Bridging locoregional therapy: Longitudinal trends and outcomes in patients with hepatocellular carcinoma

Oligane, Hayley C.; Close, Orrie; Xing, Minzhi

doi:10.1016/j.trre.2017.01.004

Cited by 11 publications

(8 citation statements)

References 101 publications

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“…( 4 ) Over the last decade, there has been a rise in the use of LRT before LT, with transarterial chemoembolization (TACE) remaining the most commonly used bridging/downstaging modality. ( 18 ) Despite this, Y90 experience continues to grow, with our group first reporting long‐term outcomes in a 291‐patient cohort, followed subsequently by a 1,000‐patient analysis. ( 7,19 ) Also, although early retrospective comparative analyses found longer TTP for Y90 than TACE, these findings were subsequently confirmed in a prospective randomized trial.…”

Section: Discussionmentioning

confidence: 99%

Liver Transplantation Following Yttrium‐90 Radioembolization: 15‐Year Experience in 207‐Patient Cohort

et al. 2020

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Background and Aims Radioembolization (yttrium‐90 [Y90]) is used in hepatocellular carcinoma (HCC) as a bridging as well as downstaging liver‐directed therapy to curative liver transplantation (LT). In this study, we report long‐term outcomes of LT for patients with HCC who were bridged/downstaged by Y90. Approach and Results Patients undergoing LT following Y90 between 2004 and 2018 were included, with staging by United Network for Organ Sharing (UNOS) tumor‐node‐metastasis criteria at baseline pre‐Y90 and pre‐LT. Post‐Y90 toxicities were recorded. Histopathological data of HCC at explant were recorded. Long‐term outcomes, including overall survival (OS), recurrence‐free survival (RFS), disease‐specific mortality (DSM), and time‐to‐recurrence, were reported. Time‐to‐endpoint analyses were estimated using Kaplan–Meier. Univariate and multivariate analyses were performed using a log‐rank test and Cox proportional‐hazards model, respectively. During the 15‐year period, 207 patients underwent LT after Y90. OS from LT was 12.5 years, with a median time to LT of 7.5 months [interquartile range, 4.4‐10.3]. A total of 169 patients were bridged, whereas 38 were downstaged to LT. Respectively, 94 (45%), 60 (29%), and 53 (26%) patients showed complete, extensive, and partial tumor necrosis on histopathology. Three‐year, 5‐year, and 10‐year OS rates were 84%, 77%, and 60%, respectively. Twenty‐four patients developed recurrence, with a median RFS of 120 (95% confidence interval, 69‐150) months. DSM at 3, 5, and 10 years was 6%, 11%, and 16%, respectively. There were no differences in OS/RFS for patients who were bridged or downstaged. RFS was higher in patients with complete/extensive versus partial tumor necrosis (P < 0.0001). For patients with UNOS T2 treated during the study period, 5.2% dropped out because of disease progression. Conclusions Y90 is an effective treatment for HCC in the setting of bridging/downstaging to LT. Patients who achieved extensive or complete necrosis had better RFS, supporting the practice of neoadjuvant treatment before LT.

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Section: Discussionmentioning

confidence: 99%

Liver Transplantation Following Yttrium‐90 Radioembolization: 15‐Year Experience in 207‐Patient Cohort

et al. 2020

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“…Bridging therapy is now the standard of care to prevent waitlist dropout and decrease HCC recurrence post-transplant. There are no prospective RCTs comparing locoregional therapy modalities before liver transplantation, therefore no single bridging modality is recommended over another (13). The literature remains difficult to analyze due to non-standardized treatment protocols and heterogeneous patient populations.…”

Section: Discussionmentioning

confidence: 99%

“…There is also a risk of liver capsule rupture (~2%) and resulting peritoneal seeding when treating peripheral tumors (3). Overall, the major complication rate ranges from 2.4-13.1%, but RFA is still superior to surgical resection (13). Livraghi et al (61), in 218 patients with small and early HCC, showed no perioperative mortality in RFA with lower than previously suggested rates of major complications (1.8%).…”

