Abstract
Background. A 58-year-old white man who was being followed by his hepatologist for nonalcoholic steatohepatitis-related liver cirrhosis and portal hypertension and who had been found to have a biopsy-proven hepatocellular carcinoma (HCC) on routine screening, self-referred to our center for a second opinion on the management of his HCC.
Investigations. Laboratory investigations, CT scan of the abdomen and chest, bone scan and technetium macroaggregated albumin scan.
Diagnosis. The patient had unresectable HCC.
Management. The patient underwent two treatments with Yttrium-90 glass microspheres, which were performed as outpatient procedures 1 month and 3 months after diagnosis. He underwent orthotopic liver transplantation (OLT) 1 year after the initial diagnosis of HCC. The post-OLT immunoregimen included OKT3 plus rituximab and high-dose steroids. On discharge from hospital he was on immunosuppressive treatment with tacrolimus. He had de novo autoimmune hepatitis 6 months post-OLT, which was treated with a short course of low-dose steroids and addition of mycophenolate mofetil.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Howe, H. L. et al. Annual report to the nation on the status of cancer (1973 through 1998), featuring cancers with recent increasing trends. J. Natl Cancer Inst. 93, 824–842 (2001).
El-Serag, H. B. & Mason, A. C. Rising incidence of hepatocellular carcinoma in the United States. N. Engl. J. Med. 340, 745–750 (1999).
El-Serag, H. B. et al. The continuing increase in the incidence of hepatocellular carcinoma in the United States: an update. Ann. Intern. Med. 139, 817–823 (2003).
Altekruse, S. F. et al. Hepatocellular carcinoma incidence, mortality, and survival trends in the United States from 1975 to 2005. J. Clin. Oncol. 27, 1485–1491 (2009).
Alberts, S. R. et al. Treatment options for hepatobiliary and pancreatic cancer. Mayo Clin. Proc. 82, 628–637 (2007).
Bruix, J. & Sherman, M. Management of hepatocellular carcinoma. Practice Guidelines Committee, American Association for the Study of Liver Diseases. Hepatology 42, 1208–1236 (2005).
Fung, J. & Marsh, W. The quandary over liver transplantation for hepatocellular carcinoma: the greater sin? Liver Transpl. 8, 775–777 (2002).
Mazzaferro, V. et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N. Engl. J. Med. 334, 693–699 (1996).
Yao, F. Y. et al. Liver transplantation for hepatocellular carcinoma: comparison of the proposed UCSF criteria with the Milan criteria and the Pittsburgh modified TNM criteria. Liver Transpl. 8, 765–774 (2002).
Yao, F. Y. et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology 33, 1394–1403 (2001).
Goin, J. E. et al. Treatment of unresectable hepatocellular carcinoma with intrahepatic yttrium 90 microspheres: factors associated with liver toxicities. J. Vasc. Interv. Radiol. 16, 205–213 (2005).
Kulik, L. M. et al. Yttrium-90 microspheres (TheraSphere) treatment of unresectable hepatocellular carcinoma: downstaging to resection, RFA and bridge to transplantation. J. Surg. Oncol. 94, 572–586 (2006).
Salem, R. & Hunter, R. D. Yttrium-90 microspheres for the treatment of hepatocellular carcinoma: a review. Int. J. Radiat. Oncol. Biol. Phys. 66, S83–S88 (2006).
Geschwind, J. F. et al. Yttrium-90 microspheres for the treatment of hepatocellular carcinoma. Gastroenterology 127, S194–S205 (2004).
Salem, R. et al. Treatment of unresectable hepatocellular carcinoma with use of 90Y microspheres (TheraSphere): safety, tumor response, and survival. J. Vasc. Interv. Radiol. 16, 1627–1639 (2005).
Moreno-Luna, L. E. et al. The clinical value of radioembolization in the treatment of inoperable liver cancer. US Gastroenterology & Hepatology Review 4, 32–36 (2009).
Carr, B. I. Hepatic arterial 90Yttrium glass microspheres (Therasphere) for unresectable hepatocellular carcinoma: interim safety and survival data on 65 patients. Liver Transpl. 10, S107–S110 (2004).
Bruix, J. & Llovet, J. M. Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatology 35, 519–524 (2002).
The Cancer of the Liver Italian Program (CLIP) Investigators. A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients: the Cancer of the Liver Italian Program (CLIP) investigators. Hepatology 28, 751–755 (1998).
Acknowledgements
Lewis R. Roberts is supported by Mayo Clinic and Mayo Cancer Center, NIH Grants CA82862 and CA100882, an Industry Research Scholar Award from the Foundation for Digestive Health and Nutrition, a Harold Amos Medical Faculty Development Award from The Robert Wood Johnson Foundation, a generous gift from The Richard M. Schulze Family Foundation and the Miles and Shirley Fiterman Center for Digestive Diseases at the Mayo Clinic, Rochester, MN. The authors thank Vicki Campion for secretarial assistance.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
Lewis R. Roberts reports receiving consulting fees from Isis Pharmaceuticals and Rosetta Genomics and grant support from Wako Diagnostics, MDS Nordion, and Bristol-Myers Squibb.
Rights and permissions
About this article
Cite this article
Luna, L., Kwo, P., Roberts, L. et al. Liver transplantation after radioembolization in a patient with unresectable HCC. Nat Rev Gastroenterol Hepatol 6, 679–683 (2009). https://doi.org/10.1038/nrgastro.2009.165
Issue Date:
DOI: https://doi.org/10.1038/nrgastro.2009.165