Arterial chemoembolization before liver transplantation in patients with hepatocellular carcinoma: marked tumor necrosis, but no survival benefit?

Oldhafer, Karl J.; Chavan, Ajay; Frühauf, Nils R.; Flemming, P.; Kubicka, Stefan; Nashan, Björn; Weimann, Arved; Raab, R.; Manns, Michael P.; Galanski, Michael

doi:10.1016/s0168-8278(98)80123-2

Cited by 143 publications

(96 citation statements)

References 29 publications

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“…14 Others, however, have debated whether pretransplantation TACE yields any survival benefit. 13 In the most recent series by Maddala et al, pre-OLT TACE in 54 predominantly early-stage cases yielded a reasonable 5-year post-OLT survival of 74%. 15 However, the benefit of TACE could not be inferred given that waiting list dropout and post-OLT recurrence rates were not markedly lower than historical controls.…”

Section: Discussionmentioning

confidence: 94%

“…One series including 15 patients transplanted after RFA showed a 3-year posttransplantation survival rate of 85%, with two (13%) recurrences. 13 Although a useful role of RFA was suggested, the study was limited by a small sample size and no analysis of waiting list dropout from tumor progression, which is a crucial gauge of bridging efficacy. Other published series were even smaller in scale, precluding meaningful analysis of clinical outcomes, or presented only in the context of overall RFA experience without a primary focus on its pretransplant role.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15] Recently in the United States and abroad, however, RFA has emerged as the first-line treatment for small, nonresectable cases of HCC, such as those fulfilling transplant criteria, with TACE filling a secondary role or reserved for more extensive disease. [16][17][18][19][20][21] Therefore, a potentially beneficial role of RFA while awaiting OLT has been widely discussed, [22][23][24][25][26] although it remains unsubstantiated.…”

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confidence: 99%

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Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation

et al. 2005

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation

et al. 2005

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“…The goal of treating HCC while patients are on the LT wait list is to halt disease progression so patients remain within Milan criteria. There is conflicting data regarding whether TACE performed on patients awaiting LT for HCC have reduced HCC recurrence and improved survival [Decaens et al 2005;Graziadei et al 2003;Oldhafer et al 1998;Troisi et al 1998;Venook et al 1995;Spreafico et al 1994]. A prospective trial evaluated the use of TACE in 63 patients awaiting LT for HCC; 48 patients met Milan criteria while 15 exceeded Milan criteria but had a greater than 50% necrosis response to TACE [Graziadei et al 2003].…”

Section: Bridging Therapymentioning

confidence: 99%

Review: Current status of therapy for hepatocellular carcinoma

Corey

Pratt

2009

Therap Adv Gastroenterol

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The incidence of hepatocellular carcinoma (HCC) is increasing worldwide. A multidisciplinary approach is required for its management. Screening high-risk patients allows for earlier diagnosis and the use of potentially curative therapies. Current recommendations for HCC screening for patients with cirrhosis are an abdominal ultrasound and serum alpha fetoprotein level every 6 to 12 months. Treatment choice depends on tumor stage, liver function and the patient's overall functional status. Curative therapies include surgical resection, liver transplantation (LT), transarterial chemoembolization, and radiofrequency ablation (RFA). Surgical resection, either primary resection or LT, is the treatment most likely to result in cure of HCC. Which option to pursue is based on multiple factors. LT has the potential benefit of treating both HCC and the underlying cirrhosis; however, long wait times incur the risk of tumor progression. Firm recommendations regarding the role of living donor LT for HCC are not yet possible because of conflicting data. HCC recurrence after LT is 8-11% and several adjuvant therapies have been investigated to reduce this. Bridging therapy and tumor downsizing are techniques that also may be considered to deal with long waiting periods and qualification for LT, respectively. If neither LT nor primary resection is possible, locoregional therapies such as RFA and TACE should be considered. Systemic chemotherapies have proved disappointing for the treatment of HCC; however, newer targeted therapies such as sorafenib and cetuximab have provided new hope for the future.

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“…Patients undergoing transplantation for HCC are also frequently treated with chemoembolization beforehand in an effort to reduce the chance of intraoperative tumor shedding. Although this has been shown to be feasible, no survival benefit has been reported as no randomized studies have been done [79][80][81][82][83].…”

Section: Hepatocellular Carcinomamentioning

confidence: 99%

Chemoembolization in the Management of Liver Tumors

Stuart

2003

The Oncologist

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The dual vascular supply of the liver affords a unique opportunity to explore intraarterial therapies for hepatic malignancies. Chemoembolization is a well-established technique combining intra-arterial chemotherapy with delivery of embolic agents in order to achieve an antitumor effect due to a high local concentration and prolonged dwell time of the drug, along with select ischemia. Many tumors, such as hepatocellular carcinoma, colorectal cancer, and neuroendocrine tumors, cause symptoms and death by local growth and destruction of the liver.While there are other methods capable of controlling small or isolated hepatic neoplasms, none are suitable for the majority of these patients. Chemoembolization can produce significant results in terms of tumor shrinkage in many of these patients, and there are studies to suggest a survival advantage in hepatocellular carcinoma. Toxicity, however, may be substantial, and patient selection is crucial in order to achieve the optimal benefit of this powerful technique for individual populations. The Oncologist 2003;8:425-437 The Oncologist 2003;8:425-437 www.TheOncologist.com

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Arterial chemoembolization before liver transplantation in patients with hepatocellular carcinoma: marked tumor necrosis, but no survival benefit?

Cited by 143 publications

References 29 publications

Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation

Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation

Review: Current status of therapy for hepatocellular carcinoma

Chemoembolization in the Management of Liver Tumors

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