Efficacy of Yttrium90 transarterial radioembolization as a bridge to surgery in hepatocellular carcinoma

<h2>Abstract</h2><h3>Background</h3> Yttrium90 transarterial radioembolization (TARE) is increasingly used for bridging or downstaging to liver transplant(LT) or resection(LR) despite a paucity of data. This study aims to illustrate its efficacy as a bridge to surgery. <h3>Methods</h3> HCC patients who received Y90 TARE as their first treatment in Honolulu, HI during 2012-2022 were identified. Wilcoxon, Kruskal-Wallis, and Fischer's t-tests identified statistical significance. <h3>Results</h3> Of 137 patients identified, 29 had advanced disease (stage III/IV) and 68 were LR candidates with inadequate FLR. Y90 TARE downstaged 14%(n=5/37) potential LR and one advanced disease to surgery. Of 40 LT candidates, 22% underwent transplantation: 26%(n=7/27) within Milan and 15%(n=2/13) within UCSF criteria underwent transplantation. Only 9(22%) were ineligible due to tumor progression; larger tumor size was the only predictor (>7.5cm, p<0.001). <h3>Conclusions</h3> Y90 TARE is an effective bridging therapy but most did not get transplanted for non-tumor reasons (comorbidities, substance abuse). Larger tumor burden and cirrhosis may impact its ability to downstage to resection. <h3>Synopsis</h3> This retrospective cohort study of 137 hepatocellular carcinoma patients demonstrates that Y90 TARE is able to successfully bridge 15-26% of patients to transplantation and 14% of previously unresectable patients to surgery however larger tumor size and cirrhosis appears to limit its efficacy. Y90 TARE has the potential to be an effective salvage therapy in medically fit individuals however a minority actually proceed to surgery, therefore further studies evaluating multi-modality therapies may improve the prospect of surgical intervention.