Neoadjuvant hepatic arterial infusion chemotherapy for resectable hepatocellular carcinomas

Abstract

Aim: To evaluate the effect of neoadjuvant hepatic arterial infusion chemotherapy (HAIC) on the survival of patients with resectable hepatocellular carcinoma (HCC). Methods: Between January 2003 and January 2014, 80 patients underwent hepatic resection for HCC. Of these patients, we evaluated 49 patients who met the following inclusion criteria: (1) preserved liver function (Child-Pugh A); (2) resectable HCC (≤ 3 nodules, regardless of the size); and (3) HCC with high-grade malignant potential. Among them, 13 patients underwent neoadjuvant HAIC and curative hepatectomy (treatment group). The remaining 36 patients underwent curative hepatic resection without neoadjuvant therapy (control group). Survival after hepatic resection was compared retrospectively between the groups. Results: During follow-up, 2 (15.4%) patients in the treatment group and 25 (69.4%) patients in the control group developed recurrence. The 1-, 3-, and 5-year disease-free rates (100%, 78.6%, and 78.6%, respectively vs. 65.8%, 33.7%, and 26.6%, respectively; P = 0.003) and overall survival rates (100%, 100%, and 100%, respectively vs. 91.7%, 77.8%, and 55.3%, respectively; P = 0.037) were significantly better in the treatment group than in the control group. Conclusion: Neoadjuvant HAIC decreased the risk of recurrence and improved survival in patients with HCC with high malignant potential.

Chinese expert consensus on neoadjuvant and conversion therapies for hepatocellular carcinoma

“…Another retrospective study showed that neoadjuvant HAIC reduced the risk of recurrence in patients at a high risk of hepatocellular carcinoma and improved patient survival rates. Compared with the control group, the 1-, 3-, and 5-year DFS rates (100%, 78.6%, and 78.6% vs 65.8%, 33.7%, and 26.6%, respectively, P = 0.003) and OS rate (100%, 100%, and 100% vs 91.7%, 77.8%, and 55.3%, respectively, P = 0.037) in the neoadjuvant HAIC group were significantly higher[ 21 ] (grade of evidence: 2B).…”

Chemoembolization with Degradable Starch Microspheres (DSM-TACE): expanding indications in HCC multidisciplinary tumor board

“…The use of TACE as a neoadjuvant treatment before liver resection is debated, because it may be useful to eradicate intrahepatic metastases and prevent tumor cell dissemination during surgery [Figure 4], but carries the risks of liver function impairment, delay in surgery and perihepatic adhesions rendering liver resection more difficult [83,84] . A meta-analysis [85] showed that the overall survival after liver resection was worse in the case of preoperative TACE, but the subgroup with complete tumor response to TACE had a benefit in disease-free survival after surgery because of reduced tumor recurrence rate. Although DSM-TACE has not yet been tested for this neoadjuvant indication, the significantly better patient outcome was obtained with hepatic artery infusion (HAI) [86] , which is based on the same principle of chemotherapeutic action.TACE has been successfully applied before thermal ablation to increase the HCC necrotic area in HCC nodules based on the ischemic effect of embolization [2,87] , but also in combination with external radiotherapy, proving effective in terms of increased tumor response and patient outcome due to the synergistic effect of chemo-radiotherapy [88] .…”