Bridging Locoregional Therapy Prolongs Survival in Patients Listed for Liver Transplant with Hepatocellular Carcinoma

Xing, Minzhi; Sakaria, Sonali; Dhanasekaran, Renumathy; Parekh, Samir; Spivey, James R.; Knechtle, Stuart J.; Zhang, Di

doi:10.1007/s00270-016-1505-0

Cited by 17 publications

(32 citation statements)

References 32 publications

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“…Recent studies have shown that lack of complete response at initial follow-up after bridge-to-transplant therapy is predictive of drop out [13]. Multiple treatments and lack of complete pathological response after TACE during bridge-to-transplant is also indicative of poor outcomes [14–19]. This growing evidence showing the effect of suboptimal TACE on long-term outcomes post-transplantation elevates the importance of investigating all aspects of the procedure that could impact the effectiveness of TACE in this patient population.…”

Section: Discussionmentioning

confidence: 99%

End-hole Versus Microvalve Infusion Catheters in Patients Undergoing Drug-Eluting Microspheres-TACE for Solitary Hepatocellular Carcinoma Tumors: A Retrospective Analysis

Titano¹,

Fischman²,

Cherian

et al. 2019

Cardiovasc Intervent Radiol

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Introduction Pre-transplant locoregional therapy for hepatocellular carcinoma (HCC) during bridge-to-transplant impacts recurrence and survival rates following liver transplantation. Optimizing the effectiveness of transarterial chemoembolization (TACE) in this population is imperative, and microvalve infusion catheters offer a means of such improvement. Methods All treatment-naive patients with solitary HCC tumors < 6.5 cm who underwent drug-eluting microspheres (DEM) TACE between 04/2015 and 08/2017 were retrospectively reviewed. Eighty-eight included patients underwent DEM-TACE with either standard end-hole catheters (EH) or microvalve infusion catheters (MVI). The EH ( n = 70) and MVI ( n = 18) cohorts had similar baseline tumor size, laboratory values, and tumor etiologies. Results Initial objective response rates were significantly higher in MVI vs. EH (100% vs. 76.5%, p = 0.019). There was no difference in adverse events between groups ( p = 0.265). MVI patients exhibited lower AST ( p = 0.003) and ALT ( p = 0.044) at 6 months. Blinded pathological analysis of explanted livers showed greater concentrations of microspheres within the tumor relative to the surrounding tissue in MVI explants (88.7 ± 10.6%) versus the EH explants (55.3 ± 32.7%) ( p = 0.002). There was significantly higher percentage tumor necrosis in the MVI group (89.0 ± 2.2%) compared with the EH group (56.1 ± 44.5%) ( p = 0.006). Conclusion In this retrospective study of a single-center cohort, DEM-TACE procedures with MVI were associated with improved tumor response, increased deposition of microspheres within tumor tissue, and higher percentage tumor necrosis at explant relative to those performed using EH catheters. Electronic supplementary material The online version of this article (10.1007/s00270-018-2150-6) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

End-hole Versus Microvalve Infusion Catheters in Patients Undergoing Drug-Eluting Microspheres-TACE for Solitary Hepatocellular Carcinoma Tumors: A Retrospective Analysis

Titano¹,

Fischman²,

Cherian

et al. 2019

Cardiovasc Intervent Radiol

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“…An analysis including 205 patients from a transplant center registry who had HCC showed that bridging locoregional therapy was associated with survival after transplant (P5.005). 119 A number of studies have investigated the role of locoregional therapies as a bridge to liver transplantation in patients on a waiting list. 120,121 These studies included radiofrequency ablation (RFA)/microwave ablation (MWA); [122][123][124][125] transarterial embolization (TAE); 126,127 transarterial chemoembolization (TACE), 124,128 including conventional TACE, 124,129,130 and TACE with drug-eluting beads (DEB-TACE); 131 selective internal radiotherapy or radioembolization (TARE) with yttrium-90 (Y-90) microspheres; 132 external beam radiation therapy (EBRT); 133 and TACE followed by EBRT, 134 as "bridge" therapies.…”

