ModifiedUnitedHealthcarePolicy CS060LA.M

Transarterial Radioembolization (TARE)/ Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (for Louisiana Only)

This Louisiana-specific medical policy covers clinical evidence, guideline recommendations, and comparative outcomes for Yttrium-90 TARE/SIRT in primary hepatocellular carcinoma and liver metastases (including colorectal and neuroendocrine), informing coverage decisions for UnitedHealthcare providers and reviewers.

Policy Summary

PayerUnitedHealthcare

PolicyTransarterial Radioembolization (TARE)/ Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (for Louisiana Only)

Policy CodePolicy CS060LA.M

Change TypeCoverage indications reviseddocumentation language added

Effective DateMar 1, 2026

Next Review Date

Key ActionObtain prior authorization with multidisciplinary documentation, performance status and pre-treatment mapping studies to confirm candidacy and adequate target isolation.

SourceLink

POLICY UPDATE CHANGES

This policy applies to individuals 19 years of age and older; Transarterial Radioembolization/selective internal radiation therapy is covered without further review for individuals younger than 19 years of age.

Revised proven and medically necessary indications to specify candidacy (e.g., 'liver dominant primary hepatocellular carcinoma in individuals who are not surgical candidates' and clarified NET, colorectal, intrahepatic cholangiocarcinoma and uveal melanoma language).

Medical records documentation language was added emphasizing that documentation may be required to assess clinical criteria and must fully support medical necessity.

19+policy age applicability

>=3 months

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minimum life expectancy suggested

2ANCCN colorectal metastases

No OSY-90 vs standard care in non-surgical HCC

variedmedian OS examples reported

Coverage criteria for Transarterial Radioembolization (TARE/SIRT)

Covered clinical scenarios

Covered when patient selection aligns with consensus/guideline-supported scenarios and treatment is performed in experienced centers:

NCCN colorectal metastases: Y-90 SIRT/TARE is an option for highly selected individuals with chemotherapy-resistant or -refractory colorectal liver metastases and predominant hepatic disease; radiation lobectomy (Y-90) can be considered to induce remnant liver hypertrophy or downsize tumors to enable resection when remnant liver volume is insufficient.NCCN category 2A

Uniform NCCN consensus for appropriateness

Neuroendocrine liver metastases: TARE/SIRT may be considered for lobar or segmental liver-dominant neuroendocrine tumor (NET) metastases, particularly after or in conjunction with systemic therapy when appropriate; selection should be by an experienced multidisciplinary team and performed in specialized centers.varied across guidance

NCCN/ NICE recommend MDT selection; better tolerated than TAE/TACE but late hepatotoxicity possible

Primary HCC - selected indications: TARE/TARE with Y-90 is acceptable for solitary unresectable HCC, as neoadjuvant locoregional therapy or bridge to transplant, for subcapsular or anatomically challenging tumors (including radiation segmentectomy), and as an alternative intra-arterial therapy for selected intermediate-stage (BCLC B) HCC when TACE is not optimal.per AASLD/ACR/NCCN guidance

Choice relative to TACE/DEB-TACE/sorafenib depends on clinical scenario; increases time to progression and may improve transplant prospects

Limited/Equivocal evidence scenarios

Scenarios without demonstrated survival benefit or with inconclusive evidence:

Non-surgical HCC general survival: Randomized trials and meta-analyses in non-surgical HCC have not demonstrated a consistent overall survival (OS) benefit for Y-90 TARE versus standard therapies; improvements reported are more consistent for time to progression and some adverse-event profiles rather than OS.no consistent OS benefit in pooled analyses

Lower rates of some grade ≤3 adverse events observed; additional RCTs needed

General eligibility per professional societies and guidelines

Coverage considerations reflected in cited guidelines and society statements:

General candidate criteria: Patient has unresectable or inoperable primary or secondary liver malignancy with liver-dominant tumor burden, performance status adequate to benefit, anticipated life expectancy of at least 3 months, and laboratory/clinical data indicating the procedure can be performed safely; selection and treatment should involve multidisciplinary expertise and be performed in experienced centers.life expectancy >= 3 months

Multidisciplinary assessment required; laboratory data should suggest safe procedure

Indications and appropriateness

Indications where TARE/SIRT may be appropriate according to AASLD/ACR/NCCN:

