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Burasakarn P, Hongjinda S, Thienhiran A, Phancharoenkit N, Fuengfoo P. Preoperative transarterial chemoembolization does not improve the outcomes of resectable hepatocellular carcinoma: A propensity score-matched study. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2023; 12:169-175. [DOI: 10.18528/ijgii230025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 01/07/2025] Open
Affiliation(s)
- Pipit Burasakarn
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
| | - Sermsak Hongjinda
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
| | - Anuparp Thienhiran
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
| | - Nichaphat Phancharoenkit
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
| | - Pusit Fuengfoo
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
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Stamatiou A, Jankovic J, Szturz P, Fasquelle F, Duran R, Schaefer N, Diciolla A, Digklia A. Case Report: Vasculitis Triggered by SIRT in a Patient With Previously Untreated Cholangiocarcinoma. Front Oncol 2021; 11:755750. [PMID: 34976803 PMCID: PMC8716376 DOI: 10.3389/fonc.2021.755750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022] Open
Abstract
Arising from the biliary tract, cholangiocarcinoma is a rare and aggressive epithelial cancer. According to the primary site, it can be further classified into intrahepatic, perihilar and distal types. Due to the lack of symptoms early in the disease course, most patients are diagnosed at advanced stages. Being not candidates for curative surgical management, these patients are treated with palliative systemic chemotherapy, and their prognosis remains poor. Using radioisotopes like yttrium-90 -labeled microspheres (90Y), radioembolization represents a local approach to treat primary and secondary liver tumors. In the case of intrahepatic cholangiocarcinoma, radioembolization can be used as a primary treatment, as an adjunct to chemotherapy or after failing chemotherapy. An 88-year-old man underwent radioembolization for a previously untreated stage II intrahepatic cholangiocarcinoma. One week later, he presented to our clinic with a non-pruritic maculopapular rash of the lower extremities and abdomen, worsening fatigue and low-grade fever. Laboratory exams, including hepatitis screening, were within normal limits. Showing positive immunofluorescence staining for immunoglobulin M (IgM) and complement 3 (C3) in vessel walls without IgA involvement, the skin biopsy results were compatible with leukocytoclastic vasculitis. Apart from the anticancer intervention, there have been no recent medication changes which could explain this complication. Notably, we did not observe any side effects during or after the perfusion scan with technetium-99m macroaggregated albumin (MAA) performed prior to radioembolization. The symptoms resolved quickly after a short course of colchicine and did not reappear at cholangiocarcinoma progression. In the absence of other evident causes, we conclude that the onset of leukocytoclastic vasculitis in our patient was directly linked to the administration of yttrium-90 -labeled microspheres. Our report therefore demonstrates that this condition can be a rare but manageable complication of 90Y liver radioembolization.
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Affiliation(s)
- Antonia Stamatiou
- Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jeremy Jankovic
- Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Petr Szturz
- Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- *Correspondence: Petr Szturz,
| | - Francois Fasquelle
- University Institute of Pathology, Clinical Pathology Service, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Rafael Duran
- Department of Diagnostic Radiology and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Niklaus Schaefer
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Antonella Diciolla
- Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Antonia Digklia
- Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Feng AL, Zhu JK, Yang Y, Wang YD, Liu FY, Zhu M, Liu CZ. Repeated postoperative adjuvant TACE after curative hepatectomy improves outcomes of patients with HCC. MINIM INVASIV THER 2019; 30:163-168. [PMID: 31880482 DOI: 10.1080/13645706.2019.1707689] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS To gain a clear picture of the influence of postoperative adjuvant transcatheter arterial chemoembolization (TACE) on recurrence after curative resection for HCC. MATERIAL AND METHODS According to the inclusion criteria and the exclusion criteria, the clinical data of 118 patients with HCC at Qilu Hospital, Shan Dong University between January 2011 and August 2013, who were treated by curative hepatectomy and postoperative TACE (two groups of patients received TACE once or twice, respectively) or by curative hepatectomy alone were retrospectively studied. RESULTS The three-year survival (RFS) rate was 51.7% for the whole study population. The three-year relapse-free RFS rates were 73.0% and 55.0% for the patients who received two and one postoperative adjuvant TACE treatments, groups respectively, and 29.3% for the hepatectomy alone group. The three-year RFS of the patients who received postoperative adjuvant TACE once was significantly higher than that of the patients who received hepatectomy alone (p = .024). And the outcome of patients with two adjuvant TACE treatments was better than that of patients who received one treatment (p = .033). CONCLUSIONS Repeated postoperative adjuvant TACE seems to be a promising treatment for HCC that might delay tumor recurrence and improve the RFS rates of patients after curative hepatectomy.
