Use of Yttrium-90 Microsphere Radioembolization of Hepatocellular Carcinoma as Downstaging and Bridge Before Liver Transplantation: A Case Report

Background and objectiveYttrium-90 microspheres radioembolization (Y90-RE) has been recently introduced as promising modality of treatment in patients with hepatocellular carcinoma (HCC) who are not otherwise candidates for local ablation, surgical resection, or liver transplantation (OLT). However, its use in downstaging HCC or as a bridge for OLT is still unclear. Herein, we have presented a case where Y90-RE was used to both downstage and to serve as a bridge for OLT.Case ReportWe report a 54-year-old lady who was known to have hepatitis B virus cirrhosis in addition to two focal hepatic lesions in segments 5 and 8, measuring 1.5 and 7.5 cm, respectfully. Extrahepatic spread was thoroughly ruled out. This tumor was clearly beyond both the Milans and University of California San Francisco criteria for OLT in HCC patients; therefore, we offered the patient Y90-RE in an attempt to downstage the tumor and as a bridge for OLT. Y90-RE was performed targeting the large lesion; the patient underwent cadaveric OLT 2 months thereafter. Gross examination of the explant showed necrotic tumor with obvious signs of irradiation-induced damage. Microscopic examination of the explant showed Y90 microspheres trapped in the large tumor with near-complete tumor necrosis. This patient completed 1-year post-OLT follow-up with no signs of tumor recurrence.ConclusionsThe use Y90-RE in HCC may be useful for downstaging or as a bridge to liver transplantation.