Aims <p>We retrospectively assessed the long-term outcomes of Yttrium-90 (⁹⁰Y) transarterial radioembolization (TARE) for hepatocellular carcinoma (HCC), focusing on overall survival (OS), radiological response, and safety.</p> Methods <p>We included patients with HCC treated with ⁹⁰Y TARE at a single center between January 2012 and December 2021 with measurable lesions and a minimum of 2 years of follow-up. Only the former was analyzed for patients with multiple TARE. The primary endpoints were long-term OS, radiological response, and safety; the secondary endpoints included predictors of OS and response, with emphasis on dosimetry. The collected data included demographics, laboratory test results, liver function, and tumor staging. Radiological response was evaluated 3–6 months post-TARE using the modified RECIST (mRECIST) criteria. OS was calculated from TARE until death or censoring. Univariate logistic regression was used to identify the predictors of complete radiological response and OS. Dosimetry was analyzed to determine correlations with mRECIST response.</p> Results <p>Among 142 patients (median age 66.8, cirrhotic 92.3%; M: F = 121:21), a median OS of 16.68 months was achieved, with a complete radiological response in 31% (44/142). OS was strongly correlated with radiological response (<i>p</i> &lt; 0.001). Absorbed dose ≥ 234.6&#xa0;Gy was associated with complete response (<i>p</i> = 0.017) but not with survival (<i>p</i> = 0.102). Rising alpha-fetoprotein levels (<i>p</i> = 0.017) and worsening Child-Pugh scores post-TARE (<i>p</i> = 0.044) were independent predictors of mortality.</p> Conclusion <p>A complete radiological response is crucial for long-term survival, highlighting the need for dosimetry optimization in TARE for HCC.</p>