Y90 Radioembolization as a Bridge to Liver Transplantation in Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

Background

Hepatocellular carcinoma, or HCC, is the most common primary liver cancer. When HCC grows into the portal vein and forms tumoral portal vein thrombosis, or PVTT, treatment becomes much more difficult. The portal vein carries blood from the intestines to the liver, so invasion of this vessel usually signals advanced disease, worse liver function, and a higher risk of spread. Because of this, PVTT has traditionally been considered a contraindication to liver transplantation in many transplant programs.

However, there is growing interest in using locoregional treatments to control the tumor, especially in carefully selected patients. Transarterial radioembolization, also called TARE or Y90 radioembolization, delivers radioactive microspheres directly into the arteries feeding the tumor. This approach can shrink liver tumors and, in some cases, cause regression of PVTT. If the disease remains controlled for long enough and the tumor burden falls within transplant criteria, some patients may become eligible for liver transplantation. This process is called downstaging.