Role of interventional oncology in hepatocellular carcinoma: Future best practice beyond current guidelines

Goyal, Piyush; Salem, Riad; Mouli, S.

doi:10.1259/bjr.20220379

Cited by 11 publications

(9 citation statements)

References 113 publications

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“…In this context, a bridging therapy, such as transarterial radioembolization (TARE) before liver transplantation (LT), is applied. The effectiveness of locoregional, neoadjuvant therapies for this purpose has been demonstrated by several studies [ 5 , 6 , 11 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. Studies directly comparing TARE with TACE found a higher disease control rate, significantly better overall and intrahepatic PFS, and better survival outcomes in the patients treated with TARE even with advanced disease [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Transarterial Radioembolization (TARE) in Patients with Hepatocellular Carcinoma: A Comparison of Palliative with Bridging-to-Transplant Concepts

Schönherr,

Seifert,

Gühne

et al. 2024

Cancers

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We investigated transarterial radioembolization (TARE) as a palliative measure and bridging-to-transplant therapy in hepatocellular carcinoma (HCC) patients. A total of 167 patients (50 bridging, 117 palliative) with 245 TARE procedures were assessed. Fourteen patients underwent subsequent liver transplantation (LT). Patients undergoing LT exhibited significantly prolonged progression-free survival (PFS) compared to those with bridging-without-transplant (p = 0.033). No significant differences were observed between patients with bridging-without-transplant and palliative cases (p = 0.116). Median overall survival (OS) post-TARE was 16.6 months, with estimated OS rates at 6/12 months of 82.0%/60.5%, respectively. Patients who underwent LT demonstrated statistically significantly longer OS compared to those with bridging-without-transplant (p = 0.001). No marked outcome distinctions were found between bridging-without-transplant and palliative groups. The findings underscored the superiority of LT over alternative treatments. TARE served as an important component in non-LT scenarios, allowing for subsequent therapeutic options. The study reflected the highly variable and complex situations of patients with HCC, emphasizing the need for further investigations to define an optimal multimodal approach.

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Section: Discussionmentioning

confidence: 99%

Transarterial Radioembolization (TARE) in Patients with Hepatocellular Carcinoma: A Comparison of Palliative with Bridging-to-Transplant Concepts

Schönherr,

Seifert,

Gühne

et al. 2024

Cancers

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“…The BCLC system, which is widely accepted for HCC staging and the treatment selection (16), does not recommend hepatectomy for stage B disease patients. However, several studies have suggested that potentially curative treatments, such as resection, can be safe and effective for stage B disease patients (17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the up-to-7 criterion for determining the treatment of hepatocellular carcinoma in Barcelona Clinic Liver Cancer stage B: a single-center retrospective cohort study

Xiao¹,

Zhang²,

Xie³

et al. 2023

J Gastrointest Oncol

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Background: At present, there are still disputes on the treatment of surgery for patients with stage B hepatocellular carcinoma (HCC). This study sought to investigate whether the up-to-7 criterion could be used to decide the treatment for HCC in Barcelona Clinic Liver Cancer stage B (BCLC-B). Methods:We analyzed 340 patients with HCC in BCLC-B who treated with hepatectomy or transcatheter arterial chemoembolization (TACE). Of the 285 HCC patients who underwent hepatectomy, 108 met the up-to-7 criterion and 177 exceeded it. All 55 patients in the TACE group met the up-to-7 criterion. We obtained the tumor status of the patients through inpatient medical records, outpatient medical records, and telephone follow-up of the hospital. We compared overall survival (OS) and progression-free survival (PFS) were compared between patients who met the up-to-7 criterion and who underwent either hepatectomy or TACE. OS and recurrence time were also compared between the patients who were treated with hepatectomy and who either met or exceeded the up-to-7 criterion. Across BCLC-B patients, we compared the OS of patients after surgical treatment between subgroups stratified by tumor number and diameter.Results: Patients who met the up-to-7 criterion had significantly higher OS rates after hepatectomy than TACE (P<0.001). However, the 2 groups did not differ in terms of PFS (P=0.758). Among the patients treated by hepatectomy, the OS rates were significantly higher in patients who met the up-to-7 criterion than in those who exceeded it (P=0.001). The recurrence rates did not differ between patients who met or exceeded the criterion (P=0.662). OS was significantly higher in patients with ≤3 tumors than those with >3 tumors (P=0.001). When we stratified patients with ≤3 tumors based in whether they met or exceeded the up-to-8 to up-to-15 criterion, OS was significantly better among those who met the criterion in all cases.Conclusions: Hepatectomy appears to be associated with better survival than TACE in patients with BCLC-B HCC who meet the up-to-7 criterion, but this criterion is not a strict indication for deciding whether to treat patients with BCLC-B surgically. Tumor number strongly affects the prognosis of BCLC-B patients after hepatectomy.

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“…In current guidance, priority on the waiting list is made for patients with HCC who are on the waiting list for at least six months and are within the Milan Criteria (i.e., one lesion up to 5 cm or up to 3 lesions ≤ 3 cm with no features of macrovascular invasion or extrahepatic disease) [ 22 ]. Notably, in recent years, a number of centres have adopted criteria beyond the standard Milan criteria, such as those of the University of California, San Francisco (UCSF).…”

Section: Non-ablative Treatment Optionsmentioning

confidence: 99%

The Role of Ablative Techniques in the Management of Hepatocellular Carcinoma: Indications and Outcomes

et al. 2023

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The management of hepatocellular carcinoma (HCC) remains complex and will continue to rely on the multidisciplinary input of hepatologists, surgeons, radiologists, oncologists and radiotherapists. With the appropriate staging of patients and selection of suitable treatments, the outcomes for HCC are improving. Surgical treatments encompassing both liver resection and orthotopic liver transplantation (OLT) are the definitive curative-intent options. However, patient suitability, as well as organ availability, pose essential limitations. Consequently, non-surgical options, such as ablative techniques, play an increasingly important role, especially in small HCCs, where overall and disease-free survival can be comparable to surgical resection. Ablative techniques are globally recommended in recognised classification systems, showing increasingly promising results. Recent technical refinements, as well as the emerging use of robotic assistance, may expand the treatment paradigm to achieve improved oncological results. At present, in very early stage and early stage unresectable disease, percutaneous thermal ablation is considered the treatment of choice. Owing to their different features, various ablative techniques, including radiofrequency ablation, microwave ablation, cryotherapy ablation and irreversible electroporation, have been shown to confer different comparative advantages and applicability. We herein review the role of available ablative techniques in the current complex multidisciplinary management of HCC, with a main focus on the indications and outcomes, and discuss future perspectives.

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Role of interventional oncology in hepatocellular carcinoma: Future best practice beyond current guidelines

Cited by 11 publications

References 113 publications

Transarterial Radioembolization (TARE) in Patients with Hepatocellular Carcinoma: A Comparison of Palliative with Bridging-to-Transplant Concepts

Transarterial Radioembolization (TARE) in Patients with Hepatocellular Carcinoma: A Comparison of Palliative with Bridging-to-Transplant Concepts

Evaluation of the up-to-7 criterion for determining the treatment of hepatocellular carcinoma in Barcelona Clinic Liver Cancer stage B: a single-center retrospective cohort study

The Role of Ablative Techniques in the Management of Hepatocellular Carcinoma: Indications and Outcomes

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