Abstract: Surgery is the main treatment for patients with hepatocellular carcinoma to achieve long‑term survival. However, only 20%-30% of patients can receive radical surgery. How to optimize the surgery oriented comprehensive treatment strategy and enable patients to successfully downstage to surgery are key issues to be solved in hepatocellular carcinoma treatment in China. Selective internal radiation therapy with yttrium‑90 microspheres (⁹⁰Y‑SIRT) has strong ability of tumor killing, and it is reported that ⁹⁰Y‑SIRT is an ideal downstaging and bridging therapy for hepatocellular carcinoma, due to its superior downstaging efficacy compared with transarterial chemoembolization. Based on the introduction of characteristics of ⁹⁰Y‑SIRT, the authors review the clinical research progress of ⁹⁰Y‑SIRT in the preoperative downstaging and bridging treatment of hepatocellular carcinoma before liver transplantation, and discuss ⁹⁰Y‑SIRT‑based conversion strategy. The ⁹⁰Y‑SIRT has shown syner-gistic effect with targeted therapy and immunotherapy, and will have a broad application prospect in downstaging and conversion therapy in the future.