Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Surgery
Published in: European Surgery 5/2017

Open Access 01-10-2017 | original scientific paper

Multimodality locoregional treatment strategies for bridging HCC patients before liver transplantation

Authors: Georg P. Györi, MD, D. Moritz Felsenreich, Gerd R. Silberhumer, Thomas Soliman, Gabriela A. Berlakovich

Published in: European Surgery | Issue 5/2017

Login to get access

Summary

Background

It is current practice that patients with hepatocellular carcinoma (HCC) listed for liver transplantation should receive locoregional treatment if the suspected waiting time for transplantation is longer than 6 months, even in the absence of prospective randomized data. Aim of this study was the comparison of single versus multimodality locoregional treatment strategies on outcomes after liver transplantation.

Methods

This is a retrospective analysis of 150 HCC patients listed for liver transplantation at our center between 2004 and 2011. Outcomes were analyzed according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) in relation to intention-to-treat and overall survival after liver transplantation.

Results

Overall, 92 patients (63%) were transplanted in this cohort. The intention-to-treat 1‑, 3‑, 5‑year waiting list survival was 80, 59, and 50% respectively. In RFA-(radiofrequency ablative) and TACE-(transarterial chemoembolisation)-based regimens, rates of transplanted patients were comparable (69 vs. 58%, p = ns). No difference was seen in overall survival after liver transplantation when comparing TACE- and RFA-based regimens. Patients receiving multimodality locoregional therapy had lower overall survival after transplantation (p = 0.05)

Conclusion

TACE- and RFA-based regimens showed equal outcomes in terms of transplantation rate, tumor response, and post-transplant survival. Patients in need of more than one treatment modality might identify a cohort with poorer post-transplant survival.

