Liver Resection and Transplantation Following Yttrium-90 Radioembolization for Primary Malignant Liver Tumors: A 15-Year Single-Center Experience

Abstract

Radioembolization (RE) may help local control and achieve tumor reduction while hypertrophies healthy liver and provides a test of time. For liver transplant (LT) candidates, it may attain downstaging for initially non-candidates and bridging during the waitlist. Methods: Patients diagnosed with HCC and ICC treated by RE with further liver resection (LR) or LT between 2005–2020 were included. All patients selected were discarded for the upfront surgical approach for not accomplishing oncological or surgical safety criteria after a multidisciplinary team assessment. Data for clinicopathological details, postoperative, and survival outcomes were retrospectively reviewed from a prospectively maintained database. Results: A total of 34 patients underwent surgery following RE (21 LR and 13 LT). Clavien–Dindo grade III-IV complications and mortality rates were 19.0% and 9.5% for LR and 7.7% and 0% for LT, respectively. After RE, for HCC and ICC patients in the LR group, 10-year OS rates were 57% and 60%, and 10-year DFS rates were 43.1% and 60%, respectively. For HCC patients in the LT group, 10-year OS and DFS rates from RE were 51.3% and 43.3%, respectively. Conclusion: Liver resection after RE is safe and feasible with optimal short-term outcomes. Patients diagnosed with unresectable or high biological risk HCC or ICC, treated with RE, and rescued by LR may achieve optimal global and DFS rates. On the other hand, bridging or downstaging strategies to LT with RE in HCC patients show adequate recurrence rates as well as long-term survival.

Transarterial Radioembolization (TARE) in Patients with Hepatocellular Carcinoma: A Comparison of Palliative with Bridging-to-Transplant Concepts

“…The estimated survival rate in our whole patient cohort was 82.0% and 60.5% at 6 and 12 months after TARE, respectively, which is similar to other studies evaluating patients with unresectable HCC, also regarding the proportion of patients who underwent LT after bridging TARE [ 11 , 23 , 24 ]. Despite our hospital being a specialized liver transplantation center, only approx.…”

“…In this context, a bridging therapy, such as transarterial radioembolization (TARE) before liver transplantation (LT), is applied. The effectiveness of locoregional, neoadjuvant therapies for this purpose has been demonstrated by several studies [ 5 , 6 , 11 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. Studies directly comparing TARE with TACE found a higher disease control rate, significantly better overall and intrahepatic PFS, and better survival outcomes in the patients treated with TARE even with advanced disease [ 19 , 20 ].…”

“…When microspheres containing beta-emitting nuclides are administered via a microcatheter into the artery feeding the tumor-containing liver tissue, the resulting tumor doses are higher than those delivered to non-tumor liver tissue [ 9 , 10 ]. In addition to palliative treatments, TARE can also be performed as a bridging therapy to delay hepatic tumor progression and to ensure that patients survive the waiting time for a liver transplant without developing contraindications for LT [ 11 , 12 ].…”

Prognostic Role of the Intrahepatic Lymphatic System in Liver Cancer

“…In 2015, approximately 854,000 cases of liver cancer were diagnosed and 810,000 patients died [ 5 ]. The most common type of primary liver cancer is hepatocellular carcinoma (HCC), followed by intrahepatic cholangiocarcinoma (ICC), comprising approximately 80% and 15%, respectively [ 5 , 6 , 7 ]. For HCC without cirrhosis, surgical resection offers the best chance of cure, but most cases are unfortunately diagnosed at an advanced stage that reduces the chances of successful surgery [ 7 ].…”

“…The most common type of primary liver cancer is hepatocellular carcinoma (HCC), followed by intrahepatic cholangiocarcinoma (ICC), comprising approximately 80% and 15%, respectively [ 5 , 6 , 7 ]. For HCC without cirrhosis, surgical resection offers the best chance of cure, but most cases are unfortunately diagnosed at an advanced stage that reduces the chances of successful surgery [ 7 ]. Furthermore, the recurrence rate remains high even if a patient with HCC undergoes curative resection, with 5-year recurrence rates of up to 70% [ 8 , 9 , 10 ].…”