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Bridging Locoregional Therapy for Hepatocellular Carcinoma Prior to Liver Transplantation

  • Hepatic and Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

The impact of locoregional therapy prior to liver transplantation for hepatocellular carcinoma utilizing either transcatheter arterial chemoembolization (TACE), yttrium-90 (90Y), radiofrequency ablation (RFA), or resection prior to orthotopic liver transplantation (OLT) is largely unknown. We sought to examine locoregional therapies and their effect on survival compared with transplantation alone.

Methods

A retrospective review of a prospectively collected database.

Results

123 patients were included. Patients were analyzed in two groups. Group I consisted of 50 patients that received therapy (20 TACE; 16 90Y; 13 RFA, 3 resections). Group II consisted of 73 patients transplanted without therapy. Median list time was 28 days (range 2–260 days ) in group I, and 24 days (range 1–380 days) in group II. Median time from therapy to OLT was 3.8 months (range 9 days to 68 months). Twelve patients (24%) were successfully downstaged (8 TACE, 2 90Y, 2 RFA/resection). Overall 1-, 3-, and 5-year survival were 81%, 74%, and 74%, respectively. Survival was not statistically significantly different between the two groups (P = 0.53). The 12 patients downstaged did not have a significant difference in survival as compared with the patients who received therapy but did not respond or the patients who were transplanted without therapy (P = 0.76).

Conclusion

Our report addresses locoregional therapy for hepatocellular carcinoma as a bridge to transplant. There was no statistical difference in overall survival between patients treated and those not treated prior to transplant. We provide further evidence that locoregional therapy is a safe tool for patients on the transplant list, does not impact survival, and can downstage selected patients to allow life-saving liver transplantation.

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References

  1. El-Serag HB, Davila JA, Petersen NJ, et al. The continuing increase in the incidence of hepatocellular carcinoma in the United States: an update. Ann Intern Med 2003; 139:817–23.

    PubMed  Google Scholar 

  2. Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996; 334:693–9.

    Article  PubMed  CAS  Google Scholar 

  3. Yao FY, Ferrell L, Bass NM, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology 2001; 33:1394–403.

    Article  PubMed  CAS  Google Scholar 

  4. Mazzaferro V, Chun YS, Poon RT, et al. Liver transplantation for hepatocellular carcinoma. Ann Surg Oncol 2008

  5. Llovet JM, Fuster J, Bruix J. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology 1999; 30:1434–40.

    Article  PubMed  CAS  Google Scholar 

  6. Yao FY, Bass NM, Nikolai B, et al. A follow-up analysis of the pattern and predictors of dropout from the waiting list for liver transplantation in patients with hepatocellular carcinoma: implications for the current organ allocation policy. Liver Transpl 2003; 9:684–92.

    Article  PubMed  Google Scholar 

  7. http://www.unos.org/PoliciesandBylaws2/policies/pdfs/policy_8.pdf. Organ Distribution: Allocation of Livers. Accessed 1 March 2008

  8. Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973; 60:646–9.

    Article  PubMed  CAS  Google Scholar 

  9. Wiesner R, Edwards E, Freeman R, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 2003; 124:91–6.

    Article  PubMed  Google Scholar 

  10. Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982; 5:649–55.

    Article  PubMed  CAS  Google Scholar 

  11. Ebied OM, Federle MP, Carr BI, et al. Evaluation of responses to chemoembolization in patients with unresectable hepatocellular carcinoma. Cancer 2003; 97:1042–50.

    Article  PubMed  Google Scholar 

  12. Carr BI. Hepatic arterial 90Yttrium glass microspheres (Therasphere) for unresectable hepatocellular carcinoma: interim safety and survival data on 65 patients. Liver Transpl 2004; 10:S107–10.

    Article  PubMed  Google Scholar 

  13. Lo CM, Ngan H, Tso WK, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002; 35:1164–71.

    Article  PubMed  CAS  Google Scholar 

  14. Llovet JM, Real MI, Montana X, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 2002; 359:1734–9.

    Article  PubMed  Google Scholar 

  15. Camma C, Schepis F, Orlando A, et al. Transarterial chemoembolization for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials. Radiology 2002; 224:47–54.

