Chemoembolization of hepatocellular carcinoma in patients who undergo liver transplantation.

Spreafico, Carlo; Marchianò, Alfonso; Regalia, Enrico; Frigerio, Laura; Garbagnati, F; Andreola, Salvatore; Milella, M; Lanocita, Rodolfo; Mazzaferro, Vincenzo

doi:10.1148/radiology.192.3.8058934

Cited by 88 publications

(54 citation statements)

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“…Several studies have reported improved post-transplant survival in HCCA patients with the use of pre-operative trans-arterial chemoembolization (13,25) or with systemic chemotherapy (9,11). Others have used both modalities (10,12).…”

Section: Discussionmentioning

confidence: 99%

Does Additional Doxorubicin Chemotherapy Improve Outcome in Patients with Hepatocellular Carcinoma Treated by Liver Transplantation?

Pokorny

Gnant

Rasoul‐Rockenschaub

et al. 2005

American Journal of Transplantation

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The aim of this prospective randomized study was to determine whether additional doxorubicin chemotherapy improves outcome in patients with hepatocellular carcinoma (HCCA) treated by liver transplantation. Stratification parameters were tumor stage (UICC I-IVa), gender, age 50 years, a -fetoprotein 20 ng/mL, cirrhosis and HbsAg status. For pre-operative chemotherapy doxorubicin (15 mg/m 2 ) was given biweekly, intra-operative chemotherapy was a single dose administered before surgical manipulation. Post-operative chemotherapy from day 10 was as given preoperatively for a total dosage of 300 mg/m 2 . Outcome parameters were overall survival (OS) and disease-free survival. Of the 75 consecutive patients who received liver transplantation for treatment of HCCA, 62 patients were enrolled. Thirty-four patients were randomized in the chemotherapy group; 28 patients were in the control group and transplanted only. OS rates at 5 years were 38% in the chemotherapy group and 40% in the control group, disease-free survival rates at 5 years 43% and 53%, respectively. Tumor stage and vascular invasion were identified as independent risk factors for recurrence of disease. Doxorubicin chemotherapy did not improve organ survival and disease-free survival in patients undergoing liver transplantation for HCCA.

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Section: Discussionmentioning

confidence: 99%

Does Additional Doxorubicin Chemotherapy Improve Outcome in Patients with Hepatocellular Carcinoma Treated by Liver Transplantation?

Pokorny

Gnant

Rasoul‐Rockenschaub

et al. 2005

American Journal of Transplantation

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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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“…AFP level >100 ng/mL and high 3-year calculated survival probability might predict a good response to downstaging therapy after TACE (17). The aim is to achieve 100% necrosis of the tumors, but less than 30% of the cases could achieve complete pathological responds in the histological evaluation (41,45,47,48), hence the reported necrosis rate in the survival benefit after downstaging by TACE remained questionable (41,45,46,49). There was also report suggesting partial necrosis was a risk factor for tumor recurrence after LT (50).…”

Section: Transarterial Chemoembolization (Tace)mentioning

confidence: 99%

Bridging and downstaging therapy in patients suffering from hepatocellular carcinoma waiting on the list of liver transplantation

She¹,

Cheung²

2016

Transl. Gastroenterol. Hepatol.

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Hepatocellular carcinoma (HCC) is a common primary malignancy worldwide especially in the patients with the background of chronic liver disease. Liver transplantation (LT) is the only curative treatment effective for both malignancy as well as the cirrhosis and portal hypertension. Unfortunately, living donor is not always possible and the deceased graft is scarce. Neoadjuvant therapies, therefore, have been developed as a downstaging treatment to try to downstage the tumor within the transplant criteria, or as a bridging therapy to control the tumor growth in patients while waiting in the transplant list. This paper reviewed the common modalities used as bridging and downstaging therapies for patients suffering from HCC before undergoing LT.

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Chemoembolization of hepatocellular carcinoma in patients who undergo liver transplantation.

Abstract: CHE seems to be an effective treatment for HCC in patients with liver cirrhosis who await OLT.

Cited by 88 publications

References 0 publications

Does Additional Doxorubicin Chemotherapy Improve Outcome in Patients with Hepatocellular Carcinoma Treated by Liver Transplantation?

Does Additional Doxorubicin Chemotherapy Improve Outcome in Patients with Hepatocellular Carcinoma Treated by Liver Transplantation?

Review: Current status of therapy for hepatocellular carcinoma

Bridging and downstaging therapy in patients suffering from hepatocellular carcinoma waiting on the list of liver transplantation

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