Is the treatment of hepatocellular carcinoma on the waiting list necessary?

Majno, Pietro; Lencioni, Riccardo; Mornex, F.; Girard, Nicolas; Poon, Ronnie Tung Ping; Cherqui, Daniel

doi:10.1002/lt.22391

Cited by 68 publications

(40 citation statements)

References 48 publications

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“…[1][2][3][4] Improved quality of life and reduced pain after the initiation of chemoembolization have been reported for patients undergoing sequential TACE. 2 Current indications for TACE include the following: a first-line treatment for unresectable, intermediate-stage HCC; a bridging measure for managing disease progression in patients awaiting liver transplantation 5 ; and a method for down-staging or qualifying patients for liver transplantation or liver resection through the reduction of the disease burden. 6,7 The patient population with intermediate HCC remains heterogeneous with varying degrees of hepatic dysfunction; as such, identifying patients who will benefit most from TACE or for whom the risks of irreversible hepatic dysfunction outweigh the potential benefits of TACE is crucial.…”

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confidence: 99%

Morbidity and mortality following transarterial liver chemoembolization in patients with hepatocellular carcinoma and synthetic hepatic dysfunction

et al. 2012

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The purpose of this study was to determine the rate and risk factors for the development of irreversible hepatotoxicity after transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) and synthetic hepatic dysfunction. Two hundred fifty-one consecutive patients with HCC and hepatic dysfunction who underwent 443 TACE procedures from 2005 to 2010 were retrospectively reviewed. The included patients met one of the following criteria: a pre-TACE bilirubin level 2 mg/dL, an international normalized ratio (INR) > 1.5, a creatinine level > 1.2 mg/dL, a platelet count 60,000/ mL, a Model for End-Stage Liver Disease (MELD) score > 15, Child-Turcotte-Pugh class B or C, ascites, or portal vein thrombosis. Hepatotoxicity was defined as new or worsening ascites, encephalopathy, or grade 3 or 4 toxicity (bilirubin, aspartate aminotransferase, alanine aminotransferase, creatinine, or INR) according to the National Cancer Institute Common Terminology Criteria for Adverse Events. The rate and risk factors for death or urgent liver transplantation within 6 weeks of TACE and irreversible hepatotoxicity were determined with a generalized estimating equation analysis. Reversible hepatotoxicity developed after 90 procedures (20%) in 78 patients (31%). Irreversible hepatotoxicity developed after 41 procedures (9%) in 37 patients (15%). Six patients (2%) underwent urgent liver transplantation, and 11 (4%) died within 6 weeks of TACE. Patients at increased risk for procedure-related mortality or urgent liver transplantation within 6 weeks of TACE had a baseline serum bilirubin level 4.0 mg/dL (P ¼ 0.01), an elevated INR (P < 0.001), hypoalbuminemia with an albumin level < 2.0 g/L (P ¼ 0.01), a serum creatinine level > 2.0 mg/dL (P ¼ 0.02), large ascites (P ¼ 0.002), encephalopathy (P ¼ 0.005), or a MELD score 20 (P < 0.001). In conclusion, TACE can be performed safely in patients with baseline hepatic dysfunction. However, a poor hepatic reserve increases the risk of irreversible hepatotoxicity, which may lead to death or the need for urgent liver transplantation. Transarterial chemoembolization (TACE) is a standard treatment option for patients with unresectable, intermediate-stage hepatocellular carcinoma (HCC) without significant hepatic synthetic dysfunction.1 TACE produces an objective tumor response rate of 35% to 40% and confers a significant survival advantage in

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confidence: 99%

Morbidity and mortality following transarterial liver chemoembolization in patients with hepatocellular carcinoma and synthetic hepatic dysfunction

et al. 2012

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“…The rapidly evolving loco-regional therapies have served well HCC patients by; (i) down staging the tumor to acceptable, within criteria, size and number, (ii) disease control, while the patient is awaiting deceased donor OLT, so called "bridging therapy" i.e. bridge to transplantation and (iii) and improving post OLT survival with particular reference to tumor recurrence [35,36]. Treatment has to be "tailored" for each patient according to their Child-Pugh score, tumor burden and location and available expertise and resources.…”

Section: The Concept Of Down Staging and Bridging Therapymentioning

confidence: 99%

“…Treatment has to be "tailored" for each patient according to their Child-Pugh score, tumor burden and location and available expertise and resources. T2 patients who are predicted to wait more than six months on the list benefit from tumor therapy [35].Loco regional therapies include percutaneous alcohol injection (PEI), thermal ablation such as radio frequency ablation (RFA) and microwave, chemotherapy delivered directly to the tumor tissue i.e. transarterial chemoembolization (TACE), radiotherapy delivered in various ways such as transarterial Yttrium-90, three dimentional conformal radiotherapy and proton beam radiotherapy.…”

Section: The Concept Of Down Staging and Bridging Therapymentioning

confidence: 99%

Liver Transplantation for Hepatocellular Carcinoma

Asham¹,

Mansour²,

Ghobrial³

2013

Hepatocellular Carcinoma - Future Outlook

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“…However, for T2 lesions approaching 5 cm where waiting time exceeds 6 months, LRT should be used to reduce dropout rates [104].…”

Section: How Should Patients With Hcc On Lt Waiting List Be Managed?mentioning

confidence: 99%

Liver Transplantation for HCC: A Review

Kakodkar¹,

Soin²

2011

Indian J Surg

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Hepatocellular carcinoma (HCC) often occurs in patients with chronic liver disease or cirrhosis. Liver transplantation for hepatocellular carcinoma has the potential to eliminate both the tumor as well as the underlying cirrhosis and is the ideal treatment for HCC in cirrhotic liver as well as massive HCC in noncirrhotic liver. Limitations in organ availability, necessitate stringent selection of patients who would likely to derive most benefit. Selection criteria have considered tumor size, number, volume as well as biological features. The Milan criteria set the benchmark for tumors that would benefit from liver transplantation but were found to be excessively restrictive. Modest expansion in criteria has also been shown to be associated with equivalent survival. Microvascular invasion is the single most important adverse prognostic factor for survival. Living donor liver transplantation has expanded donor options and has the advantage of lower waiting period and not impacting the non-HCC waiting list. Acceptable outcomes have been obtained with living donor liver transplantation for larger and more numerous tumors in the absence of microvascular invasion. Downstaging of tumors to prevent progression while waiting for an organ or for reduction in size to allow enrolment for transplantation has met with variable success.

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Is the treatment of hepatocellular carcinoma on the waiting list necessary?

Cited by 68 publications

References 48 publications

Morbidity and mortality following transarterial liver chemoembolization in patients with hepatocellular carcinoma and synthetic hepatic dysfunction

Morbidity and mortality following transarterial liver chemoembolization in patients with hepatocellular carcinoma and synthetic hepatic dysfunction

Liver Transplantation for Hepatocellular Carcinoma

Liver Transplantation for HCC: A Review

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