Case Report
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Sep 21, 2006; 12(35): 5729-5732
Published online Sep 21, 2006. doi: 10.3748/wjg.v12.i35.5729
Hepatic intra-arterial infusion of yttrium-90 microspheres in the treatment of recurrent hepatocellular carcinoma after liver transplantation: A case report
Louis Rivera, Huan Giap, William Miller, Jonathan Fisher, Donald J Hillebrand, Christopher Marsh, Randolph L Schaffer
Louis Rivera, Naval Medical Center San Diego, San Diego, CA 92134, United States
Huan Giap, Department of Radiation Oncology, Scripps Clinic/Green Hospital, La Jolla, CA 92037, United States
William Miller, Department of Hematology/Oncology, Scripps Clinic/Green Hospital, La Jolla, CA 92037, United States
Jonathan Fisher, Donald J Hillebrand, Christopher Marsh, Randolph L Schaffer, Scripps Center for Organ and Cell Transplantation, Scripps Clinic/Green Hospital, La Jolla, CA 92037, United States
Author contributions: All authors contributed equally to the work.
Correspondence to: Randolph L Schaffer, MD, Scripps Center for Organ and Cell Transplantation, 10666 N. Torrey Pines Rd, MD 200N, La Jolla, CA 92037, United States. schaffer.randolph@scrippshealth.org
Telephone: +1-858-554-2276 Fax: +1-858-554-4311
Received: March 25, 2006
Revised: April 15, 2006
Accepted: April 27, 2006
Published online: September 21, 2006
Abstract

Hepatocellular carcinoma (HCC) recurs with a reported frequency of 12%-18% after liver transplantation. Recurrence is associated with a mortality rate exceeding 75%. Approximately one-third of recurrences develop in the transplanted liver and are therefore amenable to local therapy. A variety of treatment modalities have been reported including resection, transarterial chemo-embolization (TACE), radiofrequency ablation (RFA), ethanol ablation, cryoablation, and external beam irradiation. Goals of treatment are tumor control and the minimization of toxic effect to functional parenchyma. Efficacy of treatment is mitigated by the need for ongoing immunosuppression. Yttrium-90 microspheres have been used as a treatment modality both for primary HCC and for pre-transplant management of HCC with promising results.

Twenty-two months after liver transplantation for hepatitis C cirrhosis complicated by HCC, a 42-year old man developed recurrence of HCC in his transplant allograft. Treatment of multiple right lobe lesions with anatomic resection and adjuvant chemotherapy was unsuccessful. Multifocal recurrence in the remaining liver allograft was treated with hepatic intra-arterial infusion of yttrium-90 microspheres (SIR-Spheres, Sirtex Medical Inc., Lake Forest, IL, USA). Efficacy was demonstrated by tumor necrosis on imaging and a decrease in alpha-fetoprotein (AFP) level. There were no adverse consequences of initial treatment.

Keywords: Recurrent hepatocellular carcinoma; Yttrium-90 microspheres; Liver transplantation