Efficacy of selective transarterial chemoembolization in inducing tumor necrosis in small (&lt;5 cm) hepatocellular carcinomas

Golfieri, Rita; Cappelli, Alberta; Cucchetti, Alessandro; Piscaglia, Fabio; Carpenzano, Maria; Peri, Eugenia; Ravaioli, Matteo; D’Errico, Antonietta; Pinna, Antonio Daniele; Bolondi, Luigi

doi:10.1002/hep.24246

Cited by 241 publications

(208 citation statements)

References 36 publications

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“…A potential weakness of our study is lack of pathologic confirmation. A recent study by Golfieri and colleagues (25) suggested that tumors with complete lipiodol uptake are not always translated into "pathologic CR." However, as pathologic evaluations of treated lesions are available only in selected cases following resection, transplantation, or autopsy, one can suppose that response evaluation using dynamic MRI scan would be desirable for finer prognostification.…”

Section: Discussionmentioning

confidence: 99%

Number of Target Lesions for EASL and Modified RECIST to Predict Survivals in Hepatocellular Carcinoma Treated with Chemoembolization

Kim

Kim²,

Kim³

et al. 2013

Clinical Cancer Research

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Purposes: To date, most studies about the optimal number of target lesions for enhancement criteria for hepatocellular carcinoma (HCC) have focused on cross-sectional analyses of concordance. We investigated the optimal number of target lesions for European Association for the Study of the Liver (EASL) and modified Response Evaluation Criteria in Solid Tumors (mRECIST) guidelines in predicting overall survival (OS).Experimental Design: We analyzed 254 consecutive treatment-na€ ve patients with HCC having at least 2 measurable target lesions undergoing transarterial chemoembolization. Kappa values for intermethod agreement of treatment responses were calculated for comparisons between use of maximum of 1, 2, 3, 4, or 5 targets versus use of all target lesions. Prognostic values of radiologic assessments according to number of target lesions for predicting OS were expressed as C-index.Results: By EASL and mRECIST guidelines, k values between responses assessing the longest 2, 3, 4, or 5 targets and assessing all targets were 0.924, 0.977, 1.000, or 1.000 and 0.907, 0.959, 1.000, or 1.000, respectively, whereas those between responses assessing only one target and assessing all target lesions were 0.723 and 0.666, respectively. C-index when measuring the longest 1, 2, 3, 4, 5, and all targets was similar, ranging from 0.739 to 0.749 for EASL criteria and from 0.750 to 0.759 for mRECIST. From Cox regression analyses, radiologic response from each calculation method showed independently significant effects on OS for both guidelines, regardless of number of target lesions.Conclusions: Prognostic values for predicting OS were similar regardless of number of target lesions. Assessing the 2 largest targets rather than only 1 index lesion could be recommended considering high concordances from cross-sectional analyses.

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Section: Discussionmentioning

confidence: 99%

Number of Target Lesions for EASL and Modified RECIST to Predict Survivals in Hepatocellular Carcinoma Treated with Chemoembolization

Kim

Kim²,

Kim³

et al. 2013

Clinical Cancer Research

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“…Of these treatments, TACE and RFA have been the most studied BTs, but newer therapies such as SIRT and SBRT are also being used (8)(9)(10). Five-year survival of patients after TACE prior to transplantation ranged from 51% to 93% (11)(12)(13).…”

Section: Discussionmentioning

confidence: 99%

Bridging therapy effectiveness in the treatment of hepatocellular carcinoma prior to orthotopic liver transplantation

