Not sure if this was already posted, but I'm interested in the...

Not sure if this was already posted, but I'm interested in the survival benefit associated with getting a liver transplant for downstaged HCC or use of SIRT as bridging treatment.  From memory papers seem to show a higher rate of liver Tx post-SIRT relative to TACE.  Even if OS censored at time of Tx is not much different relative to SOR, a big difference in Tx will have a big impact.  Feel free to post relevant articles in this thread!

Yttrium-90 Radioembolization for Hepatocellular Carcinoma Prior to Liver Transplantation.
Ettorre GM, et al. World J Surg. 2017.
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Abstract
BACKGROUND: Liver transplantation (LT) is a well-established procedure for hepatocellular carcinoma (HCC) within the Milan criteria. Yttrium-90 microspheres radioembolization (Y90-RE) has shown to be an effective and safe treatment of primary liver tumors. We retrospectively evaluate the efficacy of the Y90-RE in patients with HCC prior to LT.

METHODS: From January 2002 to December 2015, 365 patients were transplanted at the San Camillo Hospital Center. One hundred forty-three patients were transplanted for HCC, and in 22 cases the patients were treated with Y90-RE before LT.

RESULTS: Three patients were treated with Y90-RE within the Milan criteria, and 19 patients were out of criteria before Y90-RE. Four patients had an increasing MELD score between Y90-RE and LT. On the other hand, alpha-fetoprotein decreases after Y90-RE treatment in all cases. No patient death was observed in Y90-RE procedure or at LT. In 78.9 % of cases, a successful downstaging was observed, and in 100 % of cases bridging was achieved. From Y90-RE treatment overall survival was 43.9 months. From LT, overall mean survival was 30.2 months with a free survival of 29.6 months. The overall survival after LT analysis between the patients treated with Y90-RE and patients without was not significant (p = 0.113). Free survival analysis was not significant (p = 0.897) between the two populations.

CONCLUSIONS: We successfully performed LT in patients after Y90-RE treatment both as bridging and downstaging for HCC and obtained a similar overall and free survival of LT for HCC within Milan criteria. Y90-RE becomes a real option to provide curative therapy for patients who traditionally are not considered eligible for surgery.

PMID
27495316 [PubMed - in process]
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https://www.ncbi.nlm.nih.gov/m/pubm...iver transplantation survival hcc downstaging