Doxorubicin-eluting bead<i>vs</i>conventional transcatheter arterial chemoembolization for hepatocellular carcinoma before liver transplantation

Nicolini, Daniele; Svegliati‐Baroni, Gianluca; Candelari, Roberto; Mincarelli, Cinzia; Mandolesi, Alessandra; Bearzi, Italo; Mocchegiani, Federico; Vecchi, Andrea; Montalti, Roberto; Benedetti, Antonio; Risaliti, Andrea; Vivarelli, Marco

doi:10.3748/wjg.v19.i34.5622

Cited by 52 publications

(39 citation statements)

References 37 publications

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“…DEB-TACE has been shown to be safe and effective in palliative HCC treatment in several clinical and preclinical studies (27,(36)(37)(38)(39)(40)(41), as well as in a randomized clinical trial (RCT) comparing DEB-TACE with cTACE (23,26), but the evidence to support its use as a neoadjuvant treatment before OLT is scarce (25,(42)(43)(44)(45)(46). To our knowledge, this is the first clinical study that compares OS and DFS of patients that did and did not receive DEB-TACE before OLT and one of the largest series assessing neoadjuvant DEB-TACE clinical results in the literature so far.…”

Section: Discussionmentioning

confidence: 99%

Does neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization improve survival in patients undergoing liver transplant for hepatocellular carcinoma?

Dorcaratto

Udupa²,

Hogan³

et al. 2017

Diagn Interv Radiol

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O rthotopic liver transplant is the gold standard treatment for patients with hepatocellular carcinoma (HCC) within Milan criteria (1, 2). Conventional transarterial chemoembolization (cTACE) is widely accepted as a palliative treatment for patients who do not fulfill the criteria for OLT, HCC resection, or local therapies such as ethanol injection, radiofrequency ablation, microwave ablation, cryotherapy, or electroporation (3-11). The usefulness of pre-OLT TACE to avoid disease progression while waiting for organ allocation and to down-stage selected patients to fulfill transplant criteria is well known. However, the effect of neoadjuvant TACE treatment prior to OLT for HCC on overall survival (OS) and disease-free survival (DFS) is contentious (2,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22).Doxorubicin drug-eluting bead TACE (DEB-TACE) is a drug delivery embolization system that can achieve higher tumor and lower systemic concentrations of doxorubicin compared with cTACE and demonstrated equal efficacy with low toxicity in previous clinical studies (23-27). However, the evidence to support the use of this relatively novel technique as a neoadjuvant treatment before OLT and its impact on OS and DFS is scarce.The aim of this study was to compare OS and DFS of patient undergoing OLT for HCC who did and did not receive neoadjuvant DEB-TACE. Methods Study design and populationData was investigated from a prospectively maintained database and the need to ob- I N T E R V E N T I O N A L R A D I O LO G Y O R I G I N A L A R T I C L E PURPOSEWe aimed to compare the overall (OS) and disease-free survival (DFS) of patients undergoing orthotopic liver transplant (OLT) for hepatocellular carcinoma who did and did not have neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization (DEB-TACE). METHODSThis is a retrospective study of 94 patients with HCC transplanted between 2000 and 2014 in a single tertiary center. Pre-and postoperative features, DFS and OS were compared between patients who received pre-OLT DEB-TACE (n=34, DEB-TACE group) and those who did not (n=60, non-TACE group). Radiologic and histologic response to neoadjuvant treatment as well as its complications were also studied. RESULTSThere were no significant differences in post-transplantation DFS and OS rates between groups (5-year DFS: 70% in DEB-TACE group vs. 63% in non-TACE group, P = 0.454; 5-year OS: 70% in DEB-TACE group vs. 65% in non-TACE group, P = 0.532). The DEB-TACE group had longer OLT waiting time compared with the non-TACE group (110 vs. 72 days; P = 0.01). On univariate and multivariate analyses, alpha-fetoprotein (AFP) levels >500 ng/mL prior to OLT were associated with decreased OS and DFS regardless of neoadjuvant approach (hazard ratio of 6, P = 0.001 and 5.5, P = 0.002, respectively). CONCLUSIONPatients who underwent neoadjuvant DEB-TACE and OLT for hepatocellular carcinoma had no statistically different OS or DFS at 3 and 5 years from patients undergoing OLT alone.You may cite this article as: Dorcaratto D, Udupa V, Ho...

