Table 2.

Absorbed dose recommendations for ⁹⁰Y glass microspheres and the respective level of evidence (LOE)

	Single compartment		Multi-compartment
Clinical scenario	Perfused volume dose	LOE	Normal liver dose	Tumour dose	LOE
HCC
Segmentectomy	> 400 [83]	3	Not applicable
Lobectomy	> 150 if whole liver dose <150 [67] 140–150 [84]	1* 3	≥ 88** [85] < 75 (range: 50/90***) [86]	≥ 205 [67] ≥ 250–300****	3
Unilobar	> 150 if whole liver dose <150 [67] 80–150 [61, 74]	1* 3	< 120** if HR < 30% [67] < 75 (range: 50/90***) [86]	≥ 205 [67] ≥ 250–300****	1* 3
Bilobar	80–150**** [13, 69, 87]	1, 4	< 50/90*** [86]	≥ 205 [62]	3
ICC
Segmentectomy	> 400 [60]	4	Not applicable
Lobectomy	140–150	4	< 75 (range: 50/90***)	≥ 260 [88]	3
Unilobar	80–150 [89]	3	< 75 (range: 50/90***)	≥ 260 [88]	3
Bilobar	80–150 [89]	3	< 75 (range: 50/90***)	≥ 260 [88]	3
mCRC
Segmentectomy	> 400 [90]	3	Not applicable
Lobectomy	140–150	4	< 75 (range: 50/90***)	≥ 189 [91]	3
Unilobar	80–150 [92]	3	< 75 (range: 50/90***)	≥ 189 [91]	3
Bilobar	80–150 [92]	3	< 75 (range: 50/90***)	≥ 189 [91]	3

HR, hepatic reserve, i.e. untreated liver fraction

*In patients comparable to the DOSISPHERE-01 [67] study population (Child-Pugh A, large lesions, at least 30% of hepatic reserve)

**Dose to the normal perfused liver, based on the first treatment

***Dose to the whole normal liver. In HCC patients with total bilirubin levels >1.1 mg/dl, an upper threshold of 50 Gy should be used; in patients with total bilirubin levels <1.1 mg/dl, the whole normal liver dose should be kept below 90 Gy. Data are derived from unilobar treatments without prior RE only. Since these thresholds have been established in mostly cirrhotic HCC patients, they can be considered safe for non-HCC patients; however, caution is warranted particularly in ICC patients with underlying cirrhosis and after chemotherapy

****For large lesions [67]