Nice paper out of Italy. Lost the link, sorry. I'm sure a google...

Nice paper out of Italy. Lost the link, sorry. I'm sure a google search will find it.

Hepatocellular carcinoma with macrovascular invasion treated with yttrium-90 radioembolization prior to transplantation

Giovanni Battista Levi Sandri1
, Giuseppe Maria Ettorre1
, Marco Colasanti1
, Edoardo De Werra1
, Gianluca
Mascianà1
, Daniele Ferraro1
, Giovanni Tortorelli1
, Rosa Sciuto2
, Pierleone Lucatelli3
, Giuseppe Pizzi3
,
Ubaldo Visco-Comandini4
, Giovanni Vennarecci1
1
Division of General Surgery and Liver Transplantation, San Camillo Hospital Rome, Rome, Italy; 2
Division of Nuclear Medicine, 3 Division of  Interventional Radiology, IFO Regina Elena National Cancer Institute, Rome, Italy; 4 Division of Hepatology and Infectious Disease, National Institute for Infectious Disease “L. Spallanzani”, Rome, Italy
Contributions: (I) Conception and design: GB Levi Sandri, GM Ettorre; (II) Administrative support: GM Ettorre, P Lucatelli, R Sciuto, U Visco-Comandini; (III) Provision of study materials or patients: M Colasanti, R Santoro, P Lepiane, G Pizzi, G Vennarecci; (IV) Collection and assembly of data: GB Levi Sandri, G Mascianà, E De Werra, D Ferraro, G Tortorelli, P Lucatelli, RL Meniconi; (V) Data analysis and interpretation: GB Levi
Sandri, P Lucatelli; (VI)
Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.
Correspondence to: Giovanni Battista Levi Sandri, MD. Division of General Surgery and Liver Transplantation, San Camillo Hospital Rome, circ.ne Gianicolense 87, 00151 Rome, Italy. Email: [email protected].

Background: Yttrium-90 microspheres radioembolization (Y90-RE) has shown to be an effective and safe
treatment of primary liver tumors. According to the staging system of the Barcelona Clinic Liver Cancer
(BCLC), patients with macrovascular invasion are staged as BCLC-C. This paper comprises a presentation
of the results following application of the procedure.

Methods: From January 2002 to December 2015, 367 patients were transplanted at the San Camillo
Hospital Center. One hundred and forty-three patients were transplanted for hepatocellular carcinoma
(HCC) and in 22 cases patients were treated with Y90-RE before liver transplantation (LT), of them 4 with
macrovascular invasion were included in this study.

Results: The four patients had a complete response for the thrombosis, and were included in the waiting
list within the Milan criteria. Means interval time between Y90-RE and LT was 15.86 months. No patient
death was observed at Y90-RE procedure or at LT. We obtain a free-survival of 39.1 (range, 6–76) months.
In all four cases the complete thrombosis regression was observed.

Conclusions: We reported a short series of patients transplanted after Y90-RE in patients with BCLC
stage C. In our experience we achieved acceptable overall and disease-free survival. Eventually, Y90-RE
seems to have a place in the downstaging strategy for LT candidates.