Common appropriate indications: Solitary unresectable HCC (including subcapsular or difficult-to-ablate locations), intermediate-stage (BCLC B) HCC as an alternative to TACE, radiation segmentectomy for durable local control and remnant hypertrophy, peripheral intrahepatic cholangiocarcinoma (<3 cm) without biliary ductal dilatation or macroscopic vascular invasion per ACR appropriateness criteria, solitary or multifocal colorectal liver metastases in highly selected chemotherapy-refractory patients, and multifocal liver-dominant neuroendocrine metastases in selected patients.per society criteria and lesion context

ACR categorizes appropriateness by lesion size and context; AASLD lists TARE as acceptable for solitary unresectable HCC and as bridge to transplant

Contraindications

Contraindications and situations where therapy is not appropriate:

Absolute contraindications: Inability to catheterize the hepatic artery; fulminant liver failure; mapping angiography/MAA or cone-beam CT demonstrating unacceptable nontarget deposition that cannot be corrected; lung shunt fraction exceeding product-specific safe limits; acute hepatic infection; and uncorrectable coagulopathy.

These conditions should preclude treatment

Relative contraindications: Excessive hepatic tumor burden replacing >50–70% of parenchyma (unless synthetic function preserved); total bilirubin >2 mg/dL (nonobstructive) generally unfavorable, with NCCN advising caution when bilirubin >3 mg/dL unless segmental treatment possible; prior significant liver/upper-abdominal radiation; concurrent systemic therapies that may increase toxicity; pregnancy requires caution and MDT consultation.tumor burden >50-70%; bilirubin >2 mg/dL (relative); NCCN: >3 mg/dL unless segmental treatment possible

May be considered for segmental/subsegmental infusion in select cases

ICC: evidence and intended use

Evidence summary for intrahepatic cholangiocarcinoma (ICC):

ICC outcomes and considerations: Retrospective series, single-arm trials, and meta-analyses report median overall survival ranging approximately from 8.4–22.9 months depending on setting; disease control rates commonly reported between ~68% and 82%; downstaging to resectability occurs in a minority (~11%–17%) across series. Evidence is primarily nonrandomized and higher-quality RCT data are limited.

Supports use in selected patients often as second-line or salvage; further randomized studies needed

Device safety comparisons

Safety and comparative device information:

Microsphere safety profile: Observational syntheses comparing glass (TheraSphere) versus resin (SIR-Spheres) microspheres report device-specific differences: resin microspheres were associated with higher rates of some gastrointestinal and hepatobiliary adverse events (e.g., gastric ulcers, hepatic encephalopathy, cholecystitis, hepatic failure) and more grade ≥3 hepatobiliary AEs in some series; glass microspheres had fewer GI and pulmonary AEs but in some reports more ascites and nausea grade ≥3.

Device-specific safety differences reported in observational literature; FDA approvals informational

General coverage context

Stance and context summarized from cited guideline and evidence:

General: SIRT/TARE with Y-90 is described as a locoregional therapy for primary HCC (including bridge to transplant), for metastatic liver disease from multiple primaries (e.g., colorectal, neuroendocrine, uveal melanoma), and for select ICC cases; evidence quality varies and randomized controlled data are often lacking—guidelines emphasize multidisciplinary selection and specialist centers.

Sources include NCCN, AASLD, ACR, NICE, Hayes assessments and multiple cohort and systematic reviews

Unresectable primary intrahepatic cholangiocarcinoma (ICC)

Covered only in research context per NICE:

Unresectable primary ICC (NICE): NICE recommends that SIRT for unresectable primary intrahepatic cholangiocarcinoma should be used only in the context of research because evidence on efficacy is inadequate in quantity and quality and there are recognized serious but rare safety concerns; patient selection should be by a multidisciplinary team and procedures done in specialist centers by experienced clinicians.

NICE interventional procedures guidance (2018)

Hepatocellular carcinoma (bridge/downstaging)

Bridge to transplant / downstaging use in HCC:

HCC bridge/downstaging: Y-90 TARE may be used to bridge or downstage hepatocellular carcinoma prior to liver transplantation; observational and HTA reports suggest comparable or improved efficacy and safety versus other locoregional therapies for downstaging/bridging and potential to reduce waitlist dropout, particularly where wait times are long.

