Multimodality Treatment with Conventional Transcatheter Arterial Chemoembolization and Radiofrequency Ablation for Unresectable Hepatocellular Carcinoma

Ashoori, Nima; Paprottka, Philipp; Trumm, C.; Bamberg, Fabian; Kolligs, Frank T.; Rentsch, Markus; Reiser, Maximilian; Jakobs, Tobias

doi:10.1159/000334714

Cited by 7 publications

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“…They demonstrated no sufficient evidence of benefits when TACE is used before transplantation. Experiences with combined therapies such as TACE followed by RFA [24,25,38,39] resulted in a higher local tumor control rate due to the higher rates of complete tumor necrosis. This is also in line with our results of the histopathological evaluation of the HCC nodules of liver explants.…”

Section: Discussionmentioning

confidence: 99%

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Multimodality Treatment for Early-Stage Hepatocellular Carcinoma: A Bridging Therapy for Liver Transplantation

Ashoori¹,

Bamberg²,

Paprottka³

et al. 2012

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Purpose: To evaluate the efficiency of a multimodality approach consisting of transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) as bridging therapy for patients with hepatocellular carcinoma (HCC) awaiting orthotopic liver transplantation (OLT) and to evaluate the histopathological response in explant specimens. Materials and Methods: Between April 2001 and November 2011, 36 patients with 50 HCC nodules (1.4–5.0 cm, median 2.8 cm) on the waiting list for liver transplantation were treated by TACE and RFA. The drop-out rate during the follow-up period was recorded. The local efficacy was evaluated by histopathological examination of the explanted livers. Results: During a median follow-up time of 29 (4.0–95.3) months the cumulative drop-out rate for the patients on the waiting list was 0, 2.8, 5.5, 11.0, 13.9 and 16.7% at 3, 6, 12, 24, 36 and 48 months, respectively. 16 patients (with 26 HCC lesions) out of 36 (44.4%) were transplanted by the end of study with a median waiting list time of 13.7 (2.5–37.8) months. The histopathological examination of the explanted specimens revealed a complete necrosis in 20 of 26 HCCs (76.9%), whereas 6 (23.1%) nodules showed viable residual tumor tissue. All transplanted patients are alive at a median time of 29.9 months. Imaging correlation showed 100% specificity and 66.7% sensitivity for the depiction of residual or recurrent tumor. Conclusion: We conclude that TACE combined with RFA could provide an effective treatment to decrease the drop-out rate from the OLT waiting list for HCC patients. Furthermore, this combination therapy results in high rates of complete tumor necrosis as evaluated in the histopathological analysis of the explanted livers. Further randomized trials are needed to demonstrate if there is a benefit in comparison with a single-treatment approach.

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Section: Discussionmentioning

confidence: 99%

“…A more detailed description of the RFA procedures at our institution is depicted elsewhere [25]. After multiphase contrast-enhanced computed tomography (CT) was performed, the optimal electrode pathway to the HCC lesion was determined.…”

Section: Methodsmentioning

confidence: 99%