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

Authors

  • Laura M. Kulik,

    1. Division of Hepatology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois
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  • Bassel Atassi,

    1. Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois
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  • Lodewijk van Holsbeeck,

    1. Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois
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  • Tameem Souman,

    1. Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois
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  • Robert J. Lewandowski,

    1. Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois
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  • Mary F. Mulcahy,

    1. Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois
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  • Russell D. Hunter,

    1. MDS Pharma Services, King of Prussia PA, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois
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  • Albert A. Nemcek Jr.,

    1. Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois
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  • Michael M. Abecassis,

    1. Division of Transplant Surgery, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois
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  • Kenneth G. Haines III,

    1. Division of Surgical Pathology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois
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  • Riad Salem MD, MBA

    Corresponding author
    1. Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois
    • Department of Radiology, 676 North St. Claire, Suite 800, Chicago, IL 60611. Fax: 312-695-0654.
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  • Riad Salem is a consultant; Russell D. Hunter is an employee of MDS Pharma Services, a contract research organization and subsidiary of MDS, Inc. None of the other authors have disclosed a potential conflict of interest.

Abstract

Purpose

To present the clinical data of 35 patients with T3 unresectable hepatocellular carcinoma (HCC) that were treated with 90Y 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 90Y 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 90Y microspheres can be used as a bridge to transplantation, surgical resection, or RFA. J. Surg. Oncol. 2006;94:572–586. © 2006 Wiley-Liss, Inc.

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