title: Response to radioembolization with yttrium-90 resin microspheres may allow surgical treatment with curative intent and prolonged survival in previously unresectable hepatocellular carcinoma.
abstract: BACKGROUND
  Occasionally, patients with hepatocellular carcinoma (HCC) who receive radioembolization with palliative intent are downstaged for radical treatments. The aim of this study was to describe and analyze the overall survival (OS) in these patients compared with patients of the same baseline stage (UNOS T3), who were not eligible for radical treatment after radioembolization.
  
  
  METHODS
  Between September 2003 and August 2010, 118 patients with HCC received radioembolization with yttrium-90 ((90)Y) resin microspheres. Of these, 21 patients with UNOS T3 stage were retrospectively identified and included in this analysis.
  
  
  RESULTS
  In total, 6 of 21 patients were downstaged and treated radically between 2 and 35 months post-radioembolization. Three patients were resected, 2 received liver transplantation and 1 was ablated and then resected. Patients treated radically were significantly younger (62 vs. 73 years, p = 0.006) and had higher tumor volume (583 mL vs. 137 mL, p = 0.001) than patients who did not achieve radical treatment. There were no differences between the groups in number of lesions, BCLC stage, previous cirrhosis, activity administered per tumor volume, or median levels of alpha-fetoprotein or total bilirubin. Across the whole series, the median OS was 27.0 months (95% CI 5.0-48.9), varying significantly between those treated radically (OS not reached after a median follow-up of 41.5 months since radical therapy) and those who received palliative treatment only (22.0 months; 95% CI 15.0-30.9).
  
  
  CONCLUSIONS
  Radical therapy following tumor downstaging with radioembolization provides the possibility of long-term survival in a select subgroup (UNOS T3 stage) with otherwise limited options.
authors.affiliation: Liver Unit, Clinica Universidad de Navarra, Pamplona, Spain. minarra@unav.es
authors.forename: M
authors.initials: M
authors.lastname: Iñarrairaegui
authors.forename: F
authors.initials: F
authors.lastname: Pardo
authors.forename: J I
authors.initials: JI
authors.lastname: Bilbao
authors.forename: F
authors.initials: F
authors.lastname: Rotellar
authors.forename: A
authors.initials: A
authors.lastname: Benito
authors.forename: D
authors.initials: D
authors.lastname: D'Avola
authors.forename: J I
authors.initials: JI
authors.lastname: Herrero
authors.forename: M
authors.initials: M
authors.lastname: Rodriguez
authors.forename: P
authors.initials: P
authors.lastname: Martí
authors.forename: G
authors.initials: G
authors.lastname: Zozaya
authors.forename: I
authors.initials: I
authors.lastname: Dominguez
authors.forename: J
authors.initials: J
authors.lastname: Quiroga
authors.forename: B
authors.initials: B
authors.lastname: Sangro
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008863:Microspheres; D008875:Middle Aged; D009367:Neoplasm Staging; D016019:Survival Analysis; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D015021:Yttrium Radioisotopes