Yttrium-90 Radioembolization for Hepatocellular Carcinoma Prior to Liver Transplantation

Giuseppe Maria Ettorre, Giovanni Battista Levi Sandri, Andrea Laurenzi, Marco Colasanti, Roberto Luca Meniconi, Raffaella Lionetti, Roberto Santoro, Pasquale Lepiane, Rosa Sciuto, Giuseppe Pizzi, Roberto Cianni, Rita Golfieri, Gianpiero D’Offizi, Adriano M. Pellicelli, Mario Antonini, Giovanni Vennarecci

Research output: Contribution to journalArticle

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Abstract

Background: Liver transplantation (LT) is a well-established procedure for hepatocellular carcinoma (HCC) within the Milan criteria. Yttrium-90 microspheres radioembolization (Y90-RE) has shown to be an effective and safe treatment of primary liver tumors. We retrospectively evaluate the efficacy of the Y90-RE in patients with HCC prior to LT. Methods: From January 2002 to December 2015, 365 patients were transplanted at the San Camillo Hospital Center. One hundred forty-three patients were transplanted for HCC, and in 22 cases the patients were treated with Y90-RE before LT. Results: Three patients were treated with Y90-RE within the Milan criteria, and 19 patients were out of criteria before Y90-RE. Four patients had an increasing MELD score between Y90-RE and LT. On the other hand, alpha-fetoprotein decreases after Y90-RE treatment in all cases. No patient death was observed in Y90-RE procedure or at LT. In 78.9 % of cases, a successful downstaging was observed, and in 100 % of cases bridging was achieved. From Y90-RE treatment overall survival was 43.9 months. From LT, overall mean survival was 30.2 months with a free survival of 29.6 months. The overall survival after LT analysis between the patients treated with Y90-RE and patients without was not significant (p = 0.113). Free survival analysis was not significant (p = 0.897) between the two populations. Conclusions: We successfully performed LT in patients after Y90-RE treatment both as bridging and downstaging for HCC and obtained a similar overall and free survival of LT for HCC within Milan criteria. Y90-RE becomes a real option to provide curative therapy for patients who traditionally are not considered eligible for surgery.

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalWorld Journal of Surgery
DOIs
Publication statusAccepted/In press - Aug 5 2016

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Yttrium
Microspheres
Liver Transplantation
Hepatocellular Carcinoma
Survival
Therapeutics
alpha-Fetoproteins
Survival Analysis

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Ettorre, G. M., Levi Sandri, G. B., Laurenzi, A., Colasanti, M., Meniconi, R. L., Lionetti, R., ... Vennarecci, G. (Accepted/In press). Yttrium-90 Radioembolization for Hepatocellular Carcinoma Prior to Liver Transplantation. World Journal of Surgery, 1-9. https://doi.org/10.1007/s00268-016-3682-z

Yttrium-90 Radioembolization for Hepatocellular Carcinoma Prior to Liver Transplantation. / Ettorre, Giuseppe Maria; Levi Sandri, Giovanni Battista; Laurenzi, Andrea; Colasanti, Marco; Meniconi, Roberto Luca; Lionetti, Raffaella; Santoro, Roberto; Lepiane, Pasquale; Sciuto, Rosa; Pizzi, Giuseppe; Cianni, Roberto; Golfieri, Rita; D’Offizi, Gianpiero; Pellicelli, Adriano M.; Antonini, Mario; Vennarecci, Giovanni.

In: World Journal of Surgery, 05.08.2016, p. 1-9.

