Fig. 2.

A 62-year-old patient with a large HCC and main PVT who underwent treatment intensification (boosted). The patient showed a major response with revascularization of the portal vein. a–c Initial imaging: CT slices show a heterogeneous HCC of 9.6 cm (a) with main PVT (b); MAA SPECT/CT image shows high uptake in the main PVT (c) The patient underwent treatment intensification with 1.16 GBq of ⁹⁰Y-loaded glass microspheres (ILD 211 Gy, TD 285 Gy, HILD 65 Gy). Using the standard approach only 0.56 GBq of ⁹⁰Y-loaded glass microspheres would have been used to achieve an ILD of 120 Gy, then the TD would have been only 162 Gy and the HILD 37 Gy. d, e CT slices 3 months after injection show EASL partial response of the tumour (d) and main portal vein revascularization (e). The patient subsequently received a left hepatectomy (with complete tumour resection). PFS was 15 months with lung recurrence only. The patient was still alive at the most recent follow-up visit (18 months)