Safety and Efficacy of Multiple Sirt Treatments with Resin Microspheres® Y-90, Combined with Surgery as Bridge/Downstage to Hepatic Transplant: A Case Report and Literature Review

Abstract

Liver cancer is the fifth most common cancer and the second most frequent cause of cancer-related death globally. Hepatocellular carcinoma (HCC) represents about 90% of primary liver cancers and constitutes a major global health problem. Combined hepatocellular‐cholangiocarcinoma (cHCC‐CCA) represents about 10% of total HCC, and it is by definition a highly heterogeneous tumor, which confers a negative impact on tumor prognosis compared to HCC. Selective Internal Radiation Therapy (SIRT) using yttrium-90 microspheres shows a good safety profile and local tumor control, and it is now considered among the therapeutic options for liver cancer downstaging before liver transplant (LT). We present the case of a young man with a diagnosis of hepatitis B cirrhosis and subsequent finding of advanced primary neoplasm with particularly aggressive histology of cHCC‐CCA. The patient underwent two SIRT treatments in 6 months. The first SIRT treatment provided an adequate downstaging to surgery, then a successful SIRT retreatment after surgery, in a bridging purpose, allowed for liver transplantation, with complete necrosis at explant. We demonstrated the feasibility and safety of multi treatment approaches, with two successive SIRT treatments and surgery. We outline the efficacy of an aggressive downstaging strategy allowing a potentially curative therapy as liver transplant.