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Clinical, radiological, and procedural data were collected. Objective response rate (ORR) on lesion, complete response (CR), overall response, time-to-local progression (TLP), and time-to-progression (TTP) were evaluated on contrast-enhanced CT at 3 and 6 months according to mRECIST. The optimal\n                      <jats:italic>D<\/jats:italic>\n                      mean of ORR on the target lesion and of CR was identified with ROC analysis at 3-months. Fischer\u2019s test compared ORR, Kaplan\u2013Meier survival outcomes, and Cox regression was used for uni-and multivariable analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventy-six lesions in 64 patients (mean age 71.3\u2009\u00b1\u20099.6; 54 men) were evaluated. Median follow-up was 15.0 months (IQR 8.0\u201324.3). Mean tumor diameter was 55.2 (\u00b1\u200931.8) mm. CR on target lesion at 3-months was achieved in 42 lesions. Mean TLP and OS were 27.6\u2009\u00b1\u20092.5 and 36.2\u2009\u00b1\u20092.9 months, respectively. The calculated\n                      <jats:italic>D<\/jats:italic>\n                      mean for ORR was 296.74\u2009Gy (specificity 100, PPV 100%). Patients treated with equal or lower doses had a significantly shorter TLP (log-rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001).\n                      <jats:italic>D<\/jats:italic>\n                      mean\u2009&gt;\u2009296.74\u2009Gy did not increase the risk of complications. A\n                      <jats:italic>D<\/jats:italic>\n                      mean\u2009&gt;\u2009435.11\u2009Gy predicts CR\n                      <jats:italic>.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      A\n                      <jats:italic>D<\/jats:italic>\n                      mean threshold of 296.74\u2009Gy provides significant therapeutic efficacy without compromising patient safety. All HCC lesions treated with &gt;\u2009435.11\u2009Gy achieved CR.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>In patients with HCC treated with 90Y-resin microsphere TARE, can an optimized personalized dose improve efficacy without compromising safety<\/jats:italic>\n                      ?\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>The calculated mean dose (Dmean), even though above guideline indications, did not yield serious adverse events whilst enhancing response to treatment<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>HCC recurrence is associated with poor patient outcomes. Personalized dosimetry is best practice for tailoring radioactive doses, and the cut-off dose calculated in this cohort identifies that with the best response and yields additional data on resin microsphere doses<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-026-12562-z","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T08:50:18Z","timestamp":1777366218000},"page":"7231-7241","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Personalized dosimetry enhances hepatocellular carcinoma response in Yttrium-90 resin microsphere radioembolization"],"prefix":"10.1007","volume":"36","author":[{"given":"Ettore","family":"di Gaeta","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Taninokuchi Tomassoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Calabrese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Matassa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annarita","family":"Savi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Canevari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrizia","family":"Magnani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna","family":"Pepe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Steidler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Ratti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Cipriani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margherita","family":"Rimini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Casadei-Gardini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Braccischi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Adriana","family":"Cocozza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lidia","family":"Strigari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Della Gala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arber","family":"Golemi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa Lodi","family":"Rizzini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Fanti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Cescon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Serenari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Piscaglia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Cristina","family":"Morelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arturo","family":"Chiti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Mosconi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4014-3711","authenticated-orcid":false,"given":"Francesco","family":"De Cobelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"12562_CR1","doi-asserted-by":"publisher","first-page":"12272","DOI":"10.1002\/CAM4.5925","volume":"12","author":"KC Soares","year":"2023","unstructured":"Soares KC, Jolissaint JS, McIntyre SM et al (2023) Hepatic disease control in patients with intrahepatic cholangiocarcinoma correlates with overall survival. 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A.C.-G.\u2014Consulting or advisory role for Blue Earth Diagnostics, Telix Pharmaceuticals, InnovaRadi Therapeutic, and Speaker\u2019s Bureau for Bracco Diagnostics, General Electric, Novartis, Telix Pharmaceuticals, United Imaging, Bracco Diagnostics, General Electric. F.D.C.\u2014consulting and speaker\u2019s bureau for Bayer and Sirtex. All other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.","order":2,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"No complex statistical methods were necessary for this paper.","order":3,"name":"Ethics","label":"Statistics and biometry","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Written informed consent was obtained from all subjects (patients) in this study.","order":4,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Institutional Review Board approval was obtained\u2014IRCCS San Raffaele approval 64\/INT\/2021; IRCCS Azienda Ospedaliero-Universitaria Bologna approval number: EM109\/2924_193\/2021\/Oss\/AOUBo).","order":5,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Some study subjects or cohorts have been previously reported in di Gaeta et al [\n                      \n                      ],\n                      \n                      .","order":6,"name":"Ethics","label":"Study subjects or cohorts overlap","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"order":7,"name":"Ethics","label":"Methodology","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}}]}}