Points of novelty

Direct comparison of TACE and RFA in a multimodality setting, analysis according to mRECIST.
Literature
1.
Zheng Z, Liang W, Milgrom DP, Schroder PM, Kong NS, Yang C, et al. Liver transplantation versus liver resection in the treatment of hepatocellular carcinoma: a aeta-analysis of observational studies. Transplantation. 2013; doi:10.​1097/​tp.​0b013e3182a89383​.
2.
Mazzaferro V, Bhoori S, Sposito C, Bongini M, Langer M, Miceli R, et al. Milan criteria in liver transplantation for hepatocellular carcinoma: an evidence-based analysis of 15 years of experience. Liver Transplant. 2011;17(Suppl 2):S44–S57.CrossRef
3.
Mazzaferro V. Results of liver transplantation: with or without Milan criteria? Liver Transplant. 2007;13(11 Suppl 2):S44–S7.CrossRef
4.
Unek T, Karademir S, Arslan NC, Egeli T, Atasoy G, Sagol O, et al. Comparison of Milan and UCSF criteria for liver transplantation to treat hepatocellular carcinoma. World J Gastroenterol. 2011;17(37):4206–12.CrossRefPubMedPubMedCentral
5.
Mazzaferro V, Llovet JM, Miceli R, Bhoori S, Schiavo M, Mariani L, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol. 2009;10(1):35–43.CrossRefPubMed
6.
Ruiz Gomez A, Couce ML, Garcia-Villoria J, Torres A, Bana Souto A, Yague J, et al. Clinical, genetic, and therapeutic diversity in 2 patients with severe mevalonate kinase deficiency. Pediatrics. 2012;129(2):e535–e9.CrossRefPubMed
7.
Northup PG, Berg CL. Hepatocellular carcinoma and model for end-stage liver disease exceptions: the more we understand, the more challenging the allocation gets. Liver Transplant. 2012;18(4):381–3.CrossRef
8.
Si Y, Hu X, Du H, Lou W, Zhang H, Cao F, et al. Transarterial chemoembolization for patients with unresectable hepatocellular carcinoma: a retrospective study of a 5-year experience in a single institution. Hepatogastroenterology. 2013;60(126):1405–8.PubMed
9.
Wong LL, Tanaka K, Lau L, Komura S. Pre-transplant treatment of hepatocellular carcinoma: assessment of tumor necrosis in explanted livers. Clin Transplant. 2004;18(3):227–34.CrossRefPubMed
10.
Meza-Junco J, Montano-Loza AJ, Liu DM, Sawyer MB, Bain VG, Ma M, et al. Locoregional radiological treatment for hepatocellular carcinoma; Which, when and how? Cancer Treat Rev. 2012;38(1):54–62.CrossRefPubMed
11.
Yao FY, Kerlan RK Jr., Hirose R, Davern TJ 3rd, Bass NM, Feng S, et al. Excellent outcome following down-staging of hepatocellular carcinoma prior to liver transplantation: an intention-to-treat analysis. Hepatology. 2008;48(3):819–27.CrossRefPubMedPubMedCentral
12.
De Luna W, Sze DY, Ahmed A, Ha BY, Ayoub W, Keeffe EB, et al. Transarterial chemoinfusion for hepatocellular carcinoma as downstaging therapy and a bridge toward liver transplantation. Am J Transplant. 2009;9(5):1158–68.CrossRefPubMed
13.
Chapman WC, Majella Doyle MB, Stuart JE, Vachharajani N, Crippin JS, Anderson CD, et al. Outcomes of neoadjuvant transarterial chemoembolization to downstage hepatocellular carcinoma before liver transplantation. Ann Surg. 2008;248(4):617–25.PubMed
14.
Clavien PA, Lesurtel M, Bossuyt PM, Gores GJ, Langer B, Perrier A, et al. Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report. Lancet Oncol. 2012;13(1):e11–e22.CrossRefPubMed
15.
Pompili M, Francica G, Ponziani FR, Iezzi R, Avolio AW. Bridging and downstaging treatments for hepatocellular carcinoma in patients on the waiting list for liver transplantation. World J Gastroenterol. 2013;19(43):7515–30.CrossRefPubMedPubMedCentral
16.
Graziadei IW, Sandmueller H, Waldenberger P, Koenigsrainer A, Nachbaur K, Jaschke W, et al. Chemoembolization followed by liver transplantation for hepatocellular carcinoma impedes tumor progression while on the waiting list and leads to excellent outcome. Liver Transplant. 2003;9(6):557–63.CrossRef
17.
Hayashi PH, Ludkowski M, Forman LM, Osgood M, Johnson S, Kugelmas M, et al. Hepatic artery chemoembolization for hepatocellular carcinoma in patients listed for liver transplantation. Am J Transplant. 2004;4(5):782–7.CrossRefPubMed
18.
Decaens T, Roudot-Thoraval F, Bresson-Hadni S, Meyer C, Gugenheim J, Durand F, et al. Impact of pretransplantation transarterial chemoembolization on survival and recurrence after liver transplantation for hepatocellular carcinoma. Liver Transplant. 2005;11(7):767–75.CrossRef
