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Conversion therapy for advanced hepatocellular carcinoma following complete response to transarterial radioembolization combined with atezolizumab and bevacizumab Cover

Conversion therapy for advanced hepatocellular carcinoma following complete response to transarterial radioembolization combined with atezolizumab and bevacizumab

Open Access
|Mar 2026

Figures & Tables

FIGURE 1.

58-year-old female with a 116 mm hepatocellular carcinoma (HCC) in the right hepatic lobe, with a tumor thrombus (Japanese classification Vv3) in hepatic vein and inferior vena cava. (A). Follow up CT scan after 8 months demonstrated a complete response to transarterial radioembolization (TARE) and atezolizumab/bevacizumab treatment (B). Last follow-up CT scan was 7 months after surgery and showed no signs of disease progression (C).

FIGURE 2.

63-year-old male with a 100 mm hepatocellular carcinoma (HCC), chronic hepatitis C (CHV), without cirrhosis, with portal vein tumour thrombosis (Japanese classification Vp4) before treatment (A). Patient received transarterial radioembolization (TARE) and 13 cycles of atezolizumab/bevacizumab, achieving complete response on follow-up CT scan after 14 months (B). Subsequently, surgical resection was performed, with no signs of disease progression (C).

FIGURE 3.

50-year-old male with 170 mm hepatocellular carcinoma (HCC), portal vein tumor thrombosis (Japanese classification Vp4), inferior vena cava (IVC) tumor thrombosis (Japanese classification Vv3) and Child A cirrhosis (A). Follow-up CT scan showed a partial response 2 months after transarterial radioembolization (TARE) (B), followed by 7 cycles of atezolizumab/bevacizumab, resulting in a complete response after 4 months (C). A right hemihepatectomy with marginal excision of the vena cava was performed, with no disease progression upon follow up (D).

Comparison of literature reported transarterial radioembolization (TARE) + immunotherapy treatment

StudyStudy designNo. of patientsHCC stageLocoregional therapyImmunotherapy regimenCRRMedian OS
Villalobos et al.2Retrospective19Advanced unresectable HCC (84% BCLC C)TAREAtezo/Bev (n = 10); nivolumab (n = 9)16%12.9 months
Yu et al.21Retrospective1060% BCLC C, 40% BCLC BTAREAtezo/Bev75%90% (6 months), 77.1% (12 months)
Yeo et al.23Retrospective142BCLC CTAREMixed ICIsNot reported19.8 months
Presen studyCase series3BCLC CTARE (± DEBTACE)Atezo/Bev100%Ongoing; no recurrence at 13–53 months

Summary of key results

VariablePatient 1Patient 2Patient 3
Age / Sex58 / Female69 / Male50 / Male
Liver cirrhosisNon-cirrhotic liverChild–Pugh A (6 points)Non-cirrhotic liver
Performance status010
Baseline AFP (kU/L)7.95242.5
Tumor size (mm)116 + 15 mm satellite lesion100170
Vascular invasionHepatic vein + IVC (Vv3)Main portal vein (Vp4)Portal vein (Vp3) + hepatic vein + IVC (Vv3)
Extrahepatic diseaseLung metastasis (7 mm)NoneNone
TARE type90Y resin microspheres90Y resin microspheres90Y glass microspheres
Additional locoregional therapyNoneNoneDEB-TACE
Absorbed tumor dose (Gy)5545100
Time to immunotherapy4 months post-TARE4 months post-TARE1 month post-TARE
Immunotherapy cycles13137 preoperatively + 12 adjuvant
Best radiological response (mRECIST)CR after 8 monthsCR after 14 monthsCR after 4 months
Serious adverse events following TARE + atezo/bevaNoNoNo
Surgical procedureRight hemihepatectomy + partial IVC resectionRight hemihepatectomy + portal vein resectionRight hemihepatectomy + marginal IVC excision
Pathological responseComplete necrosis, no viable tumorComplete necrosis, no viable tumorComplete necrosis, no viable tumor
Postoperative complicationsPneumoniaNoneNone
Length of stay (POD)1267
Follow-up outcomeNo recurrence; died of cardiac arrestNo recurrence at 53 monthsNo recurrence at 13 months
Overall survival20 monthsOngoing (> 53 months)Ongoing (> 13 months)
DOI: https://doi.org/10.2478/raon-2026-0015 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
Language: English
Page range: 40 - 48
Submitted on: Nov 27, 2025
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Accepted on: Feb 4, 2026
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Published on: Mar 24, 2026
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2026 Peter Popovic, Ana Kalamutova, Mihajlo Djokic, Anka Cuderman, Gasper Boltezar, Blaz Trotovsek, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.