title: Yttrium-90 microspheres (TheraSphere) treatment of unresectable hepatocellular carcinoma: downstaging to resection, RFA and bridge to transplantation.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  These data suggest that intra-arterial (90)Y microspheres can be used as a bridge to transplantation, surgical resection, or RFA.
authors.affiliation: Division of Hepatology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois, USA.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Kulik
authors.forename: Bassel
authors.initials: B
authors.lastname: Atassi
authors.forename: Lodewijk
authors.initials: L
authors.lastname: van Holsbeeck
authors.forename: Tameem
authors.initials: T
authors.lastname: Souman
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
authors.forename: Mary F
authors.initials: MF
authors.lastname: Mulcahy
authors.forename: Russell D
authors.initials: RD
authors.lastname: Hunter
authors.forename: Albert A
authors.initials: AA
authors.lastname: Nemcek
authors.forename: Michael M
authors.initials: MM
authors.lastname: Abecassis
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Haines
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D008863:Microspheres; D009367:Neoplasm Staging; D011874:Radiometry; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D015021:Yttrium Radioisotopes / Q000008:administration & dosage
chemical_list: D015021:Yttrium Radioisotopes