Bridging Locoregional Therapy for Hepatocellular Carcinoma Prior to Liver Transplantation

Heckman, Jason T.; DeVera, Michael; Marsh, J. Wallis; Fontes, Paulo; Amesur, Nikhil B.; Holloway, Shane E.; Nalesnik, Michael A.; Geller, David A.; Steel, Jennifer L.; Gamblin, T. Clark

doi:10.1245/s10434-008-0071-3

Cited by 122 publications

(72 citation statements)

References 40 publications

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“…The median overall survival after the application of Y-90 microsphere has been reported to be around 26 months in early-stage patients (BCLC A) in recent series (20)(21)(22). Thus, it can be used as a bridge for reducing the losses on the patient waiting list of transplantation (23). In a study conducted with Y-90 RE, the median survival was detected as 17.2 months and median progression time as 13.3 months in 83 patients in the intermediate-stage group (BCLC B) (20).…”

Section: Indications and Clinical Resultsmentioning

confidence: 99%

Radioembolization Treatment for Liver Cancer

Erdoğan¹,

Özdemir²,

Aydın³

2016

Bezmialem Science

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Although curative treatment is surgery (resection/transplantation) and for small lesions ablative strategies, in primary liver carcinomas such as hepatocellular carcinoma and cholangiocellular carcinoma, palliative treatment is used for most of these patients because of lack of surgical options. These treatments are regional treatments such as transarterial chemoembolization, radiofrequency ablation, or microwave ablation and systemic treatments such as tyrosine kinase inhibitors. Surgery and chemotherapy are the main treatment options for metastatic liver tumors, particularly in colorectal tumors, although local treatment options are used for these patients. In recent years, transarterial radioembolization with yttrium-90 microsphere has emerged as a local treatment option in primary and metastatic liver tumors. The aim of this treatment is to provide an effective radiation dose distribution for the tumor in the liver tissue and to give the lowest dose in order to not harm the intact liver tissue. Radioembolization has proven to be as effective as other available palliative treatments in primary and secondary liver tumors and is a treatment method that is well tolerated. It has a risk for serious life-threatening complications, although this rate is low. Toxicity can be kept at a minimum with adequate technical and rigorous application in experienced hands and in accordance with multidisciplinarity. It is hoped that the effectiveness of radioembolization is further increased in the future by technological developments, researches on dosimetry, its use along with radiosensitizing agents, and various treatment combinations.Keywords: Radioembolization, Yttrium-90 microsphere, liver treatment IntroductionHepatocellular carcinoma (HCC) is one of the world's most common abdominal malignancies. Most patients have an underlying liver disease. The stage of tumor and the functional capacity of the liver determine the prognosis. A practical staging system based on the tumor burden, the liver function reserve, physical condition, and symptoms associated with cancer was developed by the Barcelona group (Barcelona Clinic Liver Cancer, BCLC). The tumor burden is determined by the number of tumors, size of tumor, portal vein invasion, or presence of extrahepatic metastasis. Here, the functional reserve of the liver is determined according to the Child-Pugh staging system (consists of serum albumin and bilirubin levels, the presence of acid and encephalopathy, prothrombin time/INR findings) and the physical condition is determined according to the performance classification of the Eastern Cooperative Oncology Group (ECOG). This staging system and accordingly, the overall treatment approach are summarized in Table 1 (1, 2).While only 30%-40% of patients are appropriate for curative treatment (resection, transplantation and ablation for small lesions), the vast majority of about 60% is in the middle (B) or advanced (C) stage (2). The general prognosis is poor in these patients with no potential curative treatment. Until n...

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Section: Indications and Clinical Resultsmentioning

confidence: 99%

Radioembolization Treatment for Liver Cancer

Erdoğan¹,

Özdemir²,

Aydın³

2016

Bezmialem Science

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“…Introduction of measure criteria -such as the Milan or UCSF-expanded criteria -and the proper recipient selection have led to satisfying survival, but it is necessary to achieve better results. Th e role of interventional radiological methods, such as chemoembolisation and radiofrequency ablation in bridging and down-staging modalities is prominent [11,12].…”

Section: Discussionmentioning

confidence: 99%

The Role of Liver Transplantation in the Treatment of Hepatocellular Carcinoma – a Single Center Experience from Budapest

Piros

Görög

Fehérvári

et al. 2013

Acta Medica Marisiensis

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Background: Liver transplantation for hepatic tumours is known as a proven treatment opportunity. The outcome has improved over the past decades because of the appropriate recipient selection. Materials and methods:In a single-institution study of 29 consecutive adult patients underwent orthotopic liver transplantation (OLT) between 1 January 2004 and 1 January 2011 in the Semmelweis University, Budapest with the indication of hepatocellular carcinoma (HCC). Results: The 1-year survival was 85.7% and the 3-year survival was 71.7%. Conclusions: Further investigations are needed on the fi eld of histological and biological attributes of the hepatocellular carcinoma. Our aim is to fi nd a better and individualized immunosuppressive protocol, which is also protective against malignant tumours.

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“…The observed disease free survival was better in treated patients, but the cumulative survival was not significantly different [40]. Heckmann et al compared the outcomes of 50 HCC patients treated with a bridge therapy with 73 HCC patients not treated before LT; they found no significant trend towards the improvement of 5-year survival in treated patients (81% vs. 71%) [41]. Finally, the study by Porrett et al, comparing 30 treated to 33 untreated patients before transplant, failed to show any survival difference between the groups.…”

Section: Impact On Post-lt Survival Of Hcc Bridge Treatmentsmentioning

confidence: 99%

Bridge Treatments for HCC in the Waiting List for Liver Transplantation

Pompili¹,

Abbate²,

Nicolardi³

et al. 2011

TOTRANSJ

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During the past years, several therapeutic procedures have been proposed as bridging treatments in patients with hepatocellular carcinoma waiting for liver transplantation. Resective surgery, transarterial chemoembolization, radiofrequency thermal ablation and percutaneous ethanol injection are the most experienced, with the aim to decrease the rate of drop-out from LT waiting list, and the risk of HCC recurrence after transplant. Indeed, for patients within the Milan criteria, a time on waiting list exceeding 6-12 months is a known risk factor of tumor progression and drop out. For this reason, the application of bridging treatments in these patients might be reasonable and several studies in recent years have documented their usefulness to control tumor progression before the transplant. However, the favourable impact of these treatments on post-transplant patients' survival is still under investigation and the available studies provide controversial results. Bridging therapies have also been used for the downstaging of tumors exceeding the conventional "Milan criteria". Some recent data regarding multimodal sequential therapies seem to report promising results in terms of overall and disease-free survival of treated patients attaining effective downstaging before transplant.

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Bridging Locoregional Therapy for Hepatocellular Carcinoma Prior to Liver Transplantation

Cited by 122 publications

References 40 publications

Radioembolization Treatment for Liver Cancer

Radioembolization Treatment for Liver Cancer

The Role of Liver Transplantation in the Treatment of Hepatocellular Carcinoma – a Single Center Experience from Budapest

Bridge Treatments for HCC in the Waiting List for Liver Transplantation

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