    Article  PubMed  Google Scholar 

  16. Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology 2003; 37:429–42.

    Article  PubMed  CAS  Google Scholar 

  17. Lesurtel M, Mullhaupt B, Pestalozzi BC, et al. Transarterial chemoembolization as a bridge to liver transplantation for hepatocellular carcinoma: an evidence-based analysis. Am J Transplant 2006; 6:2644–50.

    Article  PubMed  CAS  Google Scholar 

  18. Decaens T, Roudot-Thoraval F, Bresson-Hadni S, et al. Impact of pretransplantation transarterial chemoembolization on survival and recurrence after liver transplantation for hepatocellular carcinoma. Liver Transpl 2005; 11:767–75.

    Article  PubMed  Google Scholar 

  19. Veltri A, Grosso M, Martina MC, et al. Effect of preoperative radiological treatment of hepatocellular carcinoma before liver transplantation: a retrospective study. Cardiovasc Intervent Radiol 1998; 21:393–8.

    Article  PubMed  CAS  Google Scholar 

  20. Porrett PM, Peterman H, Rosen M, et al. Lack of benefit of pre-transplant locoregional hepatic therapy for hepatocellular cancer in the current MELD era. Liver Transpl 2006; 12:665–73.

    Article  PubMed  Google Scholar 

  21. Majno PE, Adam R, Bismuth H, et al. Influence of preoperative transarterial lipiodol chemoembolization on resection and transplantation for hepatocellular carcinoma in patients with cirrhosis. Ann Surg 1997; 226:688–701.

    Article  PubMed  CAS  Google Scholar 

  22. Bharat A, Brown DB, Crippin JS, et al. Pre-liver transplantation locoregional adjuvant therapy for hepatocellular carcinoma as a strategy to improve longterm survival. J Am Coll Surg 2006; 203:411–20.

    Article  PubMed  Google Scholar 

  23. Graziadei IW, Sandmueller H, Waldenberger P, et al. Chemoembolization followed by liver transplantation for hepatocellular carcinoma impedes tumor progression while on the waiting list and leads to excellent outcome. Liver Transpl 2003; 9:557–63.

    Article  PubMed  Google Scholar 

  24. Maddala YK, Stadheim L, Andrews JC, et al. Drop-out rates of patients with hepatocellular cancer listed for liver transplantation: outcome with chemoembolization. Liver Transpl 2004; 10:449–55.

    Article  PubMed  Google Scholar 

  25. Obed A, Beham A, Pullmann K, et al. Patients without hepatocellular carcinoma progression after transarterial chemoembolization benefit from liver transplantation. World J Gastroenterol 2007; 13:761–7.

    PubMed  Google Scholar 

  26. Otto G, Heise M, Moench C, et al. Transarterial chemoembolization before liver transplantation in 60 patients with hepatocellular carcinoma. Transplant Proc 2007; 39:537–9.

    Article  PubMed  CAS  Google Scholar 

  27. Bismuth H, Chiche L, Adam R, et al. Liver resection versus transplantation for hepatocellular carcinoma in cirrhotic patients. Ann Surg 1993; 218:145–51.

    Article  PubMed  CAS  Google Scholar 

  28. Fong Y, Sun RL, Jarnagin W, et al. An analysis of 412 cases of hepatocellular carcinoma at a Western center. Ann Surg 1999; 229:790–9; discussion 799–800.

    Article  PubMed  CAS  Google Scholar 

  29. Figueras J, Jaurrieta E, Valls C, et al. Resection or transplantation for hepatocellular carcinoma in cirrhotic patients: outcomes based on indicated treatment strategy. J Am Coll Surg 2000; 190:580–7.

    Article  PubMed  CAS  Google Scholar 

  30. Poon RT, Fan ST, Lo CM, et al. Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function: implications for a strategy of salvage transplantation. Ann Surg 2002; 235:373–82.

