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Background: The treatment of malignancies confined to the liver (hepatocellular carcinoma [HCC], intrahepatic cholangiocarcinoma [ICC], metastatic neuroendocrine tumors [NET] and colorectal hepatic metastases [CRHM]) is challenging. Liver resection leading to post-operative liver failure is a devastating complication that can be mitigated by pre-resection embolization techniques to increase the future liver remnant, such as portal vein embolization (PVE) and transarterial radioembolization (TARE). The purpose of this study was to understand the natural history of this treatment algorithm in disparate patient populations. Methods: This was a retrospective case-control study from 2008 to 2018. The population consisted of non-transplant eligible patients that had various malignancies without extra-hepatic disease who underwent TARE, PVE, or resection at our institution; they were propensity matched based on co-morbidities, etiology of liver disease, Child-Pugh Score, and ECOG performance status. Statistical analyses were performed with chi-square. Results: We identified 196 patients with an average age of 57.8±12.6 years and 119 patients were male (60.7%). There were 137 Caucasian patients (CC, 70%) and 59 African American patients (AA, 30%). The tumor histologies were 61 HCC, 31 ICC, 65 CRHM, 12 NET, and 28 other. 148 of these patients underwent liver resection. HCC patients were more likely to undergo TARE (36.4%) compared to ICC (20%), CRHM (23.6%), or NET (9.1%, P= 0.043). While AA patients were more likely to undergo any embolization procedure compared to CC patients (47% vs 31%, P=0.03), they were less likely to undergo PVE (P=0.018). 126 patients (64%) did not undergo any pre-resection embolization procedures. Of patients requiring pre-resection embolization, CRHM patients were more likely to undergo PVE (80%) than other patients (P=0.029). TARE was a bridge to resection for 9 patients. Conclusions: AA patients underwent more embolization procedures compared to CC patients. It is not clear whether this was because that population required more interventions to optimize FLR or had limited access to care. Citation Format: Julia Pedo Freitas, Pradeep Podila, Daniel K. Powell, Wes Angel, Jeremiah L. Deneve, Paxton V. Dickson, Evan S. Glazer. TARE and PVE as pre-operative strategies in highly selected patients with primary and metastatic hepatic malignancies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 498.

Introduction The treatment of hepatic malignancies (hepatocellular carcinoma [HCC], intrahepatic cholangiocarcinoma [ICC], metastatic neuroendocrine tumors [NET] and colorectal hepatic metastases [CRHM]) is challenging. Post-operative liver failure can be mitigated by pre-resection embolization techniques, such as portal vein embolization (PVE) and transarterial radioembolization (TARE). The purpose of this study was to understand the natural history of this treatment algorithm in disparate patient populations. Methods This was a retrospective case-control study from 2008-2018. Population consisted of non-transplant eligible patients who underwent TARE, PVE, or resection; patients were propensity matched based on co-morbidities, diagnosis, Child-Pugh Score, and ECOG score. Analyses were performed with chi-square. Results We identified 196 patients with an average age of 57.8±12.6 years, 119 of which were male (60.7%). 137 patients were Caucasian (CC, 70%) and 59 were African American (AA, 30%). HCC patients were more likely to undergo TARE (36.4%) than all other patients (P= 0.043). AA patients were more likely to undergo any embolization procedure (47% vs 31%, P=0.03), but less likely to undergo PVE (P=0.018). CRHM patients were more likely to undergo pre-resection PVE (80%, P=0.029). TARE was a bridge to resection for 9 patients. Conclusions In select cases, TARE is an option to bridge patients to resection. AA patients underwent more embolization procedures than CC patients.