systemic therapies have improved and 3 regimens have shown a survival benefit for locally advanced and metastatic HCC. ...

IR is increasingly offering Y90 radiation ‘segmentectomy’ for patients with a single HCC that is too large for thermal ablation (>3cm). I’m now seeing community IR providing Y90 for lesions that are perfectly amenable to thermal ablation. This Northwestern University retrospective study of 70 patien...