Radioembolization Effects on Liver Function and Tumor Responses in Hepatocellular Carcinoma Patients

Objectives: Transarterial radioembolization with 90Y (TARE) is used as neo-adjuvant therapy for resection, liver transplant down-staging, or frontline therapy for hepatocellular carcinoma (HCC) patients. There are few reports on its use from high-throughput liver transplant or HCC institutions in the developing world.
To evaluate responses of both the liver and tumor to TARE in patients awaiting living donor liver transplant (LDLT).
Methods: HCC patients received TARE, and suitable patients then received LDLT or otherwise continued TARE till disease progression. CAT scans, liver lobe volumes and liver function tests were assessed at baseline and 3 months.
Results: Less than 10% of patients developed decreased blood albumin or platelets, or increase in total bilirubin or ALBI grade at 3 months post TARE. Many patients with abnormal baseline liver values, had an increase in albumin (42.1% patients) and platelets (64.7% patients) or decrease in total bilirubin (71.4% patients) or ALBI grade (51.5% patients) at 3 months post TARE. To explain liver function improvements, lobar liver volumes were assessed and increased in the TARE-untreated, contralateral lobe (median 17.46%) pre-Tx. AFP levels decreased in 81.8% of patients with elevated baseline AFP levels. Survival was longer in the TARE-Tx compared with unrelated TARE-non transplanted patients.
Conclusion: Liver toxicities were low, and many patients had early improvement in liver parameters post TARE.

Keywords: HCC, lobar hypertrophy, liver function, radioembolization