TY - JOUR
T1 - Yttrium-90 Radioembolization for Hepatocellular Carcinoma Prior to Liver Transplantation
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
Y1 - 2016/8/5
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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84982943746&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84982943746&partnerID=8YFLogxK
U2 - 10.1007/s00268-016-3682-z
DO - 10.1007/s00268-016-3682-z
M3 - Article
SP - 1
EP - 9
JO - World Journal of Surgery
JF - World Journal of Surgery
SN - 0364-2313
ER -