Yttrium-90 Radioembolization as a Bridge to Liver Transplantation: A Single-Institution Experience

Abstract

PurposeTo evaluate our experience with the use of yttrium-90 (90Y) radioembolization in maintaining potential candidacy and, in some instances, downstaging hepatocellular carcinoma (HCC) that does not meet Milan criteria for liver transplantation. Materials and MethodsA retrospective review of 20 consecutive patients with HCC who were listed to receive a liver transplant and were treated with 90Y radioembolization as a sole modality for locoregional “bridge” therapy was performed. Demographics, radiographic and pathologic response, survival, and recurrences were examined. ResultsTwenty-two 90Y treatments were performed in 20 patients before transplantation. Median time from first treatment to transplantation was 3.5 months. HCC in 14 patients met the Milan criteria at the time of the first 90Y treatment, and HCC in six did not. All cases that originally met the Milan criteria remained within the criteria before transplantation, and two of six patients whose disease did not meet the criteria (33%) had their disease successfully downstaged to meet the criteria. Overall, nine patients (45%) had complete or partial radiologic response to 90Y radioembolization according to modified Response Evaluation Criteria In Solid Tumors. Complete necrosis of tumor with no evidence of viable tumor on pathologic examination was observed in five patients (36%) whose disease met the Milan criteria. ConclusionsParticularly in regions with long wait list times, 90Y treatment is effective in maintaining tumor size in potential liver transplantation candidates with HCC. In addition, it can also be considered as a downstaging therapy in select patients before transplantation.