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Yttrium‐90 microspheres (TheraSphere®) treatment of unresectable hepatocellular carcinoma: Downstaging to resection, RFA and bridge to transplantation
Author(s) -
Kulik Laura M.,
Atassi Bassel,
van Holsbeeck Lodewijk,
Souman Tameem,
Lewandowski Robert J.,
Mulcahy Mary F.,
Hunter Russell D.,
Nemcek Albert A.,
Abecassis Michael M.,
Haines Kenneth G.,
Salem Riad
Publication year - 2006
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.20609
Subject(s) - medicine , hepatocellular carcinoma , radiofrequency ablation , liver transplantation , surgery , stage (stratigraphy) , milan criteria , transplantation , resection , cohort , carcinoma , ablation , biology , paleontology
Abstract Purpose To present the clinical data of 35 patients with T3 unresectable hepatocellular carcinoma (HCC) that were treated with 90 Y with the specific intent of downstaging to resection, radiofrequency ablation (RFA) candidate, United Network for Organ Sharing (UNOS) stage T2 or liver transplantation. Materials and Methods One hundred fifty patients with unresectable HCC were treated with 90 Y microspheres. Of these, 35 patients were UNOS stage T3 at the time of treatment. Patients were followed for clinical toxicities, alterations in model for end‐stage‐liver disease (MELD) score, tumor response, downstaging to RFA, resection, transplantation, and survival. Results Nineteen of 34 patients (56%) were successfully downstaged from T3 to T2 following treatment. 11 of 34 (32%) patients treated were downstaged to target lesions measuring 3.0 cm or less. Twenty‐three of 35 (66%) were downstaged to either T2 status, lesion < 3.0 cm (RFA candidate), or resection. Seventeen of 34 (50%) had an objective tumor response by WHO criteria. Eight patients (23%) were successfully downstaged and underwent OLT following treatment. 1, 2, and 3‐year survival was 84%, 54%, and 27%, respectively. Median survival by Kaplan–Meier analysis for the entire cohort was 800 days. Conclusion These data suggest that intra‐arterial 90 Y microspheres can be used as a bridge to transplantation, surgical resection, or RFA. J. Surg. Oncol. 2006;94:572–586. © 2006 Wiley‐Liss, Inc.