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Affiliation(s)
- A Lei Feng
- Department of Oncology, Shandong Provincial Hospital affiliated to Shandong University, Shangdong, PR China
| | - Jian Kang Zhu
- Department of General Surgery, Qilu Hospital of Shan Dong University, Jinan, PR China.,Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, PR China
| | - Yupeng Yang
- Department of General Surgery, Zhangqiu District Hospital of traditional Chinese Medicine, Jinan, PR China
| | - Ya Dong Wang
- Department of General Surgery, Qilu Hospital of Shan Dong University, Jinan, PR China
| | - Feng Yue Liu
- Department of General Surgery, Qilu Hospital of Shan Dong University, Jinan, PR China
| | - Min Zhu
- Department of General Surgery, Qilu Hospital of Shan Dong University, Jinan, PR China
| | - Chong Zhong Liu
- Department of General Surgery, Qilu Hospital of Shan Dong University, Jinan, PR China
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Xing M, Kim HS. Independent prognostic factors for posttransplant survival in hepatocellular carcinoma patients undergoing liver transplantation. Cancer Med 2016; 6:26-35. [PMID: 27860456 PMCID: PMC5269691 DOI: 10.1002/cam4.936] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/18/2016] [Accepted: 09/12/2016] [Indexed: 12/21/2022] Open
Abstract
The aim of this study was to investigate longitudinal trends in locoregional therapy (LRT) use in hepatocellular carcinoma (HCC) patients listed for transplant, and evaluate independent prognostic factors for overall survival (OS) in HCC patients undergoing orthotopic liver transplantation (OLT). The United Network for Organ Sharing (UNOS) database was used to identify HCC patients listed for liver transplantation from 1988 to 2014, and longitudinal rates of bridging LRT were calculated. OLT recipients listed from 2002 to 2013 and transplanted up to 2014, with ≥1 year of follow‐up were further analyzed. OS was compared between patients receiving bridging LRT versus none, high versus low wait times (HWT vs. LWT), and by geographic region. Bridging LRT use in the US has increased dramatically over 25 years, with more than 50% of listed patients receiving at least 1 LRT in 2014. Of 17,291 HCC patients listed for LT from 2002 to 2013, 14,511 received OLT, mean age 57.4 years, 76.8% male; 3889 received bridging LRT. Comparison groups were similar for gender, race, body mass index (BMI), HCC etiology, and biological MELD scores (P > 0.05). Significant differences in mean OS in regions with HWT/high LRT (122.4 months), HWT/low LRT (104.5 months), LWT/high LRT (104.2 months), and LWT/low LRT (102.3 months) were observed, P = 0.0006. Recipient age, donor age, bridging LRT, and longer wait times were independent prognostic factors of survival from OLT. Increasing longitudinal trends in bridging LRT for HCC patients were observed. Younger age, younger donor age, high wait times, and bridging LRT were significant independent prognostic factors for prolonged survival from transplant.
