20.500.12556/DiRROS-30283 Conversion therapy for advanced hepatocellular carcinoma following complete response to transarterial radioembolization combined with atezolizumab and bevacizumab Background: The current Barcelona Clinic Liver Cancer (BCLC) classification recommends systemic treatment with atezolizumab and bevacizumab as the first-line therapy for advanced hepatocellular carcinoma (HCC). Recent studies suggest that combining systemic immunotherapy with locoregional treatments, such as transarterial radioembolization (TARE), may enhance immune responses and improve overall treatment outcomes. This article presents a case series of three patients with advanced hepatocellular carcinoma who were treated with transarterial radioembolization followed by atezolizumab and bevacizumab achieving conversion to surgical resection. Patients and methods: Between June 2020 and April 2024, three patients with advanced HCC were treated with TARE followed by atezolizumab and bevacizumab. The cohort included: Patient 1: A 59-year-old female, with noncirrhotic liver, with a 12 cm tumor and a 1.5 cm satellite lesion located in the liver, with hepatic vein and inferior vena cava (IVC) tumor thrombosis (Vv3 Japanese classification) and a small lung metastasis. Patient 2: A 63-year-old male with chronic hepatitis C (CHV), presenting with a 10 cm tumor and portal vein tumor thrombosis (Vp4 Japanese classification). Patient 3: A 50-year-old male, with non-cirrhotic liver, with a 17 cm tumor with portal vein and IVC tumor thrombosis (Vp3, Vv3 Japanese classification). Results: The combined treatment approach enabled surgical resection in all three patients, each achieving a complete pathological response. Interestingly, follow-up dosimetric analysis showed that all tumors had received a subtherapeutic absorbed radiation doses. Conclusions: In selected patients, combining transarterial radioembolization with systemic immunotherapy may enable conversion to surgical resection in advanced hepatocellular carcinoma, even with subthreshold tumor radiation doses, highlighting a potential synergistic and abscopal effect between locoregional and systemic therapies. true false true Association of Radiology and Oncology Ljubljana Angleški jezik Ni določen Članek v reviji 2026-06-18 11:20:12 2026-06-18 11:20:13 2026-06-19 03:51:59 0000-00-00 00:00:00 0 0 0 str. 40-48 no. 1 Vol. 60 2026 0000-00-00 Zaloznikova Objavljeno NiDoloceno 0000-00-00 0000-00-00 2026-03-01 1581-3207 10.2478/raon-2026-0015 https://www.sciendo.com/pdf/10.2478/raon-2026-0015 1 874ca069-6aee-11f1-be3d-001a4af901a5 https://dirros.openscience.si/Dokument.php?lang=slv&id=45905 RAZ_Popovic_Peter_0.pdf RAZ_Popovic_Peter_0.pdf 1 3EA8222D9FC0F0B6F93E8D187CFC51B6 407ed6922ab63fc59b6ca67ad16889c16df951a56f5b557112dc89cf4696bea8 f8d3d8b2-6aee-11f1-be3d-001a4af901a5 https://dirros.openscience.si/Dokument.php?lang=slv&id=45911 Društvo radiologije in onkologije 0 0 0