title: Radioembolization using yttrium-90 microspheres as bridging and downstaging treatment for unresectable hepatocellular carcinoma before liver transplantation: initial single-center experience.
abstract: BACKGROUND
  HCC is the sixth most common malignancy worldwide and is the third most common cause of cancer related mortality. Moreover, the incidence of HCC is increasing. Surgical treatments for HCC including resection and/or transplantation provide the best curative outcomes in early stages. Unfortunately, many patients present at an advanced stage. Currently, locoregional therapies have an emerging role in the management of HCC for bridging to liver transplantation and for downstaging the disease to within transplant criteria. Radioembolization is among commonly used locoregional therapies.
  
  
  OBJECTIVE
  To describe our initial experience with the use of Therasphere® as bridging or downstaging modality before liver transplantation, including our institutional indications, technique and outcome.
  
  
  METHODS
  We retrospectively examined our database for liver transplantation after the use of Therasphere®. Nine patients were identified and reported.
  
  
  RESULTS
  They were 5 females and 4 males. Their current age range is 40-72 years with a mean of 53.8 ± 9.5 years. Three patients had Therasphere® as downstaging treatment to our institutional transplantation criteria. Our institution is using UCSF criteria as a cut off limit for liver transplantation as primary treatment modality. The other 6 patients had Therasphere® as bridging for liver transplantation especially when other modalities are not possible. None of these lesions were treated by any other locoregional treatment before or after Therasphere®. Follow-up after liver transplantation ranged between 3.7 and 60.1 months (mean of 15.8 ± 17.7 months). All patients are still living, no retransplantation was done and none of them showed evidence of disease recurrence (100% graft, patient and disease free survival).
  
  
  CONCLUSIONS
  Our initial experience showed that Therasphere® is a promising therapeutic tool for both downstaging and bridging of HCC before liver transplant.
authors.affiliation: Department of Liver Transplantation and Hepatobiliary Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Department of Surgery, Faculty of Medicine, University of Alexandria, Egypt. Electronic address: mohamad.rabie@gmail.com.
authors.forename: M R
authors.initials: MR
authors.lastname: Abdelfattah
authors.affiliation: Department of Liver Transplantation and Hepatobiliary Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: M
authors.initials: M
authors.lastname: Al-Sebayel
authors.affiliation: Department of Liver Transplantation and Hepatobiliary Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: D
authors.initials: D
authors.lastname: Broering
authors.affiliation: Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: H
authors.initials: H
authors.lastname: Alsuhaibani
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000628:therapy*; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D015021:Yttrium Radioisotopes / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D015021:Yttrium Radioisotopes