Yttrium-90 microspheres (TheraSphere®) treatment of unresectable hepatocellular carcinoma:: Downstaging to resection, RFA and bridge to transplantation

Purpose: To present the clinical data of 35 patients with T3 unresectable hepatocellular carcinoma (HCC) that were treated with Y-90 with the specific intent of downstaging to resection, radiofrequency ablation (RFA) candidate, United Network for Organ Sharing (UNOS) stage T2 or liver transplantation. Materials and Methods: One hundred fifty patients with unresectable HCC were treated with Y-90 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. Conclusion: These data suggest that intra-arterial Y-90 microspheres can be used as a bridge to transplantation, surgical resection, or RFA.