Transarterial Chemoembolization Prior to Liver Transplantation in Patients with Hepatocellular Carcinoma

Hołówko, Wacław; Wróblewski, Tadeusz; Wojtaszek, Mikołaj; Grąt, Michał; Kobryń, Konrad; Ziarkiewicz‐Wróblewska, Bogna; Krawczyk, Marek

doi:10.12659/aot.896778

Cited by 19 publications

(17 citation statements)

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“…Hołówko et al present outcomes for patients reported to be beyond T2 treated with LRT, compared with those within T2 who were not treated with LRT, noting no difference in 5‐year OS. The third comparative study was from Asia and consisted predominately of living donor liver transplantations, with down‐staging consisting mostly of TACE .…”

Section: Methods Of Guideline Developmentmentioning

confidence: 99%

AASLD guidelines for the treatment of hepatocellular carcinoma

et al. 2017

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Section: Methods Of Guideline Developmentmentioning

confidence: 99%

AASLD guidelines for the treatment of hepatocellular carcinoma

et al. 2017

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“…Of these treatments, TACE and RFA have been the most studied BTs, but newer therapies such as SIRT and SBRT are also being used (8)(9)(10). Five-year survival of patients after TACE prior to transplantation ranged from 51% to 93% (11)(12)(13).…”

Section: Discussionmentioning

confidence: 99%

Bridging therapy effectiveness in the treatment of hepatocellular carcinoma prior to orthotopic liver transplantation

Rubinstein

Kaubisch

Kinkhabwala

et al. 2017

J. Gastrointest. Oncol.

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Background: Orthotopic liver transplantation (OLT) is the most effective treatment for hepatocellular carcinoma (HCC) in patients with underlying cirrhosis and portal hypertension. Availability of OLT is limited by donor-organ shortages, which increase patient waiting time until OLT. A variety of bridging therapies (BT) have been used to halt tumor progression in patients on the OLT waiting list. Despite complete radiologic responses following BT, viable tumor is often present in explants.Methods: Treatment outcomes were evaluated in 50 patients who had a total of 125 BT for treatment of 93 nodules. Success of BT was assessed by radiologic response compared to histopathological examination of explanted livers.Results: Pre-transplant treatments included: transcatheter arterial chemoembolization (TACE), alcohol ablation (ETOH), radiofrequency ablation (RFA), microwave ablation (MWA), selective internal radiation therapy (SIRT) and stereotactic body radiation therapy (SBRT). Fifty-nine (64%) nodules had a complete radiographic response to therapy; however, only 28 nodules (30%) had complete tumor necrosis (CTN) on explant examination. Ten nodules with CTN were treated with TACE alone. Seven of the 28 nodules with CTN were treated with TACE and RFA. Three of seven nodules treated with TACE and SIRT had CTN.Patients underwent a mean of 2.5 BTs. Six of 50 patients (12%) had no residual HCC in their explants. Five of those six patients (83%) had complete response (CR) on pre-transplant imaging.Conclusions: Although favorable radiologic responses are seen following BT, viable HCC is seen in the majority of liver explants and radiographic imaging cannot always accurately predict pathological response.This underscores the need for aggressive treatment of patients who otherwise may not be eligible for OLT. HCCs that meet Milan criteria (single lesion ≤5 cm or up to three lesions each ≤3 cm) (5). Since the Milan criteria began to be used to determine eligibility of patients with HCC for OLT, the 5-year survival rate after surgery has increased to 70-80% (6,7). Although OLT may be a successful treatment for patients with cirrhosis and HCC, there are many considerable challenges to transplantation. By far one of the biggest challenges to OLT for patients with HCC is the shortage of donor organs and prolonged waiting times until transplantation. While patients await transplantation, a variety of bridging therapies (BTs) have been used in an effort to maintain disease control including; radiofrequency ablation (RFA), transcatheter arterial chemoembolization (TACE), microwave ablation (MWA), selective internal radiation therapy (SIRT) and stereotactic body radiation therapy (SBRT) varies. The goal of this study was to assess the pathologic response on explant analysis for patients who undergo BT prior to OLT. MethodsWe retrospectively reviewed the clinical data in all 69 patients who underwent OLT for HCC between April, 2009 and December, 2014 at Montefiore Medical Center, Bronx, NY. During this period, 50 patients underwent a...

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“…However, the majority of cases of HCC are diagnosed at a late stage, resulting in the majority of patients unable to receive surgical resection (11). TACE has been used for the treatment of HCC, and achieves its therapeutic effect by utilizing lipiodol for the embolization of the major arterial supply to the liver tumor, (12).…”

Section: Discussionmentioning

confidence: 99%

Chest wall hernia induced by high intensity focused ultrasound treatment of unresectable massive hepatocellular carcinoma: A case report

Chen

Teng

Chen³

2016

Oncology Letters

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Abstract. In the present study, a case of unresectable massive hepatocellular carcinoma (HCC) treated with high intensity focused ultrasound (HIFU) alone is reported. Although the treatment induced chest wall hernia, its efficacy in treating the HCC was demonstrated. The medical records of a patient with an unresectable massive tumor that was effectively treated with serial HIFU ablation were retrospectively studied. Chest wall hernia was detected as a complication of the HIFU treatment, which has not been reported thus far in the literature. The patient has survived for 44 months since the first diagnosis in September 2010. Treatment resulted in partial remission of the tumor, pain relief, decreased levels of alpha-fetoprotein and chest wall hernia, as a complication. Therefore, HIFU may be an effective approach for the treatment of unresectable HCC, although it may occasionally cause complications.

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Transarterial Chemoembolization Prior to Liver Transplantation in Patients with Hepatocellular Carcinoma

Cited by 19 publications

References 0 publications

AASLD guidelines for the treatment of hepatocellular carcinoma

AASLD guidelines for the treatment of hepatocellular carcinoma

Bridging therapy effectiveness in the treatment of hepatocellular carcinoma prior to orthotopic liver transplantation

Chest wall hernia induced by high intensity focused ultrasound treatment of unresectable massive hepatocellular carcinoma: A case report

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