Abstract
We report a case of a patient with end-stage liver disease secondary to hepatitis C, complicated by a large hepatocellular carcinoma. Because of the size of the tumor exceeded the Milan criteria, he was not a can-didate for liver transplantation. However, after two treatments with yttrium-90 glass microsphere infu-sions, the tumor became smaller and the patient’s α-fetoprotein level dropped to normal range. He was listed for transplantation and subsequently received a deceased donor liver transplant. Two years after his transplantation, he remains tumor free and has normal α-fetoprotein levels. This is the first reported case in the literature of using yttrium-90 microspheres as a bridge to liver transplantation in a patient with a large hepatocellular carcinoma. This therapy should be considered in patients with cirrhosis and large hepatocellular carcinomas exceeding current size criterion, who would otherwise be good candidates for transplantation.
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References
Kew MC. Hepatic tumors and cysts. In: Feldman M, Sleisenger MH, Scharschmidt BF, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease: Pathology/Diagnosis/ Management, vol. 1, 6th ed. Philadelphia: WB Saunders; 1998, 1365–1387.
Di B, Carithers RL, Gores GJ. Hepatocellular carcinoma. Hepatology 1998;28:1161–1165.
El S, Mason AC. Rising incidence of hepatocellular carci-noma in the United States. N Engl J Med 1999;340:745–750.
Mazzaferro V, Ragalia E, Gennari Leandro, et al. Liver transplantation for the treatment of small hepatocellular car-cinomas in patients with cirrhosis. N Engl J Med 1999;344:693–699.
Figueras J, Jaurrieta E, Valls C, et al. Resection or transplan-tation for hepatocellular carcinoma in cirrhotic patients: out-comes based on indicated treatment strategy. J Am Coll Surg 2000;190:580–587.
Llovet JM, Fuster J, Bruix J. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: re-section versus transplantation. Hepatology 1999;30:1434–1440.
Otto G, Heuschen U, Hofmann WJ, et al. Survival and recurrence after liver transplantation versus liver resection for hepatocellular carcinoma: a retrospective analysis. Ann Surg 1998;227:424–432.
Georgiades CS, Ramsey DE, Geschwind JFH. New nonsur-gical therapies in the treatment of hepatocellular carcinoma. Tech Vasc Interv Radiol 2001;4:193–199.
Cha C, Dematteo RP, Blumgart LH. Surgery and ablative therapy for hepatocellular carcinoma. J Clin Gastroenterol 2000;35:S130-S137.
Salem R, Thurston KG, Carr BI, et al. Yttrium-90 micro-spheres: radiation therapy for unresectable liver cancer. J Vasc Interv Radiol 2002;13:S223-S229.
Carr BI. Hepatic arterial yttrium glass microspheres (Thera-Sphere) for unresectable hepatocellular carcinoma: interim safety and survival data on 65 patients. Liver Transpl 2004; 10:S107-S110.
Tian JH, Xu BX, Zhang JM, et al. Ultrasound-guided inter-nal radiotherapy using yttrium-90-glass microspheres for liver malignancies. J Nucl Med 1996;37:958–963.
Goin JE, Salem R, Carr BI, et al. Treatment of unresectable hepatocellular carcinoma with intrahepatic yttrium 90 mi-crospheres: factors associated with liver toxicities. J Vasc In-terv Radiol 2005;16:205–213.
Andrew JC, Walker SC, Ackermann RJ, et al. Hepatic radio-embolization with ytrrium-90 containing glass microspheres: preliminary results and clinical follow-up. J Nucl Med 1994; 35:1637–1644.
Salem R, Lewandowski R, Roberts C, et al. Use of yttrium-90 glass microspheres (TheraSphere) for the treatment of unresectable hepatocellular carcinoma in patients with portal vein thrombosis. J Vasc Interv Radiol 2004;15:335–345.
Herba MJ, Illescas FF, Thirwell MP, et al. Hepatic malig-nancies: improved treatment with intraarterial Y-90. Radiol-ogy 1988;169:311–314.
Goin JE, Salem R, Carr BI, et al. Treatment of unresectable hepatocellular carcinoma with intrahepatic yttrium 90 mi-crospheres: a risk-stratification analysis. J Vasc Interv Radiol 2005;16:195–203.
Dancey JE, Shepherd FA, Paul K, et al. Treatment of non-resectable hepatocellular carcinoma with intrahepatic Y-microspheres. J Nucl Med 2000;41:1673–1681.
Herold C, Reck T, Fischler P, et al. Prognosis of a large cohort of patients with hepatocellular carcinoma in a single European centre. Liver 2002;22:22–28.
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Kim, D.Y., Kwon, D.S., Salem, R. et al. Successful embolization of hepatocelluar carcinoma with yttrium-90 glass microspheres prior to liver transplantation. J Gastrointest Surg 10, 413–416 (2006). https://doi.org/10.1016/j.gassur.2005.06.019
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DOI: https://doi.org/10.1016/j.gassur.2005.06.019