Research output: Contribution to journalArticle

Ettorre, GM, Levi Sandri, GB, Laurenzi, A, Colasanti, M, Meniconi, RL, Lionetti, R, Santoro, R, Lepiane, P, Sciuto, R, Pizzi, G, Cianni, R, Golfieri, R, D’Offizi, G, Pellicelli, AM, Antonini, M & Vennarecci, G 2016, 'Yttrium-90 Radioembolization for Hepatocellular Carcinoma Prior to Liver Transplantation', World Journal of Surgery, pp. 1-9. https://doi.org/10.1007/s00268-016-3682-z
Ettorre, Giuseppe Maria ; Levi Sandri, Giovanni Battista ; Laurenzi, Andrea ; Colasanti, Marco ; Meniconi, Roberto Luca ; Lionetti, Raffaella ; Santoro, Roberto ; Lepiane, Pasquale ; Sciuto, Rosa ; Pizzi, Giuseppe ; Cianni, Roberto ; Golfieri, Rita ; D’Offizi, Gianpiero ; Pellicelli, Adriano M. ; Antonini, Mario ; Vennarecci, Giovanni. / Yttrium-90 Radioembolization for Hepatocellular Carcinoma Prior to Liver Transplantation. In: World Journal of Surgery. 2016 ; pp. 1-9.
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abstract = "Background: Liver transplantation (LT) is a well-established procedure for hepatocellular carcinoma (HCC) within the Milan criteria. Yttrium-90 microspheres radioembolization (Y90-RE) has shown to be an effective and safe treatment of primary liver tumors. We retrospectively evaluate the efficacy of the Y90-RE in patients with HCC prior to LT. Methods: From January 2002 to December 2015, 365 patients were transplanted at the San Camillo Hospital Center. One hundred forty-three patients were transplanted for HCC, and in 22 cases the patients were treated with Y90-RE before LT. Results: Three patients were treated with Y90-RE within the Milan criteria, and 19 patients were out of criteria before Y90-RE. Four patients had an increasing MELD score between Y90-RE and LT. On the other hand, alpha-fetoprotein decreases after Y90-RE treatment in all cases. No patient death was observed in Y90-RE procedure or at LT. In 78.9 {\%} of cases, a successful downstaging was observed, and in 100 {\%} of cases bridging was achieved. From Y90-RE treatment overall survival was 43.9 months. From LT, overall mean survival was 30.2 months with a free survival of 29.6 months. The overall survival after LT analysis between the patients treated with Y90-RE and patients without was not significant (p = 0.113). Free survival analysis was not significant (p = 0.897) between the two populations. Conclusions: We successfully performed LT in patients after Y90-RE treatment both as bridging and downstaging for HCC and obtained a similar overall and free survival of LT for HCC within Milan criteria. Y90-RE becomes a real option to provide curative therapy for patients who traditionally are not considered eligible for surgery.",
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AU - Ettorre, Giuseppe Maria

AU - Levi Sandri, Giovanni Battista

AU - Laurenzi, Andrea

AU - Colasanti, Marco

AU - Meniconi, Roberto Luca

AU - Lionetti, Raffaella

AU - Santoro, Roberto

AU - Lepiane, Pasquale

AU - Sciuto, Rosa

AU - Pizzi, Giuseppe

AU - Cianni, Roberto

AU - Golfieri, Rita

AU - D’Offizi, Gianpiero

AU - Pellicelli, Adriano M.

AU - Antonini, Mario

AU - Vennarecci, Giovanni

PY - 2016/8/5

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N2 - Background: Liver transplantation (LT) is a well-established procedure for hepatocellular carcinoma (HCC) within the Milan criteria. Yttrium-90 microspheres radioembolization (Y90-RE) has shown to be an effective and safe treatment of primary liver tumors. We retrospectively evaluate the efficacy of the Y90-RE in patients with HCC prior to LT. Methods: From January 2002 to December 2015, 365 patients were transplanted at the San Camillo Hospital Center. One hundred forty-three patients were transplanted for HCC, and in 22 cases the patients were treated with Y90-RE before LT. Results: Three patients were treated with Y90-RE within the Milan criteria, and 19 patients were out of criteria before Y90-RE. Four patients had an increasing MELD score between Y90-RE and LT. On the other hand, alpha-fetoprotein decreases after Y90-RE treatment in all cases. No patient death was observed in Y90-RE procedure or at LT. In 78.9 % of cases, a successful downstaging was observed, and in 100 % of cases bridging was achieved. From Y90-RE treatment overall survival was 43.9 months. From LT, overall mean survival was 30.2 months with a free survival of 29.6 months. The overall survival after LT analysis between the patients treated with Y90-RE and patients without was not significant (p = 0.113). Free survival analysis was not significant (p = 0.897) between the two populations. Conclusions: We successfully performed LT in patients after Y90-RE treatment both as bridging and downstaging for HCC and obtained a similar overall and free survival of LT for HCC within Milan criteria. Y90-RE becomes a real option to provide curative therapy for patients who traditionally are not considered eligible for surgery.

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