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Yttrium-90 Radioembolization for Hepatocellular Carcinoma Prior to Liver Transplantation

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Abstract

Background

Liver transplantation (LT) is a well-established procedure for hepatocellular carcinoma (HCC) within the Milan criteria. Yttrium-90 microspheres radioembolization (Y90-RE) has shown to be an effective and safe treatment of primary liver tumors. We retrospectively evaluate the efficacy of the Y90-RE in patients with HCC prior to LT.

Methods

From January 2002 to December 2015, 365 patients were transplanted at the San Camillo Hospital Center. One hundred forty-three patients were transplanted for HCC, and in 22 cases the patients were treated with Y90-RE before LT.

Results

Three patients were treated with Y90-RE within the Milan criteria, and 19 patients were out of criteria before Y90-RE. Four patients had an increasing MELD score between Y90-RE and LT. On the other hand, alpha-fetoprotein decreases after Y90-RE treatment in all cases. No patient death was observed in Y90-RE procedure or at LT. In 78.9 % of cases, a successful downstaging was observed, and in 100 % of cases bridging was achieved. From Y90-RE treatment overall survival was 43.9 months. From LT, overall mean survival was 30.2 months with a free survival of 29.6 months. The overall survival after LT analysis between the patients treated with Y90-RE and patients without was not significant (p = 0.113). Free survival analysis was not significant (p = 0.897) between the two populations.

Conclusions

We successfully performed LT in patients after Y90-RE treatment both as bridging and downstaging for HCC and obtained a similar overall and free survival of LT for HCC within Milan criteria. Y90-RE becomes a real option to provide curative therapy for patients who traditionally are not considered eligible for surgery.

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Authors and Affiliations

  1. Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy

    Giuseppe Maria Ettorre, Giovanni Battista Levi Sandri, Andrea Laurenzi, Marco Colasanti, Roberto Luca Meniconi, Roberto Santoro, Pasquale Lepiane & Giovanni Vennarecci

  2. Division of Hepatology and Infectious Disease, National Institute for Infectious Disease “L. Spallanzani”, via Portuense 292, 00152, Rome, Italy

    Raffaella Lionetti & Gianpiero D’Offizi

  3. Division of Nuclear Medicine, IFO Regina Elena National Cancer Institute, via Elio Chianesi 53, 00100, Rome, Italy

    Rosa Sciuto

  4. Division of Interventional Radiology, IFO Regina Elena National Cancer Institute, via Elio Chianesi 53, 00100, Rome, Italy

    Giuseppe Pizzi

  5. Division of Interventional Radiology, S.M. Goretti Hospital, via Guido Reni, 04010, Latina, Italy

    Roberto Cianni

  6. Division of Radiology, S. Orsola-Malpighi Hospital, via Pietro Albertoni 15, 40138, Bologna, Italy

    Rita Golfieri

  7. Liver Unit, San Camillo Forlanini Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy

    Adriano M. Pellicelli

  8. Anesthesiology and Intensive Care Unit, National Institute for Infectious Disease “L. Spallanzani”, Rome, Italy

    Mario Antonini

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  1. Giuseppe Maria Ettorre
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  2. Giovanni Battista Levi Sandri
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  3. Andrea Laurenzi
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  9. Rosa Sciuto
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Correspondence to Giuseppe Maria Ettorre or Giovanni Battista Levi Sandri.

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Ettorre, G.M., Levi Sandri, G.B., Laurenzi, A. et al. Yttrium-90 Radioembolization for Hepatocellular Carcinoma Prior to Liver Transplantation. World J Surg 41, 241–249 (2017). https://doi.org/10.1007/s00268-016-3682-z

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