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Affiliation(s)
- Minzhi Xing
- Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Hyun S Kim
- Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
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Li HL, Ji WB, Zhao R, Duan WD, Chen YW, Wang XQ, Yu Q, Luo Y, Dong JH. Poor prognosis for hepatocellular carcinoma with transarterial chemoembolization pre-transplantation: retrospective analysis. World J Gastroenterol 2015; 21:3599-3606. [PMID: 25834326 PMCID: PMC4375583 DOI: 10.3748/wjg.v21.i12.3599] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 09/30/2014] [Accepted: 10/21/2014] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate whether transarterial chemoembolization (TACE) before liver transplantation (LT) improves long-term survival in hepatocellular carcinoma (HCC) patients. METHODS A retrospective study was conducted among 204 patients with HCC who received LT from January 2002 to December 2010 in PLA General Hospital. Among them, 88 patients received TACE before LT. Prognostic factors of serum α-fetoprotein (AFP), intraoperative blood loss, intraoperative blood transfusion, disease-free survival time, survival time with tumor, number of tumor nodules, tumor size, tumor number, presence of blood vessels and bile duct invasion, lymph node metastasis, degree of tumor differentiation, and preoperative liver function were determined in accordance with the Child-Turcotte-Pugh (Child) classification and model for end-stage liver disease. We also determined time of TACE before transplant surgery and tumor recurrence and metastasis according to different organs. Cumulative survival rate and disease-free survival rate curves were prepared using the Kaplan-Meier method, and the log-rank and χ(2) tests were used for comparisons. RESULTS In patients with and without TACE before LT, the 1, 3 and 5-year cumulative survival rate was 70.5% ± 4.9% vs 91.4% ± 2.6%, 53.3% ± 6.0% vs 83.1% ± 3.9%, and 46.2% ± 7.0% vs 80.8% ± 4.5%, respectively. The median survival time of patients with and without TACE was 51.857 ± 5.042 mo vs 80.930 ± 3.308 mo (χ(2) = 22.547, P < 0.001, P < 0.05). The 1, 3 and 5-year disease-free survival rates for patients with and without TACE before LT were 62.3% ± 5.2% vs 98.9% ± 3.0%, 48.7% ± 6.7% vs 82.1% ± 4.1%, and 48.7% ± 6.7% vs 82.1% ± 4.1%, respectively. The median survival time of patients with and without TACE before LT was 50.386 ± 4.901 mo vs 80.281 ± 3.216 mo (χ(2) = 22.063, P < 0.001, P < 0.05). TACE before LT can easily lead to pulmonary or distant metastasis of the primary tumor. Although there was no significant difference between the two groups, the chance of metastasis of the primary tumor in the group with TACE was significantly higher than that of the group without TACE. CONCLUSION TACE pre-LT for HCC patients increased the chances of pulmonary or distant metastasis of the primary tumor, thus reducing the long-term survival rate.
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Halazun KJ, Patzer RE, Rana AA, Verna EC, Griesemer AD, Parsons RF, Samstein B, Guarrera JV, Kato T, Brown RS, Emond JC. Standing the test of time: outcomes of a decade of prioritizing patients with hepatocellular carcinoma, results of the UNOS natural geographic experiment. Hepatology 2014; 60:1957-62. [PMID: 24954365 DOI: 10.1002/hep.27272] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 06/17/2014] [Indexed: 01/28/2023]
Abstract
UNLABELLED Priority is given to patients with hepatocellular carcinoma (HCC) to receive liver transplants, potentially causing significant regional disparities in organ access and possibly outcomes in this population. Our aim was to assess these disparities by comparing outcomes in long waiting time regions (LWTR, regions 5 and 9) and short waiting time regions (SWTR regions 3 and 10) by analyzing the United Network for Organ Sharing (UNOS) database. We analyzed 6,160 HCC patients who received exception points in regions 3, 5, 9, and 10 from 2002 to 2012. Data from regions 5 and 9 were combined and compared to data from regions 3 and 10. Survival was studied in three patient cohorts: an intent-to-treat cohort, a posttransplant cohort, and a cohort examining overall survival in transplanted patients only (survival from listing to last posttransplant follow-up). Multivariate analysis and log-rank testing were used to analyze the data. Median time on the list in the LWTR was 7.6 months compared to 1.6 months for SWTR, with a significantly higher incidence of death on the waiting list in LWTR than in SWTR (8.4% versus 1.6%, P < 0.0001). Patients in the LWTR were more likely to receive loco-regional therapy, to have T3 tumors at listing, and to receive expanded-criteria donor (ECD) or donation after cardiac death (DCD) grafts than patients in the SWTR (P < 0.0001 for all). Survival was significantly better in the LWTR compared to the SWTR in all three cohorts (P < 0.0001 for all three survival points). Being listed/transplanted in an SWTR was an independent predictor of poor patient survival on multivariate analysis (P < 0.0001, hazard ratio = 1.545, 95% confidence interval 1.375-1.736). CONCLUSION This study provides evidence that expediting patients with HCC to transplant at too fast a rate may adversely affect patient outcomes.