Rubinstein

Kaubisch

Kinkhabwala

et al. 2017

J. Gastrointest. Oncol.

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Background: Orthotopic liver transplantation (OLT) is the most effective treatment for hepatocellular carcinoma (HCC) in patients with underlying cirrhosis and portal hypertension. Availability of OLT is limited by donor-organ shortages, which increase patient waiting time until OLT. A variety of bridging therapies (BT) have been used to halt tumor progression in patients on the OLT waiting list. Despite complete radiologic responses following BT, viable tumor is often present in explants.Methods: Treatment outcomes were evaluated in 50 patients who had a total of 125 BT for treatment of 93 nodules. Success of BT was assessed by radiologic response compared to histopathological examination of explanted livers.Results: Pre-transplant treatments included: transcatheter arterial chemoembolization (TACE), alcohol ablation (ETOH), radiofrequency ablation (RFA), microwave ablation (MWA), selective internal radiation therapy (SIRT) and stereotactic body radiation therapy (SBRT). Fifty-nine (64%) nodules had a complete radiographic response to therapy; however, only 28 nodules (30%) had complete tumor necrosis (CTN) on explant examination. Ten nodules with CTN were treated with TACE alone. Seven of the 28 nodules with CTN were treated with TACE and RFA. Three of seven nodules treated with TACE and SIRT had CTN.Patients underwent a mean of 2.5 BTs. Six of 50 patients (12%) had no residual HCC in their explants. Five of those six patients (83%) had complete response (CR) on pre-transplant imaging.Conclusions: Although favorable radiologic responses are seen following BT, viable HCC is seen in the majority of liver explants and radiographic imaging cannot always accurately predict pathological response.This underscores the need for aggressive treatment of patients who otherwise may not be eligible for OLT. HCCs that meet Milan criteria (single lesion ≤5 cm or up to three lesions each ≤3 cm) (5). Since the Milan criteria began to be used to determine eligibility of patients with HCC for OLT, the 5-year survival rate after surgery has increased to 70-80% (6,7). Although OLT may be a successful treatment for patients with cirrhosis and HCC, there are many considerable challenges to transplantation. By far one of the biggest challenges to OLT for patients with HCC is the shortage of donor organs and prolonged waiting times until transplantation. While patients await transplantation, a variety of bridging therapies (BTs) have been used in an effort to maintain disease control including; radiofrequency ablation (RFA), transcatheter arterial chemoembolization (TACE), microwave ablation (MWA), selective internal radiation therapy (SIRT) and stereotactic body radiation therapy (SBRT) varies. The goal of this study was to assess the pathologic response on explant analysis for patients who undergo BT prior to OLT. MethodsWe retrospectively reviewed the clinical data in all 69 patients who underwent OLT for HCC between April, 2009 and December, 2014 at Montefiore Medical Center, Bronx, NY. During this period, 50 patients underwent a...

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“…DEB-TACE delivers small beads that have been soaked for several hours, generally in doxorubicin. The loaded beads occlude the feeding vessels of HCC and the anticancer drug is gradually released, thereby creating tumor necrosis and increasing chemotherapeutic concentrations locally (25).…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary decision making in the management of hepatocellular carcinoma: A hospital-based study

Zaky

Makhlouf²,

Abdelmalek³

et al. 2015

Turk J Gastroenterol

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Background/Aims: To evaluate the short-term outcome of the decision taken by the Hepatoma Board for the treatment of Hepatocellular carcinoma (HCC). Materials and Methods: This was a prospective descriptive study involving 74 patients with HCC diagnosed by the known criteria. The decisions taken by the Hepatoma Board for the 74 patients were as follows: 1-surgical resection (7 patients), 2-local ablative therapy (LAT) (22 patients), 3-conventional transarterial chemoembolization (TACE) (24 patients), and 4-palliative supportive care (21 patients).Results: The short-term mortality rate was 25.7% of the total patients. The success rate was nearly equal in LAT (68.2%) and surgery (71.4%), whereas the success rate was approximately 33.3% in TACE. There was no difference in the mean total bilirubin level before and after LAT, surgery, or TACE (p>0.05 for each). There was a significant decrease in the mean serum albumin level after TACE (p=0.000). There was a decrease in the mean alpha fetoprotein level after surgery and LAT (p=0.033) for surgery and (p=0.048) for LAT. Conclusion: The management of HCC is better performed through a multidisciplinary team decision. Surgery has comparable outcome to LAT but is more invasive. According to our local experience, conventional TACE has a success rate of 33.3%.

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Efficacy of selective transarterial chemoembolization in inducing tumor necrosis in small (<5 cm) hepatocellular carcinomas

Cited by 241 publications

References 36 publications

Number of Target Lesions for EASL and Modified RECIST to Predict Survivals in Hepatocellular Carcinoma Treated with Chemoembolization

Number of Target Lesions for EASL and Modified RECIST to Predict Survivals in Hepatocellular Carcinoma Treated with Chemoembolization

Bridging therapy effectiveness in the treatment of hepatocellular carcinoma prior to orthotopic liver transplantation

Multidisciplinary decision making in the management of hepatocellular carcinoma: A hospital-based study

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