Hayes assessment and cohort studies report favorable bridge/downstage outcomes

Liver-dominant metastatic disease

Metastatic disease and other primary tumors:

Uveal melanoma metastases: Systematic reviews and small prospective trials report disease control and median overall survival for hepatic metastases from uveal melanoma often in the range of approximately 9–19 months; evidence is mostly retrospective or small cohorts and further prospective research is needed.

Alexander 2022, Rowcroft 2020, Gonsalves 2019

Breast cancer liver metastases: Meta-analyses and systematic reviews report median OS after SIRT roughly 9.8–11.5 months with variable disease control; evidence is heterogeneous and comparative randomized trials are lacking.

Liu 2022, Rivera 2021, Fendler 2016

Other nonconventional primaries (pancreatic, renal, etc.): Limited, heterogeneous observational data suggest possible palliative benefit for some nonconventional primaries, but randomized data are needed to determine comparative effectiveness and appropriate selection criteria.

Small cohort studies reported; RCTs required

Proven / Medically Necessary Indications

Covered when the indication matches one of the following proven/medically necessary groups and the patient meets the specified clinical context (e.g., not a surgical candidate, refractory disease, liver-dominant disease):

Proven/Medically Necessary Indications (summary): Includes: metastasis from uveal/ocular melanoma when confined to the liver; liver-dominant primary hepatocellular carcinoma (HCC) in individuals who are not surgical candidates; liver metastases from neuroendocrine tumors in individuals who are not surgical candidates when systemic therapy has failed to control symptoms; liver metastases from colorectal carcinoma in individuals with chemotherapy-resistant or -refractory disease and with predominant hepatic metastases; and liver metastases from intrahepatic cholangiocarcinoma in individuals who are not surgical candidates.

Policy revision clarified wording and candidate context; documentation required to support medical necessity

SIRT/TARE procedures should be performed only by clinicians with specific training in SIRT and within specialized centers experienced in performing these treatments. Documentation of center expertise and clinician training is expected when prior authorization or medical-record review is requested because procedures performed outside specialist settings may not meet guidance for appropriate use.

NICE concludes that evidence for SIRT in unresectable primary intrahepatic cholangiocarcinoma (ICC) is inadequate in both quantity and quality. Given recognized serious but rare safety concerns, NICE recommends use of SIRT for unresectable primary ICC only in the context of research and within prospective studies.

Per NICE guidance, SIRT for unresectable primary ICC is recommended only within research settings; patient selection should be determined by a multidisciplinary team, and procedures must be performed in specialist centers by clinicians experienced in managing cholangiocarcinoma. Routine use outside approved research protocols is not supported by NICE.

Local (liver-directed) therapies should be proposed only for very selected patients with good performance status, limited liver involvement, and no extrahepatic disease after systemic therapy has demonstrated control of disease. Patients must be informed that randomized data demonstrating a survival benefit for many local therapies are lacking and technique selection should be individualized.

Randomized and systematic-review evidence indicates that Y-90 TARE increases time to progression and can improve transplant candidacy in selected HCC patients, but it has not consistently demonstrated an overall survival benefit in non-surgical HCC populations; pooled analyses have not shown OS improvement versus standard treatments.

Absolute contraindications that should preclude SIRT include inability to catheterize the hepatic artery, fulminant liver failure, clinically unacceptable nontarget deposition on mapping angiography/MAA that cannot be corrected, an unacceptable lung shunt fraction above product-specific limits, acute hepatic infection, and uncorrectable coagulopathy.

Evidence for SIRT in many nonconventional indications and non-colorectal liver metastases is limited and heterogeneous; available data are largely retrospective or from small prospective cohorts, so routine use outside clinical trials is not well supported and further randomized studies are needed.

Treating patients outside established selection criteria (for example, with poor performance status, extensive hepatic replacement by tumor, significant extrahepatic disease, or at centers lacking SIRT expertise) should be approached with caution. Guidance emphasizes multidisciplinary selection and informed discussion about the limited randomized evidence for survival benefit in many contexts; such departures from criteria may increase the risk of noncoverage or denial.

Coding, device and numeric thresholds

No explicit CPT/HCPCS/ICD-10 codes listed in this document segmentmixed

No codes listed

Referenced procedure coding (not specified in text)mixed

mixed

Policy portion lists Y-90 microsphere TARE/SIRT as a locoregional therapy; specific CPT/HCPCS codes not provided in this document section.

