An ace in the hole for hepatocellular carcinoma: yttrium-90 radioembolization

Very good data supporting the use of y90 for bridge to transplant.

http://tcr.amegroups.com/article/view/10582/pdf

'From October 2009 to October 2015, 45 patients were enrolled into the study after randomization. In the Y90-RE
group 24 patients were analyzed and 13 of them were transplanted after LRT. In the TACE group of 21 allocated patients, 19 were analyzed and 7 were transplanted. The ultimate intent of treatment of these patients was LT. '

' The role of radiological response to loco-regional therapies has been recently shown to be important selection criteria for the risk of intention-totreat death and recurrence (9). If we consider the LT as the ultimate point for these patients, 13 were transplanted in Y90-RE group and 7 in TACE group. In case of longer waiting-time list for HCC patient there is an important risk of drop-out due to the tumor progression beyond the LT criteria. Therefore, a longer TTP will decreasing the dropout risk in patients treated with
Y90-RE. We think that according to the authors study this is a complete revolutionary message. In case of HCC patients in a LT setting a bridge therapy should be performed with Y90-RE when necessary. Authors presented a rate of 87% of LT in patients treated with Y90-RE. Nonetheless, authors described a change in local practice according to the study results and nowadays, patients bridged to LT receive
Y90-RE. We fully agree with this practice and applied in both bridge and downstaging patients (5,6). In conclusion, the study of Salem et al. (8) successfully compared the effectiveness of Y90-RE vs. TACE for HCC in an intention to treat cohort. The important results of a longer TTP after Y90-RE open a new horizon for HCC bridge and downstaging therapy. We have a new ace in the hole for HCC. '