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Affiliation(s)
- Karim J Halazun
- Emory Transplant Center, Emory University Hospital, Atlanta, GA
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Andersen KJ, Grønbaek H, Villadsen GE, Knudsen AR, Ott P, Vildstrup H, Nielsen DT, Bharadwaz A. Chemoembolization of intermediate stage hepatocellular carcinomas: results from a Nordic tertiary liver cancer center. Indian J Gastroenterol 2014; 33:322-9. [PMID: 24307495 DOI: 10.1007/s12664-013-0428-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 10/14/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Transarterial chemoembolization (TACE) is used as palliative treatment of hepatocellular carcinoma (HCC). Most publications are from HCC patient populations where viral hepatitis is the primary cause of liver disease. In the Nordic countries, most patients have either alcohol-induced cirrhosis or are noncirrhotic. The aim of this single-center study was to evaluate patient characteristics, survival, and side effects of TACE in a Danish referral center for HCC treatment. METHODS Fifty-nine consecutive patients with HCC, treated with TACE, either chemoembolization with drug-eluting beads or conventional-TACE with Lipiodol, were included in the study. Their medical records were retrospectively reviewed, computed tomography images analyzed, and biochemical markers recorded. The primary endpoint was overall survival. Analyses were by intention to treat. RESULTS Thirty-five patients (59 %) had HCC on a background of liver cirrhosis most often caused by alcohol (60 % of cirrhotics or 35 % overall). Before the first chemoembolization, the patients had a median Child-Pugh score of 6 (5-7) and a median MELD score of 10 (6-21). Median survival after chemoembolization was 18.9 months (13.1-24.7). TACE patients were hospitalized for an average of 3 days (2-30). Prolonged stay was most often due to side effects-eg. pain (31 %), fever (14 %), nausea (10 %), and infection (10 %). Thirty-three patients (56 %) did not have any side effects. CONCLUSIONS In this cohort, we observed an acceptable survival following TACE without significant side effects.
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Affiliation(s)
- Kasper J Andersen
- Department of Surgical Gastroenterology (Dept. L), Aarhus University Hospital, Nørrebrogade 44, Aarhus C, 8000, Aarhus, Denmark,
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Chua TC, Liauw W, Saxena A, Chu F, Glenn D, Chai A, Morris DL. Systematic review of neoadjuvant transarterial chemoembolization for resectable hepatocellular carcinoma. Liver Int 2010; 30:166-174. [PMID: 19912531 DOI: 10.1111/j.1478-3231.2009.02166.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Resection of hepatocellular carcinoma (HCC) offers the only hope for cure. However, in patients undergoing resection, recurrences, in particular, intrahepatic recurrence are common. The effectiveness of transarterial chemoembolization (TACE) as a neoadjuvant therapy for unresectable HCC was exploited by numerous liver units and employed preoperatively in the setting of resectable HCC with an aim to prevent recurrence and prolong survival. A systematic literature search of databases (Medline and PubMed) to identify published studies of TACE administered preoperatively as a neoadjuvant treatment for resectable HCC was undertaken. A systematic review by tabulation of the results was performed with disease-free survival (DFS) as the primary endpoint. Overall survival (OS), rate of pathological response, impact on surgical morbidity and mortality and pattern of recurrences were secondary endpoints of this review. Eighteen studies; three randomized trials and 15 observational studies were evaluated. This comprised of 3927 patients, of which, 1293 underwent neoadjuvant TACE. The median DFS in the TACE and non-TACE group ranged from 10 to 46 and 8 to 52 months, respectively, with 67% of studies reporting similar DFS between groups despite higher extent of tumour necrosis from the resected specimens indicating a higher rate of pathological response (partial TACE 27-72% vs. non-TACE 23-52%; complete TACE 0-28% vs. non-TACE zero), with no difference in surgical morbidity and mortality outcome. No conclusion could be drawn with respect to OS. Both randomized and non-randomized trials suggest the use of TACE preoperatively as a neoadjuvant treatment in resectable HCC is a safe and efficacious procedure with high rates of pathological responses. However, it does not appear to improve DFS.
