Conversion Therapy of Large Unresectable Hepatocellular Carcinoma With Ipsilateral Portal Vein Tumor Thrombus Using Portal Vein Embolization Plus Transcatheter Arterial Chemoembolization

He, Chengjian; Ge, Naijian; Wang, Xiangdong; Li, Hai; Chen, Shiguang; Yang, Yue

doi:10.3389/fonc.2022.923566

Cited by 2 publications

(2 citation statements)

References 33 publications

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“… 16 Additionally, the integration of local or systemic therapy targeting the tumor, if liver function permits, during PVE or ALPPS transformation therapy can further increase the success rate of conversion. 18 It is also crucial to provide supportive treatment and complications management for CNLC stage II patients awaiting surgery to prevent the failure of conversion therapy due to perioperative complications.…”

Section: Selecting the Appropriate Conversion Strategymentioning

confidence: 99%

Improving the Conversion Success Rate of Hepatocellular Carcinoma: Focus on the Use of Combination Therapy with a High Objective Response Rate

Chen,

Chen

et al. 2024

J Clin Transl Hepatol

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The high mortality rate in hepatocellular carcinoma (HCC) is partially due to the fact that a significant number of patients are diagnosed at an intermediate or advanced stage, with surgical treatment options unavailable. Conversion therapy, which involves both locoregional and systemic treatments, has the potential to downstage tumors in selected patients with initially unresectable HCC, thereby making surgical treatment a possibility and potentially increasing long-term survival. To optimize the conversion rate, it is necessary to maximize successful conversions and clearly define the target population for conversion treatment through a collaborative effort. In this review article, we summarize the clinical experience and evidence for conversion therapy in patients with ‘potentially resectable’ HCC from four perspectives: 1) defining the target population for conversion therapy, 2) selecting the appropriate conversion strategy, placing emphasis on the utilization of combination therapy that exhibits a significant objective response rate, 3) determining the timing and urgency of surgical resection, 4) promoting the adoption of a multidisciplinary team model. The authors are optimistic that with the continuous progress in treatment and a deeper understanding of HCC, the success rate of HCC conversion therapy will increase, and the overall survival of HCC patients will be prolonged.

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Section: Selecting the Appropriate Conversion Strategymentioning

confidence: 99%

Improving the Conversion Success Rate of Hepatocellular Carcinoma: Focus on the Use of Combination Therapy with a High Objective Response Rate

Chen,

Chen

et al. 2024

J Clin Transl Hepatol

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“…Patients with HCC who undergo TARE conversion therapy have a median OS time of up to 54 months (46). Locoregional combination therapies, such as HAIC (FOLFOX: folinic acid, fluorouracil, and oxaliplatin) plus TACE (13), portal vein embolization (PVE) plus TACE (7), TACE plus external beam radiotherapy (EBRT) (8), RT plus HAIC (fluorouracil) (37), and TACE plus RT (40), are mainly performed in Asia and have a conversion rate ranging from 11.1% to 57.6%. A trial of RT plus HAIC (fluorouracil) revealed that the group receiving a radiation dose ≥ 72 Gy had a higher conversion rate in advanced BCLC-C HCC compared to the intensity-modulated radiotherapy (IMRT) radiation dose < 72 Gy group (20% vs. 12%, p = 0.03) (37).…”

Section: Locoregional Therapymentioning

confidence: 99%

Conversion therapy for initially unresectable hepatocellular carcinoma: Current status and prospects

Ma,

Jiang,

Liu

et al. 2023

BST

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Research has shown that locoregional and/or systemic treatments can reduce the tumor stage, enabling radical surgical resection in patients with initially unresectable hepatocellular carcinoma. This is referred to as conversion therapy. Patients who undergo conversion therapy followed by curative surgery experience a significant survival benefit compared to those who receive chemotherapy alone, those who are successfully downstaged with conversion therapy but not treated with surgery, or those who are treated with upfront surgery. Several treatments have been studied as conversion therapy. However, the success rate of conversion varies greatly, ranging from 0.8% to 60%. Combined locoregional plus systemic conversion therapy has demonstrated significant clinical advantages, with a conversion rate of up to 60%, an objective remission rate of 96% for patients, and a disease control rate of up to 100%. However, patients who underwent conversion therapy experienced significantly more complications than those who underwent direct LR without conversion therapy. Conversion therapy can cause hepatotoxicity, bone marrow suppression, local adhesions, increased fragility of blood vessels and liver tissues, and hepatic edema, which can increase the difficulty of surgery. In addition, criteria need to be established to evaluate the efficacy of conversion therapy and subsequent treatment. Further clinical evidence in this area is urgently needed.

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Conversion Therapy of Large Unresectable Hepatocellular Carcinoma With Ipsilateral Portal Vein Tumor Thrombus Using Portal Vein Embolization Plus Transcatheter Arterial Chemoembolization

Cited by 2 publications

References 33 publications

Improving the Conversion Success Rate of Hepatocellular Carcinoma: Focus on the Use of Combination Therapy with a High Objective Response Rate

Improving the Conversion Success Rate of Hepatocellular Carcinoma: Focus on the Use of Combination Therapy with a High Objective Response Rate

Conversion therapy for initially unresectable hepatocellular carcinoma: Current status and prospects

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