    Article  PubMed  Google Scholar 

  31. Poon RT, Fan ST. Resection prior to liver transplantation for hepatocellular carcinoma: a strategy of optimizing the role of resection and transplantation in cirrhotic patients with preserved liver function. Liver Transpl 2004; 10:813–5.

    Article  PubMed  Google Scholar 

  32. Belghiti J, Cortes A, Abdalla EK, et al. Resection prior to liver transplantation for hepatocellular carcinoma. Ann Surg 2003; 238:885–92.

    Article  PubMed  Google Scholar 

  33. Yao FY, Bass NM, Nikolai B, et al. Liver transplantation for hepatocellular carcinoma: analysis of survival according to the intention-to-treat principle and dropout from the waiting list. Liver Transpl 2002; 8:873–83.

    Article  PubMed  Google Scholar 

  34. Cherqui D, Laurent A, Tayar C, et al. Laparoscopic liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: midterm results and perspectives. Ann Surg 2006; 243:499–506.

    Article  PubMed  Google Scholar 

  35. Hong SN, Lee SY, Choi MS, et al. Comparing the outcomes of radiofrequency ablation and surgery in patients with a single small hepatocellular carcinoma and well-preserved hepatic function. J Clin Gastroenterol 2005; 39:247–52.

    Article  PubMed  Google Scholar 

  36. Lu DS, Yu NC, Raman SS, et al. Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation. Hepatology 2005; 41:1130–7.

    Article  PubMed  Google Scholar 

  37. Mazzaferro V, Battiston C, Perrone S, et al. Radiofrequency ablation of small hepatocellular carcinoma in cirrhotic patients awaiting liver transplantation: a prospective study. Ann Surg 2004; 240:900–9.

    Article  PubMed  Google Scholar 

  38. Pompili M, Mirante VG, Rondinara G, 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 Transpl 2005; 11:1117–26.

    Article  PubMed  Google Scholar 

  39. Belghiti J. CB, Greig PD, Lencioni R, et al. Treatment before Liver Transplantation for HCC. Ann Surg Oncol 2008; Jan 31(Epub ahead of print)

  40. Salem R, Lewandowski RJ, Atassi B, et al. Treatment of unresectable hepatocellular carcinoma with use of 90Y microspheres (TheraSphere): safety, tumor response, and survival. J Vasc Interv Radiol 2005; 16:1627–39.

    PubMed  Google Scholar 

  41. Kulik LM, Atassi B, van Holsbeeck L, et al. Yttrium-90 microspheres (TheraSphere) treatment of unresectable hepatocellular carcinoma: downstaging to resection, RFA and bridge to transplantation. J Surg Oncol 2006; 94:572–86.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Transplantation, University of Pittsburgh, Pittsburgh, PA, USA

    Jason T. Heckman MD, Michael B. deVera MD, J. Wallis Marsh MD, MBA, Paulo Fontes MD, Michael Nalesnik MD, David A. Geller MD, Jennifer L. Steel PhD & T. Clark Gamblin MD, MS

  2. Division of Interventional Radiology, University of Pittsburgh, Pittsburgh, PA, USA

    Nikhil B. Amesur MD

  3. Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA, USA

    Shane E. Holloway MD & T. Clark Gamblin MD, MS

  4. UPMC Liver Cancer Center, 3459 Fifth Avenue, Pittsburgh, PA, 15213, USA

    T. Clark Gamblin MD, MS

Authors
  1. Jason T. Heckman MD
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  2. Michael B. deVera MD
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  3. J. Wallis Marsh MD, MBA
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  4. Paulo Fontes MD
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  5. Nikhil B. Amesur MD
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  10. T. Clark Gamblin MD, MS
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Corresponding author

Correspondence to T. Clark Gamblin MD, MS.

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Heckman, J.T., deVera, M.B., Marsh, J.W. et al. Bridging Locoregional Therapy for Hepatocellular Carcinoma Prior to Liver Transplantation. Ann Surg Oncol 15, 3169–3177 (2008). https://doi.org/10.1245/s10434-008-0071-3

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  • DOI: https://doi.org/10.1245/s10434-008-0071-3

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