Section: Liver Transplantationmentioning

confidence: 99%

Hepatobiliary Cancers, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology

Benson¹,

D’Angelica

Abbott

et al. 2021

Journal of the National Comprehensive Cancer Network

641

416

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The NCCN Guidelines for Hepatobiliary Cancers focus on the screening, diagnosis, staging, treatment, and management of hepatocellular carcinoma (HCC), gallbladder cancer, and cancer of the bile ducts (intrahepatic and extrahepatic cholangiocarcinoma). Due to the multiple modalities that can be used to treat the disease and the complications that can arise from comorbid liver dysfunction, a multidisciplinary evaluation is essential for determining an optimal treatment strategy. A multidisciplinary team should include hepatologists, diagnostic radiologists, interventional radiologists, surgeons, medical oncologists, and pathologists with hepatobiliary cancer expertise. In addition to surgery, transplant, and intra-arterial therapies, there have been great advances in the systemic treatment of HCC. Until recently, sorafenib was the only systemic therapy option for patients with advanced HCC. In 2020, the combination of atezolizumab and bevacizumab became the first regimen to show superior survival to sorafenib, gaining it FDA approval as a new frontline standard regimen for unresectable or metastatic HCC. This article discusses the NCCN Guidelines recommendations for HCC.

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“…Yao et al[7], reported 68% eligibility for LT in the MC group, similarly seen in our study. In a recent study, a dropout rate of 2.58% due to tumor progression was observed in patients who received bridging LRT, while the rate among patients who did not receive LTR was 8.18% ( P = 0.01)[28]. Among downstaging patients, neo-adjuvant success rates regarding eligibility for LT widely vary from 11% to more than 70%[29].…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of hepatocellular carcinoma that underwent chemoembolization for bridging or downstaging

Affonso

Galastri

Motta-Leal-Filho

et al. 2019

WJG

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BACKGROUNDProspective study of 200 patients with hepatocellular carcinoma (HCC) that underwent liver transplant (LT) after drug-eluting beads transarterial chemoembolization (DEB-TACE) for downstaging versus bridging. Overall survival and tumor recurrence rates were calculated, eligibility for LT, time on the waiting list and radiological response were compared. After TACE, only patients within Milan Criteria (MC) were transplanted. More patients underwent LT in bridging group. Five-year post-transplant overall survival, recurrence-free survival has no difference between the groups. Complete response was observed more frequently in bridging group. Patients in DS group can achieve post-transplant survival and HCC recurrence-free probability, at five years, just like patients within MC in patients undergoing DEB-TACE.AIMTo determine long-term outcomes of patients with HCC that underwent LT after DEB-TACE for downstaging vs bridging.METHODSProspective cohort study of 200 patients included from April 2011 through June 2014. Bridging group included patients within MC. Downstaging group (out of MC) was divided in 5 subgroups (G1 to G5). Total tumor diameter was ≤ 8 cm for G1, 2, 3, 4 (n = 42) and was > 8 cm for G5 (n = 22). Downstaging (n = 64) and bridging (n = 136) populations were not significantly different. Overall survival and tumor recurrence rates were calculated by the Kaplan-Meier method. Additionally, eligibility for LT, time on the waiting list until LT and radiological response were compared.RESULTSAfter TACE, only patients within MC were transplanted. More patients underwent LT in bridging group 65.9% (P = 0.001). Downstaging population presented: higher number of nodules 2.81 (P = 0.001); larger total tumor diameter 8.09 (P = 0.001); multifocal HCC 78% (P = 0.001); more post-transplantation recurrence 25% (P = 0.02). Patients with maximal tumor diameter up to 7.05 cm were more likely to receive LT (P = 0.005). Median time on the waiting list was significantly longer in downstaging group 10.6 mo (P = 0.028). Five-year post-transplant overall survival was 73.5% in downstaging and 72.3% bridging groups (P = 0.31), and recurrence-free survival was 62.1% in downstaging and 74.8% bridging groups (P = 0.93). Radiological response: complete response was observed more frequently in bridging group (P = 0.004).CONCLUSIONTumors initially exceeding the MC down-staged after DEB-TACE, can achieve post-transplant survival and HCC recurrence-free probability, at five years, just like patients within MC in patients undergoing DEB-TACE.

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Bridging Locoregional Therapy Prolongs Survival in Patients Listed for Liver Transplant with Hepatocellular Carcinoma

Abstract: Bridging LRT and high wait times were independent positive prognostic factors for survival from HCC diagnosis and OLT.

Cited by 17 publications

References 32 publications

End-hole Versus Microvalve Infusion Catheters in Patients Undergoing Drug-Eluting Microspheres-TACE for Solitary Hepatocellular Carcinoma Tumors: A Retrospective Analysis

End-hole Versus Microvalve Infusion Catheters in Patients Undergoing Drug-Eluting Microspheres-TACE for Solitary Hepatocellular Carcinoma Tumors: A Retrospective Analysis

Hepatobiliary Cancers, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology

Long-term outcomes of hepatocellular carcinoma that underwent chemoembolization for bridging or downstaging

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