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Section: Discussionmentioning

confidence: 99%

Does neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization improve survival in patients undergoing liver transplant for hepatocellular carcinoma?

Dorcaratto

Udupa²,

Hogan³

et al. 2017

Diagn Interv Radiol

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“…Neoadjuvant locoregional therapies are recommended when the expected time to LT is longer than 6 mo in order to prevent drop-out and increase long term survival, while minimizing the risk of tumour recurrence after LT [23,[66][67][68][69][70][71][72] . However many LT institutions treat most of the patients within the waiting list, since the actual time to LT may be unpredictable, and this strategy has demonstrated a favourable cost-effect balance [73] .…”

Section: Waiting List Management and Bridging Therapymentioning

confidence: 99%

Strategies to improve outcome of patients with hepatocellular carcinoma receiving a liver transplantation

Guerrero-Misas

Rodríguez‐Perálvarez

Mata

2015

WJH

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Liver transplantation is the only therapeutic option which allows to treat both, the hepatocellular carcinoma and the underlying liver disease. Indeed, liver transplantation is considered the standard of care for a subset of patients with cirrhosis and hepatocellular carcinoma.However, tumour recurrence rates are as high as 20%, and once the recurrence is established the therapeutic options are scarce and with little impact on prognosis. Strategies to minimize tumour recurrence and thus to improve outcome may be classified into 3 groups: (1) An adequate selection of candidates for liver transplantation by using the Milan criteria; (2) An optimized management within waiting list including prioritization of patients at high risk of tumour progression, and the implementation of bridging therapies, particularly when the expected length within the waiting list is longer than 6 mo; and (3) Tailored immunosuppression comprising reduced exposure to calcineurin inhibitors, particularly early after liver transplantation, and the addition of mammalian target of rapamycin inhibitors. In the present manuscript the available scientific evidence supporting these strategies is comprehensively reviewed, and future directions are provided for novel research approaches, which may contribute to the final target: to cure more patients with hepatocellular carcinoma and with an improved long term outcome. Core tip: Liver transplantation is the only therapeutic option which allows to treat both, the hepatocellular carcinoma and the underlying liver disease. However, tumour recurrence rates are 15%-20% with a very poor prognosis. Strategies to minimize tumour recurrence and thus to improve outcome are focused in a careful selection of candidates for liver transplantation, an optimized management within waiting list and a tailored immunosuppression. The available scientific evidence supporting these strategies is reviewed, and future directions are provided for novel research approaches, which may contribute to the final target: to cure more REVIEW Submit a

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“…Despite reports suggested that there was no significant difference in terms of the safety profile, tumor response, tumor recurrence and overall survival rate for DEB as compared to TACE in non-transplant patients (57,59), DEB was shown to have lower tumor recurrence rate after LT and was identified as an independent predictor of recurrence-free survival in the multivariate analysis (60). Further study should be carried out to confirm the superiority of this technique.…”

Section: Doxorubicin Eluting Bead (Deb) Transarterial Chemoembolizatimentioning

confidence: 95%

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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Doxorubicin-eluting beadvsconventional transcatheter arterial chemoembolization for hepatocellular carcinoma before liver transplantation

Abstract: DEB-TACE can effectively promote tumor necrosis and improves recurrence-free survival after LT in HCC.

Cited by 52 publications

References 37 publications

Does neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization improve survival in patients undergoing liver transplant for hepatocellular carcinoma?

Does neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization improve survival in patients undergoing liver transplant for hepatocellular carcinoma?

Strategies to improve outcome of patients with hepatocellular carcinoma receiving a liver transplantation

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

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