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Affiliation(s)
- Terence C Chua
- Department of Surgery, University of New South Wales, St George Hospital, Kogarah, Sydney, NSW, Australia
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Díaz-Sánchez A, Matilla A, Núñez O, Merino B, Peligros I, Rincón D, Salcedo M, Lo Iacono O, Vega Catalina M, Clemente G, Bañares R. [Influence of treatment of hepatocellular carcinoma before liver transplantation on post transplant tumor recurrence and survival]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 33:155-64. [PMID: 19945770 DOI: 10.1016/j.gastrohep.2009.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 10/04/2009] [Accepted: 10/08/2009] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To evaluate the effectiveness of treatment of hepatocellular carcinoma (HCC) before liver transplantation (LT) and its influence on survival and tumor recurrence in patients transplanted for HCC. PATIENTS AND METHODS We included 67 liver transplant patients with a preoperative diagnosis of HCC and pathological confirmation in the native liver between January 2000 and October 2007. Treatment before LT was performed in 46 (68.7%) patients [radiofrequency ablation in 18, transarterial chemoembolization in 31 and percutaneous ethanol injection in two]. RESULTS The median time between inclusion on the waiting list and LT was 4 months and was similar in treated and untreated patients. The median time between pre-transplantation locoregional therapy and LT was less than 6 months in 65.2% of the patients. Treated patients had better liver function (Child A 52.2 vs 19%; Child B 39.1 vs 33.3%; Child C 8.7 vs. 47.6%; p=0.001) and a higher proportion of total tumor size > 3 cm (59.1% vs 30%; p=0.031). Total tumor necrosis was observed in 26.1% of the patients, with no differences according to treatment modality or tumor size. Tumor recurrence occurred in six patients (9%). The median time between LT and tumor recurrence was 26.5 months with a subsequent median survival of 6.6 months. Overall survival was 83.5%, 69.9% and 59.5%, and tumor recurrence-free survival was 83.5%, 68.3% and 58% at 1, 3 and 5 years, respectively. Previous HCC treatment showed no influence on survival or tumor recurrence. Likewise, the grade of tumor necrosis was unrelated to overall survival or the probability of recurrence. CONCLUSION Treatment of HCC before LT in patients with a waiting list time of less than 6 months does not appear to influence survival or tumor recurrence.
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Affiliation(s)
- Antonio Díaz-Sánchez
- Sección de Hepatología, CIBEREHD, Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España.
