Resin-based Yttrium-90 Radioembolization as a Bridging or Downstaging Treatment to Liver Transplantation for Hepatocellular Carcinoma

PURPOSE: To evaluate the outcomes of resin-based yttrium-90 radioembolization (TARE) for hepatocellular carcinoma (HCC) as a bridging or downstaging therapy to liver transplantation (LT) in terms of safety, tumor response, recurrence, and survival. MATERIALS & METHODS: A single-center retrospective analysis of patients with HCC treated with resin-based TARE as bridging or downstaging treatment to LT between January 2006 and April 2021 was performed. TARE-related liver toxicity was assessed. Imaging data were analyzed to assess tumor response. Histopathological analysis of explant livers was performed to assess HCC necrosis. Survival and bridging/downstaging success predictor analysis was performed. RESULTS: Thirty-six patients underwent resin-based TARE with the intention to bridge (33%) or downstage (67%) to LT. 44% had ≥3 HCC lesions, 53% had bilobar disease. Median largest tumor diameter was 3.4 cm. TARE was segmental, lobar, and bilobar in 20%, 36%, and 44% of cases, respectively. 17% had grade 3 bilirubin toxicities. Objective response rate per mRECIST was 72%. Patients meeting UNOS-DS criteria had higher chances of successful bridging/downstaging. 23 patients were transplanted. Complete pathologic response was seen in 30% of explant livers. Post-transplant tumor recurrence occurred in 26% within a median follow-up period of 1710 days. Estimated 5-year progression-free, disease-specific, and overall survival rates after LT were 89%, 69%, and 89%, respectively. For the entire patient cohort, these rates were 87%, 53% and 70%. CONCLUSION: Resin-based 90Y TARE can be considered a valuable treatment option for bridging or downstaging patients with HCC to LT, including patients requiring (bi-)lobar TARE for extensive tumoral disease.