Device/Manufacturer referencesmixed

TheraSphere	Glass Y-90 microspheres (TheraSphere) - FDA Humanitarian Device Exemption; PMA expanded SIRT indication for solitary HCC (PMA 03/17/2021).
SIR-Spheres	Resin Y-90 microspheres (SIR-Spheres) - FDA premarket approval (P990065) for unresectable metastatic colorectal liver tumors with adjunct IHAC of floxuridine.

inv-24: tumor-to-liver volume — research/selection detail

ContextNICE recommends that research reports for SIRT include details of patient selection, including tumor-to-liver volume; tumor-to-liver volume is explicitly called out as a selection/reporting detail for colorectal metastases research

Use in selectionTumor-to-liver volume should be reported in prospective research and used to inform selection in studies of colorectal liver metastases (NICE 2024 update)

Documentation expectationFurther research should record tumor-to-liver volume alongside laterality (left/right colon), extrahepatic disease, and outcomes such as survival and quality of life

inv-25: Serum total bilirubin for inclusion in some ICC studies

Reported inclusion cutoffSome iCCA studies required serum total bilirubin < 2.0 mg/dL for inclusion (e.g., Yu et al. 2024)

Prior authorization, documentation, and procedural expectations

Prior Authorization

Prior Authorization Required

Prior authorization is required for selective internal radiation therapy (SIRT)/transarterial radioembolization (TARE) requests. Prior authorization must confirm appropriate patient selection per specialty guidance (performance status, life expectancy, liver-dominant disease, prior lines of therapy, and that procedures are to be performed in specialized centers by trained clinicians).

A prior authorization request should include documentation of prior systemic and locoregional therapies and rationale for selecting SIRT/TARE over other options (e.g., TACE).
Requests for bridge-to-transplant or other locoregional uses should be identified as such; prior authorization is advised to assess intent, timing, and transplant candidacy.
Mapping angiography and MAA shunt assessment results must be included with the prior auth when available.

Documentation Required

Multidisciplinary Evaluation and Mapping Documentation

Documentation must demonstrate multidisciplinary evaluation and procedural planning. Multidisciplinary expertise should include (but is not limited to) interventional radiology, radiation oncology, nuclear medicine, hepatology, medical oncology, surgical oncology, and medical physics. Documentation should include pre-procedure mapping, measures to mitigate nontarget deposition, and confirmation of acceptable lung shunt fraction per product labeling.

Background and clinical context

Transarterial radioembolization (TARE), also called selective internal radiation therapy (SIRT) with yttrium-90 microspheres, is an intra-arterial, liver-directed radiotherapeutic technique used to treat unresectable primary hepatocellular carcinoma and liver-dominant metastases. It delivers radioactive microspheres via the hepatic arterial circulation to produce high local radiation doses to tumor while sparing uninvolved liver, and is used for tumor control, downstaging or bridging to transplant, and, in selected patients, as an alternative locoregional therapy to TACE or other modalities.

Definitions and key terms

inv-44: Radiation segmentectomy / lobectomy definition

DefinitionA high-dose, segmental or lobar application of Y-90 TARE intended to provide durable local tumor control, induce remnant liver hypertrophy, or enable resection/transplant (radiation lobectomy)

Anatomic scopeMay be applied to a single segment or an entire lobe depending on treatment intent (control vs hypertrophy induction)

Clinical intentUsed for tumor control, contralateral remnant hypertrophy, or as bridge/downstaging to surgery or transplant in selected patients

inv-45: Absolute contraindications (selected)

Inability to catheterize hepatic arteryAbsolute contraindication — inability to selectively catheterize the hepatic arterial supply precludes delivery of Y-90

Fulminant liver failure

Policy Summary

PayerUnitedHealthcare

PolicyTransarterial Radioembolization (TARE)/ Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (for Louisiana Only)

Policy CodePolicy CS060LA.M

Change TypeCoverage indications reviseddocumentation language added

Effective DateMar 1, 2026

Next Review Date

Key ActionObtain prior authorization with multidisciplinary documentation, performance status and pre-treatment mapping studies to confirm candidacy and adequate target isolation.

