title: Hepatocellular carcinoma with macrovascular invasion treated with yttrium-90 radioembolization prior to transplantation.
abstract: BACKGROUND
  Yttrium-90 microspheres radioembolization (Y90-RE) has shown to be an effective and safe treatment of primary liver tumors. According to the staging system of the Barcelona Clinic Liver Cancer (BCLC), patients with macrovascular invasion are staged as BCLC-C. This paper comprises a presentation of the results following application of the procedure.
  
  
  METHODS
  From January 2002 to December 2015, 367 patients were transplanted at the San Camillo Hospital Center. One hundred and forty-three patients were transplanted for hepatocellular carcinoma (HCC) and in 22 cases patients were treated with Y90-RE before liver transplantation (LT), of them 4 with macrovascular invasion were included in this study.
  
  
  RESULTS
  The four patients had a complete response for the thrombosis, and were included in the waiting list within the Milan criteria. Means interval time between Y90-RE and LT was 15.86 months. No patient death was observed at Y90-RE procedure or at LT. We obtain a free-survival of 39.1 (range, 6-76) months. In all four cases the complete thrombosis regression was observed.
  
  
  CONCLUSIONS
  We reported a short series of patients transplanted after Y90-RE in patients with BCLC stage C. In our experience we achieved acceptable overall and disease-free survival. Eventually, Y90-RE seems to have a place in the downstaging strategy for LT candidates.
authors.affiliation: Division of General Surgery and Liver Transplantation, San Camillo Hospital Rome, Rome, Italy.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Levi Sandri
authors.affiliation: Division of General Surgery and Liver Transplantation, San Camillo Hospital Rome, Rome, Italy.
authors.forename: Giuseppe Maria
authors.initials: GM
authors.lastname: Ettorre
authors.affiliation: Division of General Surgery and Liver Transplantation, San Camillo Hospital Rome, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Colasanti
authors.affiliation: Division of General Surgery and Liver Transplantation, San Camillo Hospital Rome, Rome, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: De Werra
authors.affiliation: Division of General Surgery and Liver Transplantation, San Camillo Hospital Rome, Rome, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Mascianà
authors.affiliation: Division of General Surgery and Liver Transplantation, San Camillo Hospital Rome, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Ferraro
authors.affiliation: Division of General Surgery and Liver Transplantation, San Camillo Hospital Rome, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tortorelli
authors.affiliation: Division of Nuclear Medicine, IFO Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Sciuto
authors.affiliation: Division of Interventional Radiology, IFO Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Pierleone
authors.initials: P
authors.lastname: Lucatelli
authors.affiliation: Division of Interventional Radiology, IFO Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pizzi
authors.affiliation: Division of Hepatology and Infectious Disease, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy.
authors.forename: Ubaldo
authors.initials: U
authors.lastname: Visco-Comandini
authors.affiliation: Division of General Surgery and Liver Transplantation, San Camillo Hospital Rome, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vennarecci
keywords: Barcelona Clinic Liver Cancer (BCLC); Yttrium; downstaging; hepatocellular carcinoma (HCC); liver transplantation (LT); macrovascular invasion; radioembolization