Skip to main content

Role of Radioembolization in the Management of Liver-Dominant Metastatic Renal Cell Carcinoma: A Single-Center, Retrospective Study



The management of Renal cell carcinoma (RCC) patients with liver metastases is challenging. Liver-directed therapy, such as Transarterial radioembolization (TARE), is a reasonable option for these patients; however, its safety and efficacy are not well characterized. This study evaluated the safety and efficacy of TARE in patients with liver-dominant metastatic RCC.

Materials and Methods

This is a retrospective, single-center study. Thirty-eight patients’ medical records were reviewed who underwent TARE between January 1, 2009, and December 31, 2019, in a tertiary cancer center. Two were excluded from further analysis. Thirty-six patients received 51 TARE treatments. Median follow-up time was 18.2 months. Imaging data were evaluated using mRECIST or RECIST 1.1 criteria. Toxicities, treatment responses, liver progression-free survival (LPFS), and median overall survival (OS) were calculated. Univariate and multivariate analyses were conducted to reveal predictors of OS.


Median OS from TARE was 19.3 months (95% CI, 22.6–47.4) and from diagnosis of liver metastases was 36.5 months (95% CI: 26.4–49.8). Mild, grade 1 or 2, biochemical toxicity developed in 27 patients (75%). Grade 3–4 toxicity was noted in two patients (5.5%). The objective response rate was 89%; the disease control rate was 94% (21 complete response, 11 partial response, two stable disease, and two progressive disease). Univariate and multivariate analyses showed longer survival in patients who had objective response, lower lung shunt fraction, and better baseline liver function.


TARE is safe and effective and led to promising overall survival in patients with liver-dominant metastatic RCC.

Level of Evidence: Level 3, retrospective cohort study.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Capitanio U, Bensalah K, Bex A, Boorjian SA, Bray F, Coleman J, et al. Epidemiology of Renal Cell Carcinoma. Eur Urol. 2019;75:74–84.

    Article  Google Scholar 

  2. 2.

    Capitanio U, Montorsi F. Renal cancer Lancet Lond Engl. 2016;387:894–906.

    Article  Google Scholar 

  3. 3.

    Bianchi M, Sun M, Jeldres C, Shariat SF, Trinh Q-D, Briganti A, et al. Distribution of metastatic sites in renal cell carcinoma: a population-based analysis. Ann Oncol. 2012;23:973–80.

    CAS  Article  Google Scholar 

  4. 4.

    Hamada S, Ito K, Kuroda K, Sato A, Asakuma J, Horiguchi A, et al. Clinical characteristics and prognosis of patients with renal cell carcinoma and liver metastasis. Mol Clin Oncol. 2015;3:63–8.

    Article  Google Scholar 

  5. 5.

    Staehler MD, Kruse J, Haseke N, Stadler T, Roosen A, Karl A, et al. Liver resection for metastatic disease prolongs survival in renal cell carcinoma: 12-year results from a retrospective comparative analysis. World J Urol. 2010;28:543–7.

    Article  Google Scholar 

  6. 6.

    Kis B, Shah J, Choi J, El-Haddad G, Sweeney J, Biebel B, et al. Transarterial Yttrium-90 Radioembolization Treatment of Patients with Liver-Dominant Metastatic Renal Cell Carcinoma. J Vasc Interv Radiol. 2017;28:254–9.

    Article  Google Scholar 

  7. 7.

    Heng DYC, Xie W, Regan MM, Harshman LC, Bjarnason GA, Vaishampayan UN, et al. External validation and comparison with other models of the International Metastatic Renal-Cell Carcinoma Database Consortium prognostic model: a population-based study. Lancet Oncol. 2013;14:141–8.

    Article  Google Scholar 

  8. 8.

    Heng DYC, Xie W, Regan MM, Warren MA, Golshayan AR, Sahi C, et al. Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J Clin Oncol Off J Am Soc Clin Oncol. 2009;27:5794–9.

    CAS  Article  Google Scholar 

  9. 9.

    Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 2010;30:52–60.

    CAS  Article  Google Scholar 

  10. 10.

    Radosa CG, Radosa JC, Grosche-Schlee S, Zöphel K, Plodeck V, Kühn JP, et al. Holmium-166 radioembolization in hepatocellular carcinoma: Feasibility and safety of a new treatment option in clinical practice. Cardiovasc Intervent Radiol. 2019;42:405–12.

    Article  Google Scholar 

  11. 11.

    Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, et al. A model to predict survival in patients with end-stage liver disease. Hepatol Baltim Md. 2001;33:464–70.

    CAS  Article  Google Scholar 

  12. 12.

    Vouche M, Habib A, Ward TJ, Kim E, Kulik L, Ganger D, et al. Unresectable solitary hepatocellular carcinoma not amenable to radiofrequency ablation: multicenter radiology-pathology correlation and survival of radiation segmentectomy. Hepatol Baltim Md. 2014;60:192–201.