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Decaens T, Hurtova M, Duvoux C. Transplantation hépatique pour carcinome hépatocellulaire. ACTA ACUST UNITED AC 2009; 33:61-9. [DOI: 10.1016/j.gcb.2008.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Optimal strategies for combining transcatheter arterial chemoembolization and radiofrequency ablation in rabbit VX2 hepatic tumors. J Vasc Interv Radiol 2008; 19:1740-8. [PMID: 18951042 DOI: 10.1016/j.jvir.2008.08.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Revised: 08/24/2008] [Accepted: 08/31/2008] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To determine the optimum combination strategy of transcatheter arterial chemoembolization and radiofrequency (RF) ablation in an experimentally induced hepatic tumor model. MATERIALS AND METHODS Twenty-five New Zealand White rabbits with VX2 carcinoma-induced hepatic tumors were randomly divided into five treatment groups, which received (i) chemoembolization followed 15 minutes later by RF ablation; (ii) RF ablation followed by chemoembolization; (iii) chemoembolization alone; (iv) RF ablation alone; and (v) bland embolization followed by RF ablation. Animals were euthanized at 48 hours to determine tumor infarction and coagulation, which were compared with analysis of variance. Representative histopathologic slides were compared. RESULTS Significantly larger areas of coagulation were produced by chemoembolization followed by RF ablation (22.0 cm(3) +/- 7.7) compared with RF ablation followed by chemoembolization (13.1 cm(3) +/- 3.2) and RF ablation alone (10.0 cm(3) +/- 4.5; P < .05). RF ablation followed by chemoembolization showed larger treatment areas than chemoembolization alone (25.0 cm(3) +/- 9.6 vs 12.1 cm(3) +/- 4.6; P < .001), with chemotherapeutic agent preferentially depositing around the coagulation zone. Histopathologic analysis revealed greater vascular thrombosis and necrosis and reduced islands of viable tumor cells in the chemoembolization/RF ablation group versus the groups treated with chemoembolization alone or bland embolization/RF ablation. CONCLUSIONS Larger treatment volumes were produced when chemoembolization was performed before RF ablation than when RF ablation preceded chemoembolization or when RF ablation or chemoembolization were performed alone. Larger treatment volumes were also produced when chemoembolization rather than bland embolization was performed before RF ablation, indicating the importance and synergy of the chemotherapeutic regimen. These results suggest that the reduction of tumor blood flow combined with the effect of hyperthermia and local chemotherapy creates the largest dimensions of treatment.
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Aloia TA, Adam R, Samuel D, Azoulay D, Castaing D. A decision analysis model identifies the interval of efficacy for transarterial chemoembolization (TACE) in cirrhotic patients with hepatocellular carcinoma awaiting liver transplantation. J Gastrointest Surg 2007; 11:1328-32. [PMID: 17682827 DOI: 10.1007/s11605-007-0211-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Accepted: 06/10/2007] [Indexed: 02/06/2023]
Abstract
INTRODUCTION For liver transplant candidates with hepatocellular carcinoma (HCC), the ability of neoadjuvant transarterial chemoembolization (TACE) to improve outcomes remains unproven. The objective of our study was to determine if there was a specific time interval where neoadjuvant TACE would decrease the number of HCC patients removed from the pretransplant waitlist. MATERIALS AND METHODS A decision model was developed to simulate a randomized trial of neoadjuvant treatment with TACE vs. no TACE in 600 virtual patients with HCC and cirrhosis. Transition probabilities for TACE morbidity (1 +/- 1%), TACE response rates (30 +/- 20%), and disease progression (7 +/- 7% per month) were assigned by systematic review of the literature (18 reports). Sensitivity analyses were performed to determine time thresholds where TACE would decrease the number of delisted patients. RESULTS TACE treatment had statistical benefit at waitlist time breakpoints of 4 and 9 months (P < 0.05). When waitlist times were less than 4 months, waitlist attrition was similar (20% vs. 34%, P = 0.08). When waitlist times exceed 9 months, waitlist dropout rates re-equilibrated (33% vs. 46%, P = 0.06). Review of the current literature determined that only those studies reporting on patients with waitlist times between 4 and 9 months found a benefit to neoadjuvant TACE. CONCLUSIONS This analysis indicates that the benefit of neoadjuvant TACE may be limited to those patients transplanted from 4 to 9 months from first TACE. These data may help transplant programs to tailor TACE treatments based on predicted waitlist times to achieve optimal resource utilization and improved organ allocation efficiency.
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Affiliation(s)
- Thomas A Aloia
- Division of Abdominal Transplantation and Hepatobiliary Surgery, Department of Surgery, Baylor College of Medicine, 1709 Dryden, Suite 15.37, Houston, TX 77030, USA.
