Selective internal radiation therapy by yttrium‐90 microspheres for hepatocellular carcinoma after renal transplantation

We report a HBsAg‐positive patient who developed hepatocellular carcinoma (HCC) 7 years after cadaveric kidney transplantation. The tumor was unresectable because of coexisting cirrhosis. Selective internal radiation (SIR) therapy, a novel therapy with the technique recently perfected, was used. Yttrium‐90 microspheres were given via an angiographic catheter under fluoroscopy guidance. Serum alpha‐fetal protein (AFP) was normalized within 2 wk. A follow‐up abdominal CT scan revealed significant necrosis of the tumor and compensatory hypertrophy of non‐diseased liver. The treatment was well tolerated except for transient liver function deterioration. The patient enjoyed 15 months of symptom‐free survival before she died of liver failure. Practical aspects and potential applications of SIR therapy in this group of patients are discussed.

[1]  M. Sherman,et al.  Screening for hepatocellular carcinoma , 2007, Hepatology research : the official journal of the Japan Society of Hepatology.

[2]  C. Lo,et al.  Early detection of hepatocellular carcinoma in hepatitis‐B‐positive renal transplant recipients , 1999, Journal of surgical oncology.

[3]  W. Yeo,et al.  Adjuvant intra-arterial lipiodol-iodine-131 for resectable hepatocellular carcinoma: a prospective randomised trial , 1999, The Lancet.

[4]  D. Machin,et al.  Adjuvant intra-arterial iodine-131-labelled lipiodol for resectable hepatocellular carcinoma: a prospective randomised trial. , 1999, Lancet.

[5]  W. Lau,et al.  Internal radiation therapy for patients with primary or metastatic hepatic cancer , 1998, Cancer.

[6]  A. Li,et al.  Selective internal radiation therapy for nonresectable hepatocellular carcinoma with intraarterial infusion of 90yttrium microspheres. , 1998, International journal of radiation oncology, biology, physics.

[7]  F. Carnot,et al.  The long-term virologic and pathologic impact of renal transplantation on chronic hepatitis B virus infection. , 1996, Transplantation.

[8]  A. Li,et al.  Treatment of inoperable hepatocellular carcinoma with intrahepatic arterial yttrium-90 microspheres: a phase I and II study. , 1994, British Journal of Cancer.

[9]  L. Jover,et al.  Phase II study of transarterial embolization in european patients with hepatocellular carcinoma: Need for controlled trials , 1994, Hepatology.

[10]  A. Li,et al.  Diagnostic pharmaco-scintigraphy with hepatic intra-arterial technetium-99m macroaggregated albumin in the determination of tumour to non-tumour uptake ratio in hepatocellular carcinoma. , 1994, The British journal of radiology.

[11]  A. Li,et al.  Measuring lung shunting in hepatocellular carcinoma with intrahepatic-arterial technetium-99m macroaggregated albumin. , 1994, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[12]  Huiyang Zhao,et al.  An experimental study and clinical pilot trials on Yttrium‐90 glass microspheres through the hepatic artery for treatment of primary liver cancer , 1993, Cancer.

[13]  S. Houle,et al.  A phase I dose escalation trial of yttrium‐90 microspheres in the treatment of primary hepatocellular carcinoma , 1992, Cancer.

[14]  S. Fan,et al.  Subclinical hepatocellular carcinoma in Hong Kong Chinese. , 1992, Oncology.

[15]  T. Starzl,et al.  Accelerated growth rates of recurrent hepatocellular carcinoma after liver transplantation , 1991, Cancer.

[16]  I. Penn.  Cancers complicating organ transplantation. , 1990, The New England journal of medicine.

[17]  C. Lui,et al.  Hepatocellular carcinoma in Hong Kong: clinical study on 340 cases. , 1990, Oncology.

[18]  S. Houle,et al.  Hepatocellular carcinoma: pilot trial of treatment with Y-90 microspheres. , 1989, Radiology.

[19]  P. Bret,et al.  Hepatic malignancies: improved treatment with intraarterial Y-90. , 1988, Radiology.

[20]  R. Calne,et al.  Decreased rate of growth of hepatocellular carcinoma recurrence after liver transplantation in patients maintained on cyclosporine immunosuppression. , 1988, Transplantation proceedings.

[21]  H. Hasegawa,et al.  Natural history of hepatocellular carcinoma and prognosis in relation to treatment study of 850 patients , 1985, Cancer.

[22]  P. Lavin,et al.  Chemotherapy studies in primary liver cancer. A prospective randomized clinical trial , 1978, Cancer.

[23]  G. Pack,et al.  Treatment of inoperable cancer of the liver by intra‐arterial radioactive isotopes and chemotherapy , 1967, Cancer.

[24]  I. Ariel.  Treatment of Inoperable Primary Pancreatic and Liver Cancer by the Intra‐Arterial Administration of Radioactive Isotopes (Y Radiating Microspheres) , 1965, Annals of surgery.