    Article  Google Scholar 

  13. 13.

    Naito S, Yamamoto N, Takayama T, Muramoto M, Shinohara N, Nishiyama K, et al. Prognosis of Japanese metastatic renal cell carcinoma patients in the cytokine era: a cooperative group report of 1463 patients. Eur Urol. 2010;57:317–25.

    CAS  Article  Google Scholar 

  14. 14.

    Amato RJ. Chemotherapy for renal cell carcinoma. Semin Oncol. 2000;27:177–86.

    CAS  PubMed  Google Scholar 

  15. 15.

    Schullian P, Putzer D, Eberle G, Laimer G, Bale R. Simultaneous Stereotactic Radiofrequency Ablation of Multiple (≥ 4) Liver Tumors: Feasibility, Safety, and Efficacy. J Vasc Interv Radiol. 2020;31:943–52.

    Article  Google Scholar 

  16. 16.

    Jonasch E. NCCN Guidelines Updates: Management of Metastatic Kidney Cancer. J Natl Compr Cancer Netw JNCCN. 2019;17:587–9.

    Google Scholar 

  17. 17.

    Motzer RJ, Tannir NM, McDermott DF, Frontera OA, Melichar B, Choueiri TK, et al. Nivolumab plus Ipilimumab versus Sunitinib in Advanced Renal-Cell Carcinoma. N Engl J Med. 2018;378:1277–90.

    CAS  Article  Google Scholar 

  18. 18.

    Rini BI, Plimack ER, Stus V, Gafanov R, Hawkins R, Nosov D, et al. Pembrolizumab plus Axitinib versus Sunitinib for Advanced Renal-Cell Carcinoma. N Engl J Med. 2019;380:1116–27.

    CAS  Article  Google Scholar 

  19. 19.

    Motzer RJ, Penkov K, Haanen J, Rini B, Albiges L, Campbell MT, et al. Avelumab plus Axitinib versus Sunitinib for advanced renal-cell carcinoma. N Engl J Med. 2019.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Nabil M, Gruber T, Yakoub D, Ackermann H, Zangos S, Vogl TJ. Repetitive transarterial chemoembolization (TACE) of liver metastases from renal cell carcinoma: local control and survival results. Eur Radiol. 2008;18:1456–63.

    Article  Google Scholar 

  21. 21.

    Adashek JJ, Salgia M, Dizman N, Kessler J, Pal SK. Concomitant radioembolization and immune checkpoint inhibition in metastatic renal cell carcinoma. Case Rep Oncol. 2018;11:276–80.

    CAS  Article  Google Scholar 

  22. 22.

    Abdelmaksoud MHK, Louie JD, Hwang GL, Kothary N, Minor DR, Sze DY. Yttrium-90 radioembolization of renal cell carcinoma metastatic to the liver. J Vasc Interv Radiol. 2012;23:323-330.e1.

    Article  Google Scholar 

  23. 23.

    Riaz A, Awais R, Salem R. Side Effects of Yttrium-90 Radioembolization. Front Oncol [Internet]. 2014 [cited 2020 Nov 23];4. Available from:

  24. 24.

    Atassi B, Bangash AK, Lewandowski RJ, Ibrahim S, Kulik L, Mulcahy MF, et al. Biliary Sequelae following Radioembolization with Yttrium-90 Microspheres. J Vasc Interv Radiol Elsevier. 2008;19:691–7.

    Article  Google Scholar 

  25. 25.

    Spina JC, Hume I, Pelaez A, Peralta O, Quadrelli M, Garcia Monaco R. Expected and Unexpected Imaging Findings after 90Y Transarterial Radioembolization for Liver Tumors. Radiogr Rev Publ Radiol Soc N Am Inc. 2019;39(2): 578–95.

  26. 26.

    Ferician O, Cimpean AM, Ceausu AR, Dema A, Raica M, Cumpanas A. Heterogeneous vascular patterns in renal cell carcinomas. Pol J Pathol Off J Pol Soc Pathol. 2016;67:46–53.

    CAS  Article  Google Scholar 

Download references


This study was not supported by any funding.

Author information



Corresponding author

Correspondence to Bela Kis.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Formal Consent

For this type of study formal consent is not required.

Informed Consent

Informed consent was obtained from all individual patients included in the study.

Publication Consent

For this type of study, consent for publication is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Bibok, A., Mhaskar, R., Jain, R. et al. Role of Radioembolization in the Management of Liver-Dominant Metastatic Renal Cell Carcinoma: A Single-Center, Retrospective Study. Cardiovasc Intervent Radiol (2021).

Download citation


  • Interventional radiology
  • Hepatic neoplasms
  • Therapeutic embolization
  • Renal cell carcinoma
  • Yttrium radioisotopes