Section: Thermal Ablationmentioning

confidence: 98%

“…Patients derive more benefit from locoregional therapy as the expected liver transplant list increases (12). Recommendations from the 2010 International Consensus Conference and EASL/ EORTC Clinical Practice Guidelines suggest bridging therapy for all patients with HCC within the Milan criteria, with wait times >6 months for liver transplantation (13). In those meeting criteria for the Milan criteria, bridging therapy has decreased waitlist dropout to 0-10% (12).…”

Section: Bridging Therapymentioning

confidence: 99%

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Locoregional Therapies for Bridging and Downstaging Hepatocellular Carcinoma Prior to Liver Transplant

2021

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Hepatocellular carcinoma is the most common primary liver malignancy and is a common indication for liver transplantation. To qualify for liver transplantation, the size and number of tumors must be within established criteria. The Milan criteria is the most well-established of these criteria, however there is evidence these criteria can be safely expanded without affecting outcomes. While awaiting liver transplantation, locoregional therapy can be used as bridging therapy to maintain the tumor burden within criteria. Locoregional therapy can also be used to decrease tumor burden within transplant criteria, a process called downstaging. For tumors <3 cm, thermal ablation-most commonly using a radio-frequency probe-is preferred when feasible and offers tumor control approaching that of resection. Larger or multifocal lesions are usually treated with either trans-arterial chemoembolization or yttrium-90 trans-arterial radioembolization. The choice between these two interventions is generally based on institutional preference as neither has demonstrated survival advantage in the transplant population. However, single center trials show longer time to progression, improved downstaging success, and less microvascular invasion in patients treated

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“…Waiting times vary depending on the region, with dropout rates of patients awaiting liver transplantation ranging between 25% at 6 months, 38% at 12 months, and up to 55.1% at 18 months [3]. Therefore, bridging therapy has been suggested for all patients with HCC within transplantation criteria, with wait times >6 months [14]. As a bridge therapy, TACE has been shown to be effective by several studies, with lower dropout rates (3-13%) than previously reported [15].…”

Section: Indications Of Tacementioning

confidence: 99%

In the Era of Systemic Therapy for Hepatocellular Carcinoma Is Transarterial Chemoembolization Still a Card to Play?

Bucalau

Tancredi

Verset

2021

Cancers

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Conventional transarterial embolization (cTACE) has been proven to be effective for intermediate stage hepatocellular carcinoma (HCC), with a recent systematic review showing an overall survival (OS) of 19.4 months. Nevertheless, due to the rapid development of the systemic therapeutic landscape, the place of TACE is becoming questionable. Is there still a niche for TACE in the era of immunotherapy and combination treatments such as atezolizumab–bevacizumab, which has shown an OS of 19.2 months with excellent tolerance? The development of drug-eluting microspheres (DEMs) has led to the standardization of the technique, and along with adequate selection, it showed an OS of 48 months in a retrospective study. In order to increase treatment selectivity, new catheters have also been added to the TACE arsenal as well as the use of cone-beam CT (CBCT), which provides three-dimensional volumetric images and guidance during procedures. Moreover, the TACE indications have also widened. It may serve as a “bridging therapy” for liver transplantation candidates while they are on the waiting list, and it represents a valuable downstaging tool to transplantation criteria. The aim of this review is to explore the current data on the advancements of TACE and its future place amongst the growing panel of treatments.

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Bridging locoregional therapy: Longitudinal trends and outcomes in patients with hepatocellular carcinoma

Cited by 11 publications

References 101 publications

Liver Transplantation Following Yttrium‐90 Radioembolization: 15‐Year Experience in 207‐Patient Cohort

Liver Transplantation Following Yttrium‐90 Radioembolization: 15‐Year Experience in 207‐Patient Cohort

Locoregional Therapies for Bridging and Downstaging Hepatocellular Carcinoma Prior to Liver Transplant

In the Era of Systemic Therapy for Hepatocellular Carcinoma Is Transarterial Chemoembolization Still a Card to Play?

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