INTERVENTIONAL radiology remained the most utilised specialty in hepatocellular carcinoma care over 25 years, although its patient share declined following approval of atezolizumab plus bevacizumab as first-line systemic therapy. The findings also showed a substantial shift in interventional radiology practice towards transarterial radioembolisation.
The retrospective, single-centre cohort included 3,473 patients with hepatocellular carcinoma treated between 2000–2025 at a high-volume liver transplant centre. Overall, 71.7% of patients were male and the median age was 64 years. Data were obtained from institutional procedure records and Current Procedural Terminology codes, with analyses including descriptive statistics and chi-square tests.
Interventional radiology treated 2,520 patients (72.6%) and performed 4,313 procedures. By comparison, surgery treated 1,350 patients (38.9%), medical oncology treated 746 (21.5%), and radiation oncology treated 96 (2.8%).
Transarterial radioembolisation (TARE) accounted for 72.6% of all interventional radiology procedures, compared with 18.7% for transarterial chemoembolisation (TACE) and 7.9% for ablation.
A pronounced change in procedural composition was observed following approval of atezolizumab plus bevacizumab. TARE increased from 67.4% to 86.8% of interventional radiology procedures, while TACE declined from 24.7% to 2.3%.
Despite this shift, annual interventional radiology procedural volume remained stable after approval: 151 versus 192 procedures (p=0.366). However, the proportion of patients receiving interventional radiology treatment decreased significantly from 75.7% to 64.6% (p<0.001).
Interventional radiology also had a substantial role before liver transplantation. Among 939 patients who underwent liver transplantation, 510 (54.3%) received interventional radiology treatment before transplant, at a median of 201 days before transplantation. TARE accounted for 67.0% of these pre-transplant interventions.
Across the 25-year study period, the data showed that interventional radiology remained the most frequently utilised specialty in multidisciplinary hepatocellular carcinoma care. Although its proportional utilisation declined following atezolizumab plus bevacizumab approval, procedural volume was maintained, alongside a marked transition towards TARE and away from TACE.
Reference
Nadeem A et al. Interventional Radiology as the Most Utilized Treatment Specialty for Hepatocellular Carcinoma: A 25-Year Multidisciplinary Analysis at a High-Volume Academic Transplant Center. J Vasc and Interventional Radiol. 2026. https://doi.org/10.1016/j.jvir.2026.109089
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