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. 2017 Feb;6(1):44-48.
doi: 10.21037/hbsn.2017.01.08.

Hepatocellular carcinoma with macrovascular invasion treated with yttrium-90 radioembolization prior to transplantation

Giovanni Battista Levi Sandri  1 , Giuseppe Maria Ettorre  1 , Marco Colasanti  1 , Edoardo De Werra  1 , Gianluca Mascianà  1 , Daniele Ferraro  1 , Giovanni Tortorelli  1 , Rosa Sciuto  2 , Pierleone Lucatelli  3 , Giuseppe Pizzi  3 , Ubaldo Visco-Comandini  4 , Giovanni Vennarecci  1
Affiliations

Hepatocellular carcinoma with macrovascular invasion treated with yttrium-90 radioembolization prior to transplantation

Giovanni Battista Levi Sandri et al. Hepatobiliary Surg Nutr. 2017 Feb.

Abstract

Background: Yttrium-90 microspheres radioembolization (Y90-RE) has shown to be an effective and safe treatment of primary liver tumors. According to the staging system of the Barcelona Clinic Liver Cancer (BCLC), patients with macrovascular invasion are staged as BCLC-C. This paper comprises a presentation of the results following application of the procedure.

Methods: From January 2002 to December 2015, 367 patients were transplanted at the San Camillo Hospital Center. One hundred and forty-three patients were transplanted for hepatocellular carcinoma (HCC) and in 22 cases patients were treated with Y90-RE before liver transplantation (LT), of them 4 with macrovascular invasion were included in this study.

Results: The four patients had a complete response for the thrombosis, and were included in the waiting list within the Milan criteria. Means interval time between Y90-RE and LT was 15.86 months. No patient death was observed at Y90-RE procedure or at LT. We obtain a free-survival of 39.1 (range, 6-76) months. In all four cases the complete thrombosis regression was observed.

Conclusions: We reported a short series of patients transplanted after Y90-RE in patients with BCLC stage C. In our experience we achieved acceptable overall and disease-free survival. Eventually, Y90-RE seems to have a place in the downstaging strategy for LT candidates.

Keywords: Barcelona Clinic Liver Cancer (BCLC); Yttrium; downstaging; hepatocellular carcinoma (HCC); liver transplantation (LT); macrovascular invasion; radioembolization.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Macroscopic view of liver after radioembolization. (A) Liver aspect at laparotomy during transplantation. The right liver appears hypotrophic; (B) specimen after total hepatectomy.
Figure 2
Figure 2
Radiological images before Y90-RE and liver transplantation. (A) Computed tomography, a major vascular invasion is observed; (B) complete radiological response after Y90-RE, no vascular invasion is observed. Y90-RE, yttrium-90 microspheres radioembolization.
Figure 3
Figure 3
Nonviable tumor with fibrosis and microspheres. (A) H&E stained section (HE 40×) peritumoral liver parenchymal fibrosis; (B) H&E stained section with microspheres (80×).
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