Yttrium-90 Radioembolization prior to Surgical Resection for Hepatocellular Carcinoma

Objective: To evaluate yttrium-90 radioembolization (Y90) patients who underwent curative surgical resection for hepatocellular carcinoma (HCC). Summary Background Data: Surgical resection for HCC is a potential curative treatment, but many patients are deemed unresectable due to large tumors or inadequate FLR. Y90 has previously been found to be an effective way to induce remnant liver hypertrophy while simultaneously providing tumor control. Methods: HCC patients that underwent surgical resection following Y90 were evaluated in a 5-year period. Parenchymal volumes of liver segments and future liver remnant were calculated pre/post-Y90 imaging. Radiographic response post-Y90 and pathological necrosis were assessed. An exploratory analysis of post-operative phosphorus was performed. Post-Y90 and long-term outcomes were recorded. Overall and recurrence-free survival were estimated using Kaplan-Meier model. Results: 31 HCC patients were treated with Y90 prior to surgical resection. Median time between the first Y90 treatment and surgical resection was 2.9 months (IQR=2.4). Contralateral hepatic lobe volumes increased from a median of 652 cc (CI:540-765) to 822 cc (CI:683-961, P=0.0002). Complete, 50-99%, and <50% pathologic necrosis was identified in 14 (45%), 10 (32%), and 7 (23%) of resected tumors, respectively. 12 patients displayed stable disease (39%), 1 patient displayed progressive disease (3%), 9 (29%) patients displayed partial response, and 9 (29%) patients displayed complete response. Survival rates were 96% at 1 year (81-99) and 86% at 3 years (52-99), with median not reached. Median recurrence-free survival was 34.2 months (CI:18.7-34.2). Exploratory analysis of post-operative phosphorus demonstrated no significant change. Conclusion: Y90 can serve as an effective neoadjuvant treatment prior to surgical resection that can achieve tumor control, contralateral lobe hypertrophy, and recurrence-free survival post resection.