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Dharancy S, Boitard J, Decaens T, Sergent G, Boleslawski E, Duvoux C, Vanlemmens C, Meyer C, Gugenheim J, Durand F, Boillot O, Declerck N, Louvet A, Canva V, Romano O, Ernst O, Mathurin P, Pruvot FR. Comparison of two techniques of transarterial chemoembolization before liver transplantation for hepatocellular carcinoma: a case-control study. Liver Transpl 2007; 13:665-71. [PMID: 17427172 DOI: 10.1002/lt.21109] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Supraselective transarterial chemoembolization (STACE) more efficiently targets chemotherapy delivered via the feeding arterial branches of the tumor than does conventional transarterial chemoembolization (TACE). However, the hypothesis of its greater efficacy compared with the latter is subject to controversy. The aim of the present study was to compare STACE to conventional TACE in a controlled study of candidates for liver transplantation (LT) for hepatocellular carcinoma (HCC). Patients were matched for factors associated with HCC recurrence and survival. Sixty patients were included: 30 who were treated with STACE and 30 treated with conventional TACE. The 2 groups were similar in terms of matched criteria. In the overall population (uni- and multinodular HCC), there was no marked difference between the 2 groups in 5-year disease-free survival: 76.8% vs. 74.8%. In sensitivity analysis of patients considered to be the best candidates for TACE (uninodular HCC < or =5 cm), there was a trend toward significance between STACE and TACE in 5-year disease-free survival: 87% vs. 64% (P = 0.09). The only factor associated with complete tumor necrosis was STACE in the overall population (30.8% vs. 6.9%, P = 0.02), with a similar trend in the subgroup of patients with a single nodule (33.3% vs. 6.7%, P = 0.06), whereas the mean number of procedures was similar in the 2 groups (mean, 1.3 procedures; range 1-5 procedures; P = NS). STACE is more efficient at inducing complete tumor necrosis in the liver. This study observed trends toward improvement in the disease-free survival of patients with uninodular HCC < or =5 cm. Future studies focusing on such patients are warranted.
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Affiliation(s)
- Sébastien Dharancy
- Service des Maladies de l'Appareil Digestif et de la Nutrition, Hôpital Huriez, CHU Lille, France.
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14
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Ogata S, Belghiti J, Farges O, Varma D, Sibert A, Vilgrain V. Sequential arterial and portal vein embolizations before right hepatectomy in patients with cirrhosis and hepatocellular carcinoma. Br J Surg 2006; 93:1091-8. [PMID: 16779884 DOI: 10.1002/bjs.5341] [Citation(s) in RCA: 181] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Selective transarterial chemoembolization (TACE) and portal vein embolization (PVE) could improve the rate of hypertrophy of the future liver remnant (FLR) in patients with chronic liver disease. This study evaluated the feasibility and efficacy of this combined procedure. METHODS Between November 1998 and October 2004, 36 patients with cirrhosis and hepatocellular carcinoma underwent right hepatectomy after PVE. Additional TACE preceded PVE by 3-4 weeks in 18 patients (TACE+PVE group) and the remaining 18 patients had PVE alone (PVE group). RESULTS PVE was well tolerated in all patients. The mean increase in percentage FLR volume was significantly higher in the TACE+PVE group than in the PVE group (mean(s.d.) 12(5) versus 8(4) percent; P=0.022). The rate of hypertrophy was more than 10 percent in 12 patients in the TACE+PVE group and in five who had PVE alone (P=0.044). Duration of surgery, blood loss, incidence of liver failure and mortality (two patients in each group) were similar in the two groups. None of the 17 patients with an increase in FLR volume of more than 10 percent died, whereas there were four deaths among 19 patients with a smaller increase. The incidence of complete tumour necrosis was significantly higher in the TACE+PVE group (15 of 18 versus one of 18; P<0.001), with a higher 5-year disease-free survival rate (37 versus 19 percent; P=0.041). CONCLUSION Sequential TACE and PVE before operation increases the rate of hypertrophy of the FLR and leads to a high rate of complete tumour necrosis associated with longer recurrence-free survival.
