Yttrium-90 Radioembolization for Hepatocellular Carcinoma Prior to Liver Transplantation

G. M. Ettorre, G. B. Levi Sandri, A. Laurenzi, M. Colasanti, R. L. Meniconi, R. Lionetti, R. Santoro, P. Lepiane, R. Sciuto, G. Pizzi, R. Cianni, R. Golfieri, G. D'Offizi, A. M. Pellicelli, M. Antonini, G. Vennarecci

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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)241-249
Number of pages9
JournalWorld Journal of Surgery
Volume41
Issue number1
DOIs
Publication statusPublished - Jan 1 2017

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Ettorre, G. M., Sandri, G. B. L., Laurenzi, A., Colasanti, M., Meniconi, R. L., Lionetti, R., Santoro, R., Lepiane, P., Sciuto, R., Pizzi, G., Cianni, R., Golfieri, R., D'Offizi, G., Pellicelli, A. M., Antonini, M., & Vennarecci, G. (2017). Yttrium-90 Radioembolization for Hepatocellular Carcinoma Prior to Liver Transplantation. World Journal of Surgery, 41(1), 241-249. https://doi.org/10.1007/s00268-016-3682-z [doi]