title: Yttrium-90 radioembolization as a bridge to liver transplantation: a single-institution experience.
abstract: OBJECTIVE
  To evaluate our experience with the use of yttrium-90 ((90)Y) radioembolization in maintaining potential candidacy and, in some instances, downstaging hepatocellular carcinoma (HCC) that does not meet Milan criteria for liver transplantation.
  
  
  METHODS
  A retrospective review of 20 consecutive patients with HCC who were listed to receive a liver transplant and were treated with (90)Y radioembolization as a sole modality for locoregional "bridge" therapy was performed. Demographics, radiographic and pathologic response, survival, and recurrences were examined.
  
  
  RESULTS
  Twenty-two (90)Y treatments were performed in 20 patients before transplantation. Median time from first treatment to transplantation was 3.5 months. HCC in 14 patients met the Milan criteria at the time of the first (90)Y treatment, and HCC in six did not. All cases that originally met the Milan criteria remained within the criteria before transplantation, and two of six patients whose disease did not meet the criteria (33%) had their disease successfully downstaged to meet the criteria. Overall, nine patients (45%) had complete or partial radiologic response to (90)Y radioembolization according to modified Response Evaluation Criteria In Solid Tumors. Complete necrosis of tumor with no evidence of viable tumor on pathologic examination was observed in five patients (36%) whose disease met the Milan criteria.
  
  
  CONCLUSIONS
  Particularly in regions with long wait list times, (90)Y treatment is effective in maintaining tumor size in potential liver transplantation candidates with HCC. In addition, it can also be considered as a downstaging therapy in select patients before transplantation.
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery and Department of Surgery, University of Pittsburgh, 3471 Fifth Ave., Suite 300, Pittsburgh, PA 15213.
authors.forename: Samer
authors.initials: S
authors.lastname: Tohme
authors.forename: Daniel
authors.initials: D
authors.lastname: Sukato
authors.forename: Hui-Wei
authors.initials: HW
authors.lastname: Chen
authors.forename: Nikhil
authors.initials: N
authors.lastname: Amesur
authors.forename: Albert B
authors.initials: AB
authors.lastname: Zajko
authors.forename: Abhinav
authors.initials: A
authors.lastname: Humar
authors.forename: David A
authors.initials: DA
authors.lastname: Geller
authors.forename: James W
authors.initials: JW
authors.lastname: Marsh
authors.forename: Allan
authors.initials: A
authors.lastname: Tsung
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality; D009367:Neoplasm Staging; D019275:Radiopharmaceuticals / Q000009:adverse effects / Q000627:therapeutic use*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists / Q000401:mortality; D015021:Yttrium Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes
keywords: HCC; UNOS; United Network for Organ Sharing, yttrium-90 = (90)Y; hepatocellular carcinoma