Clinical Outcomes of Hepatic Resection after Combined Radiotherapy and Transarterial Chemoembolization in Patients with Advanced Hepatocellular Carcinoma Showing Macroscopic Vascular Invasion

Song, K-W; Jung, Jinhong; Song, Gi‐Won; Lee, H.C.; Joo, Ji Hyeon; Kim, Young Jae; Kim, J.H.; Park, J.H.; Yoon, Sang Min

doi:10.1016/j.ijrobp.2019.06.1989

Cited by 1 publication

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“…There were 2,528 patients undergoing conversion therapy and 331 patients undergoing surgical resection after successful conversion therapy. Conversion therapies included TACE monotherapy [nine studies ( 15 , 17 , 18 , 21 – 24 )] or TACE combined with other therapies [nine studies ( 11 – 16 , 19 , 20 )]. All patients were diagnosed with HCC by pathology or non-invasive methods (imaging, serology, etc.).…”

Section: Resultsmentioning

confidence: 99%

“…Among the nine studies ( 15 , 17 , 18 , 21 – 24 ) on TACE monotherapy, six ( 15 , 18 , 21 – 24 ) used conventional TACE (cTACE) conversion therapy and three ( 17 , 18 , 21 ) used drug-eluting bead TACE (DEB-TACE) conversion therapy. Of the remaining nine studies ( 11 – 16 , 19 , 20 ), five ( 12 , 15 , 16 , 19 , 20 ) reported bigeminy therapy and four ( 11 , 13 , 14 , 16 ) reported triple therapy. Among the bigeminy therapy studies, there were three studies ( 12 , 19 , 20 ) on TACE combined with RT, one study ( 15 ) on TACE combined with HAIC, and one study ( 16 ) on TACE combined with tyrosine kinase inhibitor (TKI) therapy.…”

Section: Resultsmentioning

confidence: 99%

“…Of the remaining nine studies ( 11 – 16 , 19 , 20 ), five ( 12 , 15 , 16 , 19 , 20 ) reported bigeminy therapy and four ( 11 , 13 , 14 , 16 ) reported triple therapy. Among the bigeminy therapy studies, there were three studies ( 12 , 19 , 20 ) on TACE combined with RT, one study ( 15 ) on TACE combined with HAIC, and one study ( 16 ) on TACE combined with tyrosine kinase inhibitor (TKI) therapy. The remaining four triple therapy studies ( 11 , 13 , 14 , 16 ) covered TACE in combination with TKI and immune checkpoint inhibitor (ICI) therapy.…”

Section: Resultsmentioning

confidence: 99%

“…In terms of long-term survival outcomes, nine studies ( 12 , 15 – 18 , 20 ) revealed the overall survival (OS) of patients initially treated with conversion therapy, with 1- and 2-year OS rates of 66% (95% CI, 0.57–0.75) and 35% (95% CI, 0.21–0.50), respectively ( Figure 6A ). A total of six studies ( 11 , 14 , 19 , 20 , 23 , 24 ) described the postoperative OS in patients who underwent successful surgical resection after conversion therapy. The lowest 1-year postoperative OS rate was 77% and the highest was 95%.…”

Section: Resultsmentioning

confidence: 99%

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Efficacy of transarterial chemoembolization monotherapy or combination conversion therapy in unresectable hepatocellular carcinoma: A systematic review and meta-analysis

Pei

Wang

et al. 2022

Front. Oncol.

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BackgroundHepatocellular carcinoma (HCC) is a highly malignant disease with poor prognosis, and most cases were already considered unresectable at the time of presentation. Conversion therapy, as an emerging treatment, is designed to provide patients with initially unresectable hepatocellular carcinoma (uHCC) the opportunity to undergo radical resection. At present, conversion therapy for patients with uHCC remains controversial. Transarterial chemoembolization (TACE) is currently the most widely selected treatment for uHCC, but its efficacy as a conversion therapy remains controversial.MethodsWe compared and evaluated the conversion rate for and tumor response to TACE monotherapy or combination therapy. Meanwhile, postoperative complications and overall survival (OS) in uHCC patients who underwent conversion therapy were also analyzed.ResultsA total of 18 studies were included in this meta-analysis. The conversion rate for triple therapy [TACE in combination with tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs)] was 42% [95% confidence interval (CI), 0.29–0.56], higher than any other group [TACE monotherapy: 10% (95% CI, 0.08–0.12), bigeminy therapy: 19% (95% CI, 0.06–0.36)]. Meanwhile, triple therapy yielded a better tumor response than TACE monotherapy or bigeminy therapy. Among the patients with successful surgical resection after conversion therapy, the pooled postoperative OS rates at 1, 2, and 5 years were 90% (95% CI, 0.81–0.97), 58% (95% CI, 0.42–0.73), and 42% (95% CI, 0.26–0.60), respectively, and the major postoperative complications were biliary leakage (7%; 95% CI, 0.03–0.12) and liver failure (3%; 95% CI, 0.00–0.07).ConclusionTACE conversion therapies showed good conversion rates, especially the triple therapy of TACE in combination with TKIs and ICIs. Surgical resection after successful conversion therapy could maximize the outcome of patients with uHCC.

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