Radioembolization Using Yttrium-90 Microspheres as Bridging and Downstaging Treatment for Unresectable Hepatocellular Carcinoma Before Liver Transplantation: Initial Single-Center Experience

IntroductionHCC is the sixth most common malignancy worldwide and is the third most common cause of cancer related mortality. Moreover, the incidence of HCC is increasing. Surgical treatments for HCC including resection and/or transplantation provide the best curative outcomes in early stages. Unfortunately, many patients present at an advanced stage. Currently, locoregional therapies have an emerging role in the management of HCC for bridging to liver transplantation and for downstaging the disease to within transplant criteria. Radioembolization is among commonly used locoregional therapies.ObjectiveTo describe our initial experience with the use of Therasphere® as bridging or downstaging modality before liver transplantation, including our institutional indications, technique and outcome.Materials and MethodsWe retrospectively examined our database for liver transplantation after the use of Therasphere®. Nine patients were identified and reported.ResultsThey were 5 females and 4 males. Their current age range is 40–72 years with a mean of 53.8 ± 9.5 years. Three patients had Therasphere® as downstaging treatment to our institutional transplantation criteria. Our institution is using UCSF criteria as a cut off limit for liver transplantation as primary treatment modality. The other 6 patients had Therasphere® as bridging for liver transplantation especially when other modalities are not possible. None of these lesions were treated by any other locoregional treatment before or after Therasphere®. Follow-up after liver transplantation ranged between 3.7 and 60.1 months (mean of 15.8 ± 17.7 months). All patients are still living, no retransplantation was done and none of them showed evidence of disease recurrence (100% graft, patient and disease free survival).ConclusionOur initial experience showed that Therasphere® is a promising therapeutic tool for both downstaging and bridging of HCC before liver transplant.