Systematic review: the role of liver transplantation in the management of hepatocellular carcinoma

Maggs, James; Suddle, Abid; Aluvihare, Varuna; Heneghan, Michael A.

doi:10.1111/j.1365-2036.2012.05072.x

Cited by 38 publications

(37 citation statements)

References 128 publications

(253 reference statements)

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“…LT is a treatment for HCC, which was first performed in the late 80s and early 90s (45). Early studies indicated a poor outcome with regards to survival rates and high tumor recurrence (46,47).…”

Section: Periodontitis and Liver Diseasesmentioning

confidence: 99%

Interaction between periodontitis and liver diseases

2016

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Section: Periodontitis and Liver Diseasesmentioning

confidence: 99%

Interaction between periodontitis and liver diseases

2016

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“…This concept of prophylactic LT for high-risk recurrent HCC before the development of recurrence is also called “de principe LT”[13]. Recently, some authors suggested the use of the histopathological features of the specimen of the resected tumor as the selection tool for LT to improve the outcome of cases with high recurrence rate after LR[13-16]. However, most of these histopathological features are also prognostic factors of post-transplant HCC recurrence.…”

Section: Introductionmentioning

confidence: 99%

Prophylactic liver transplantation for high-risk recurrent hepatocellular carcinoma

Yang¹,

Ho²,

Hu³

et al. 2016

WJH

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Hepatocellular carcinoma (HCC) is the second most common cause of cancer-related death in the world. Radical treatment of HCC in early stages results in a long disease-free period and improved overall survival. The choice of optimal management strategy for HCC mainly depends on the severity of the underlying liver disease. For patients with decompensated liver cirrhosis and HCC within Milan criteria (MC), liver transplant (LT) is the choice of treatment. However, for patients with good residual liver reserve and HCC within MC, selection of other curative treatments such as liver resection (LR) or radiofrequency ablation may be a reasonable alternative. For patients without cirrhosis, LR can result in an overall survival similar to that provided by LT. Therefore, it is an accepted alternative to LT especially in areas with organ shortage. However, the cumulative 5-year recurrence rate of HCC post LR might be as high as 70%. For initial transplant-eligible (within MC) patients with recurrent HCC post LR, salvage liver transplant (SLT) was first proposed in 2000. However, most patients with recurrent HCC considered for SLT are untransplantable cases due to HCC recurrence beyond MC or comorbidity. Thus, the strategy of opting for SLT results in the loss of the opportunity of LT for these patients. Some authors proposed the concept of “de principe liver transplant” (i.e., prophylactic LT before HCC recurrence) to prevent losing the chance of LT for these potential candidates. Factors associated with the failure of SLT will be dissected and discussed in three parts: Patient, tumor, and underlying liver disease. Regarding patient-related factors, the rate of transplantability depends on patient compliance. Patients without regular follow-up tend to develop HCC recurrence beyond MC at the time of tumor detection. Advancing age is another factor related to severe comorbidities when LT is considered for HCC recurrence, and these elderly candidates become ineligible as time goes by. Regarding tumor-related factors, histopathological features of the resected specimen are used mostly for determining the prognosis of early HCC recurrences. Such prognostic factors include the presence of microvascular invasion, poor tumor differentiation, the presence of microsatellites, the presence of multiple tumors, and the presence of the gene-expressing signature associated with aggressive HCC. These prognostic factors might be used as a selection tool for SLT or prophylactic LT, while remaining mindful of the fact that most of them are also prognostic factors for post-transplant HCC recurrence. Regarding underlying liver disease-related factors, progression of chronic viral hepatitis and high viral load may contribute to the development of late (de novo) HCC recurrence as a consequence of sustained inflammatory reaction. However, correlation between the severity of liver fibrosis and tumor recurrence is still controversial. Some prognostic scoring systems that integrate these three factors have been proposed to predict recurrence pattern...

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“…Bridging therapy is thus needed to halt tumor progression and minimize wait list dropout [8,9]. Some patients with advanced HCC could benefit from OLT after downstaging the tumor with neoadjuvant treatment [10,11].…”

Section: Introductionmentioning

confidence: 99%

Radiation therapy for primary and metastatic tumors of the liver

et al. 2012

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Background Hepatic tumors can be either primary disease (i.e., hepatocellular carcinoma) or a site of metastases from other solid malignancies. The primary therapy for all liver tumors is resection, but only a minority of patients present with resectable disease. Various nonsurgical ablative techniques have been investigated to cure or palliate unresectable hepatic tumors by improving locoregional control. Purpose The objective of this article is to review the radiotherapy options in managing primary or metastatic liver cancer. Design and methods Two emerging radical radiotherapy options include stereotactic body radiation therapy (SBRT) and selective internal radiotherapy (SIRT). SBRT delivers ablative doses of radiation in a hypofractionated course and has been used in metastatic disease to the brain, spine, lung, and liver. The local tumor control for SBRT appears to exceed that of conventional fractionation external beam radiotherapy (EBRT). SIRT, also known as radioembolization, is the intraarterial delivery of microspheres impregnated with yttrium-90 (Y90) via the hepatic artery. The evidence is limited to cohort and comparative studies with historical controls; nonetheless, results appear to be promising. Both SBRT and SIRT to liver tumors may serve as a bridge to liver transplantation (LT) and as a treatment strategy for metastasis from colorectal cancer to achieve the effect of metastasectomy. Meanwhile, combining molecular-targeted agents with radiotherapy is an emerging strategy to enhance the therapeutic ratio. Conclusion SBRT and/or SIRT are promising local ablative modalities for management of unresectable liver tumors. Further well-designed trials are warranted to establish the proper combination of different therapeutic modalities.

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Systematic review: the role of liver transplantation in the management of hepatocellular carcinoma

Abstract: SUMMARY BackgroundHepatocellular carcinoma (HCC) is a major cause of morbidity and mortality worldwide. Liver transplantation offers a potential cure for this otherwise devastating disease. The selection of the most appropriate candidates is paramount in an era of graft shortage.

Cited by 38 publications

References 128 publications

Interaction between periodontitis and liver diseases

Interaction between periodontitis and liver diseases

Prophylactic liver transplantation for high-risk recurrent hepatocellular carcinoma

Radiation therapy for primary and metastatic tumors of the liver

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