19.
Millonig G, Graziadei IW, Freund MC, Jaschke W, Stadlmann S, Ladurner R, et al. Response to preoperative chemoembolization correlates with outcome after liver transplantation in patients with hepatocellular carcinoma. Liver Transplant. 2007;13(2):272–9.CrossRef
20.
Tsochatzis E, Garcovich M, Marelli L, Papastergiou V, Fatourou E, Rodriguez-Peralvarez ML, et al. Transarterial embolization as neo-adjuvant therapy pretransplantation in patients with hepatocellular carcinoma. Liver Int. 2013;33(6):944–9.CrossRefPubMed
21.
Golfieri R, Cappelli A, Cucchetti A, Piscaglia F, Carpenzano M, Peri E, et al. Efficacy of selective transarterial chemoembolization in inducing tumor necrosis in small (〈5 cm) hepatocellular carcinomas. Hepatology. 2011;53(5):1580–9.CrossRefPubMed
22.
Mazzaferro V, Battiston C, Perrone S, Pulvirenti A, Regalia E, Romito R, et al. Radiofrequency ablation of small hepatocellular carcinoma in cirrhotic patients awaiting liver transplantation: a prospective study. Ann Surg. 2004;240(5):900–9.CrossRefPubMedPubMedCentral
23.
Lu DS, Yu NC, Raman SS, Lassman C, Tong MJ, Britten C, et al. Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation. Hepatology. 2005;41(5):1130–7.CrossRefPubMed
24.
Pompili M, Mirante VG, Rondinara G, Fassati LR, Piscaglia F, Agnes S, et al. Percutaneous ablation procedures in cirrhotic patients with hepatocellular carcinoma submitted to liver transplantation: assessment of efficacy at explant analysis and of safety for tumor recurrence. Liver Transplant. 2005;11(9):1117–26.CrossRef
25.
Majno P, Giostra E, Mentha G. Management of hepatocellular carcinoma on the waiting list before liver transplantation: time for controlled trials? Liver Transplant. 2007;13(11 Suppl 2):S27–S35.CrossRef
26.
Fontana RJ, Hamidullah H, Nghiem H, Greenson JK, Hussain H, Marrero J, et al. Percutaneous radiofrequency thermal ablation of hepatocellular carcinoma: a safe and effective bridge to liver transplantation. Liver Transplant. 2002;8(12):1165–74.CrossRef
27.
Porrett PM, Peterman H, Rosen M, Sonnad S, Soulen M, Markmann JF, et al. Lack of benefit of pre-transplant locoregional hepatic therapy for hepatocellular cancer in the current MELD era. Liver Transplant. 2006;12(4):665–73.CrossRef
28.
Heckman JT, Devera MB, Marsh JW, Fontes P, Amesur NB, Holloway SE, et al. Bridging locoregional therapy for hepatocellular carcinoma prior to liver transplantation. Ann Surg Oncol. 2008;15(11):3169–77.CrossRefPubMed
29.
Rossi S, Garbagnati F, Lencioni R, Allgaier HP, Marchiano A, Fornari F, et al. Percutaneous radio-frequency thermal ablation of nonresectable hepatocellular carcinoma after occlusion of tumor blood supply. Radiology. 2000;217(1):119–26.CrossRefPubMed
30.
Veltri A, Moretto P, Doriguzzi A, Pagano E, Carrara G, Gandini G. Radiofrequency thermal ablation (RFA) after transarterial chemoembolization (TACE) as a combined therapy for unresectable non-early hepatocellular carcinoma (HCC). Eur Radiol. 2006;16(3):661–9.CrossRefPubMed
31.
Ashoori N, Bamberg F, Paprottka P, Rentsch M, Kolligs FT, Siegert S, et al. Multimodality treatment for early-stage hepatocellular carcinoma: a bridging therapy for liver transplantation. Digestion. 2012;86(4):338–48.CrossRefPubMed
Metadata
Title
Multimodality locoregional treatment strategies for bridging HCC patients before liver transplantation
Authors
Georg P. Györi, MD
D. Moritz Felsenreich
Gerd R. Silberhumer
Thomas Soliman
Gabriela A. Berlakovich
Publication date
01-10-2017
Publisher
Springer Vienna
Published in
European Surgery / Issue 5/2017
Print ISSN: 1682-8631
Electronic ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-017-0487-8

Other articles of this Issue 5/2017

European Surgery 5/2017 Go to the issue

Editorial

Surgery and quantum physics

case report

A rare but life-threatening complication of aortic surgery: iliac appendiceal fistula

original scientific paper

Preoperative diagnosis of hiatal hernia: barium swallow X-ray, high-resolution manometry, or endoscopy?

case report

A rare case of Calot’s triangle paraganglioma

original article

Dual-port vs. single-port laparoscopic colectomy for colon cancer

review

Notch and its oncogenic activity in human malignancies