SourceLink

On This Page

Study contextIn the cited retrospective iCCA series, inclusion also required biopsy-proven disease and albumin > 3 g/dL

Multidisciplinary selectionPatients were evaluated by a multidisciplinary team for resectability and transplant candidacy as part of study inclusion and treatment planning

inv-26: Relative bilirubin contraindication threshold (guideline)

Relative bilirubin threshold (general)> 2 mg/dL (nonobstructive) is considered a relative contraindication to radioembolization in many guidance statements

NCCN-specific guidanceNCCN states arterially directed therapies are relatively contraindicated with bilirubin > 3 mg/dL unless segmental treatment can be performed

Clinical nuanceElevated bilirubin from nonobstructive causes suggests impaired hepatic function and may tip risk–benefit against treatment unless segmental infusion is feasible

Evidence of multidisciplinary tumor board review or equivalent consultation notes.
Pre-procedural angiography, cone-beam CT, and MAA perfusion scintigraphy reports (including measured lung shunt fraction) and any embolization maneuvers performed to prevent nontarget embolization.
Performance status and estimated life expectancy documentation (life expectancy ≥ 3 months when applicable).

Prior Authorization

Prior Authorization Advised for Bridge-to-Transplant / Locoregional Use

When SIRT/TARE is being requested as a bridge to transplant or for downstaging, prior authorization is advised to document transplant intent, waitlist status, and expected timing. Include prior locoregional treatments and the rationale for choosing radioembolization for bridging/downstaging.

Documentation of transplant listing status or transplant evaluation notes.
Tumor measurements, AFP (if applicable), and imaging demonstrating response or stability after prior therapies.
Rationale comparing TARE versus other locoregional options (e.g., why TACE is not preferred or feasible).

Denial Risk

Procedures Should Be Performed in Specialized Centers

Procedures performed outside specialized centers or without clinicians trained in SIRT/TARE may not meet appropriate-use guidance and carry increased risk of adverse outcomes. NICE and other guidance recommend these procedures be performed in specialist centers by experienced clinicians.

If treatment is to be performed outside a specialist center, provide justification and documentation of clinician training/experience.
Requests lacking evidence of specialist oversight or training may be subject to denial or further review.

Note

Research-only Use for Unresectable Intrahepatic Cholangiocarcinoma (NICE)

NICE recommends that SIRT for unresectable intrahepatic cholangiocarcinoma (ICC) be used only in the context of research due to limited evidence on efficacy and safety. Protocols should be prospective, multidisciplinary, and conducted in specialist centers.

Requests for SIRT/TARE for unresectable primary ICC should include research protocol identifiers or documentation of enrollment in an approved study when applicable.
If requested as non-research clinical care, provide detailed justification and supporting evidence; absence of research context may increase denial risk given NICE recommendations.

Denial Risk

Medical Records and Documentation — Denial Risk

Medical records must fully support the medical necessity of the requested SIRT/TARE. Failure to provide complete, legible, and timely documentation may result in partial or full denial of the request.

Required records include relevant medical history, physical exam, prior therapy details (systemic and locoregional), imaging reports, laboratory data, multidisciplinary notes, and pre-procedure mapping studies.
Benefit coverage is subject to federal, state, or contractual plan requirements; submission of records for review does not guarantee coverage.
If requested records are not provided or do not support necessity, the request may be denied.

Documentation Required

Documentation Should Include Rationale, Prior Therapy Tolerance/Response, and Extent of Liver-Dominant Disease

Documentation submitted with prior authorization should include the clinical rationale for SIRT/TARE selection, prior therapy tolerance and response, and evidence of liver-dominant disease. Include comparative rationale when selecting Y-90 over alternative therapies (e.g., TACE) and note prior lines of systemic and locoregional therapy.

Summary of prior systemic therapies (agents, dates, best response, intolerance or progression) and prior locoregional treatments.
Explicit rationale why SIRT/TARE is preferred (e.g., chemo-refractory disease, anatomic considerations, need for tumor downsizing, inability to perform TACE or ablation).
Extent and distribution of hepatic disease (bilobar vs unilobar, tumor-to-liver volume estimates) and presence/extent of extrahepatic disease.

Step Therapy

Consideration of Prior Lines of Therapy and Step/Sequence Rationale

When selecting SIRT/TARE, consider prior lines and sequencing of therapy. Many guidelines recommend TACE as first-line for intermediate-stage HCC; radioembolization is an alternative when TACE is inappropriate or has failed. Document comparative step/sequence considerations and provide rationale if deviating from common sequencing.

If TACE was considered but not used, provide reasons (e.g., anatomy, prior intolerance, portal vein thrombosis, insufficient remnant liver concerns).
Document any prior systemic therapy exposure and whether disease is refractory or resistant to standard agents.
When selecting Y-90 over other locoregional options, include comparative benefits/risks and expected impact on transplant candidacy if relevant.

Documentation Required

Suggested Peri-procedural Documentation and Follow-up

Suggested peri-procedural documentation and follow-up schedule should be provided with the treatment plan and included in prior authorization when available. This supports safe care and facilitates outcome assessment.

Peri-procedural plan: pre- and post-procedure labs, prophylactic measures, and expected inpatient vs outpatient disposition.
Recommended follow-up imaging schedule (e.g., CT/MRI at ~1 month, then every 3 months for surveillance as clinically indicated) and frequency of clinical and laboratory monitoring.
Documentation of plan for managing potential complications and criteria for additional treatments or escalation of care.

Absolute contraindication — fulminant hepatic failure should preclude SIRT

Unacceptable nontarget deposition or lung shuntAbsolute contraindication — mapping angiography/MAA demonstrating unacceptable nontarget deposition or a lung shunt fraction above product-specific limits prohibits treatment

Acute hepatic infectionAbsolute contraindication — active hepatic infection precludes treatment

Uncorrectable coagulopathyAbsolute contraindication — bleeding risk that cannot be corrected prevents safe angiographic delivery

inv-46: Relative contraindications (selected)

Excessive tumor burdenRelative contraindication when >50–70% of liver parenchyma is replaced by tumor; may be considered if synthetic function is preserved

Total bilirubin > 2 mg/dLRelative contraindication (nonobstructive elevations indicate severe hepatic impairment) — treatment generally unfavorable

Prior significant liver/upper-abdominal radiationRelative contraindication requiring clinical judgment about cumulative hepatic dose

Concurrent systemic therapies and pregnancyConcurrent therapies that potentiate toxicity and pregnancy require caution and multidisciplinary evaluation

inv-47: Bridge to transplant definition

DefinitionUse of locoregional therapies (including Y-90 TARE) to control tumor progression and maintain transplant eligibility or to downstage tumors so they meet transplant criteria

Evidence summaryHayes assessment and cohort studies report that Y-90 may have similar or greater benefits than other locoregional therapies for bridging/downstaging and may reduce transplant waitlist dropout

Outcome examplesReported 3-, 5-, and 10-year OS after bridging/downstaging with Y-90 in cohort data (e.g., Gabr et al. 2021) demonstrates favorable long-term outcomes in selected patients

inv-48: Research-only indication (per NICE)

NICE positionNICE recommends SIRT for unresectable primary intrahepatic cholangiocarcinoma only in the context of research due to inadequate evidence on efficacy and recognized serious but rare safety concerns

Research requirementsFurther prospective studies (including RCTs) should address patient selection, quality-of-life outcomes and overall survival; selection should be by a multidisciplinary team

Center expertiseProcedure should only be done in specialist centers by clinicians trained and experienced in managing cholangiocarcinoma when used in research

inv-49: TheraSphere / SIR-Spheres (device commercial names and notes)

TheraSphere (glass)Glass 90Y microspheres (TheraSphere) — FDA-cleared under HDE and with a PMA expanded indication for solitary HCC 1–8 cm in select patients (PMA 03/17/2021)

SIR-Spheres (resin)Resin 90Y microspheres (SIR-Spheres) — FDA PMA (P990065) indicated for unresectable metastatic colorectal liver tumors with adjunct IHAC of floxuridine

Regulatory noteBoth devices are regulated and their use is subject to NRC licensing; FDA approvals are informational and not alone dispositive for coverage decisions

inv-50: Local therapy definition

DefinitionLiver-directed interventions (e.g., surgery, stereotactic radiotherapy, intrahepatic chemotherapy, transarterial radioembolization) used in selected patients with limited liver involvement and good performance status

Selection cautionLocal therapy should be proposed only in very selected cases after adequate systemic therapy has controlled disease; patients must be informed that randomized data for survival benefit are often lacking

Context of useChoice of local technique (surgery, RT, intrahepatic chemotherapy, TARE) should be individualized; no consensus on a superior modality in many metastatic settings