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Affiliation(s)
- S Ogata
- Department of Hepato-Pancreato-Biliary Surgery, Hospital Beaujon-University Paris VII, Clichy, France
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15
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Decaens T, Roudot-Thoraval F, Bresson-Hadni S, Meyer C, Gugenheim J, Durand F, Bernard PH, Boillot O, Boudjema K, Calmus Y, Hardwigsen J, Ducerf C, Pageaux GP, Dharancy S, Chazouilleres O, Dhumeaux D, Cherqui D, Duvoux C. Impact of pretransplantation transarterial chemoembolization on survival and recurrence after liver transplantation for hepatocellular carcinoma. Liver Transpl 2005; 11:767-775. [PMID: 15973710 DOI: 10.1002/lt.20418] [Citation(s) in RCA: 163] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The actual impact of transarterial chemoembolization before liver transplantation (LT) for hepatocellular carcinoma (HCC) on patient survival and HCC recurrence is not known. Between 1985 and 1998, 479 patients with HCC in 14 French centers were evaluated for LT. Among these 479 patients, this case-control study included 100 patients who received transarterial chemoembolization before LT (TACE group) and 100 control patients who did not receive chemoembolization (no-TACE group). Patients and controls were matched for the pre-LT tumor characteristics, the period of transplantation, the time spent on the waiting list, and pre- and posttransplantation treatments. Kaplan-Meier estimates were calculated 5 years after LT and were compared with the log-rank test. The mean waiting time before LT was 4.2 +/- 3.2 months in the TACE group and 4.3 +/- 4.4 months in the no-TACE group. The median number of TACE procedures was 1 (range: 1-12). Demographic data, median alpha-fetoprotein level (21.6 ng/mL and 22.0 ng/mL, respectively), and pre- and post-LT morphologic characteristics of the tumors did not differ in the TACE and no-TACE groups. Overall 5-year survival was 59.4% with TACE and 59.3% without TACE (ns). Survival rates did not differ significantly between the two groups with respect to the time on the waiting list, the tumor diameter, or the type of TACE (selective or nonselective). In the TACE group, 30 patients had tumor necrosis > or =80% on the liver explant with a 5-year survival rate of 63.2%, compared with 54.2% among their matched controls (P = 0.9). In conclusion, with a mean waiting period of 4.2 months and 1 TACE procedure, pre-LT TACE does not influence post-LT overall survival and disease-free survival.
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Affiliation(s)
- Thomas Decaens
- Service d'Hépatologie et de Gastroentérologie, AP-HP, Hôpital Henri Mondor, Créteil, France
- Institut Cochin, Inserm U567, Paris, France
| | | | | | - Carole Meyer
- Service de Transplantation, Hôpital Hautefeuille, Strasbourg, France
| | - Jean Gugenheim
- Service de Chirurgie Digestive, Hôpital L'Archet 2, Nice, France
| | - Francois Durand
- Service d'Hépatologie, AP-HP, Hôpital Beaujon, Clichy, France
| | - Pierre-Henri Bernard
- Service d'Hépatologie et de Gastroentérologie, Hôpital Pellegrin, Bordeaux, France
| | - Olivier Boillot
- Service de Chirurgie Digestive, Hôpital Edouard Herriot, Lyon, France
| | - Karim Boudjema
- Département de Chirurgie Viscérale, Hôpital Ponchaillou, Rennes, France
| | - Yvon Calmus
- Service de Chirurgie Digestive, AP-HP, Hôpital Cochin, Paris, France
| | - Jean Hardwigsen
- Service de Chirurgie Digestive, Hôpital la Conception, Marseille, France
| | - Christian Ducerf
- Service de Chirurgie Digestive, Hôpital de la Croix Rousse, Lyon, France
| | - Georges Philippe Pageaux
- Fédération Médico-Chirurgicale des Maladies de l'Appareil Digestif, Hôpital Saint-Eloi, Montpellier, France
| | - Sebastien Dharancy
- Service d'Hépatologie et de Gastroentérologie, Hôpital Claude Huriez, Lille, France
| | | | - Daniel Dhumeaux
- Service d'Hépatologie et de Gastroentérologie, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - Daniel Cherqui
- Service de Chirurgie Générale et Digestive, AP-HP, Hopital Henri Mondor, Créteil, France
| | - Christophe Duvoux
- Service d'Hépatologie et de Gastroentérologie, AP-HP, Hôpital Henri Mondor, Créteil, France
- Inserm U581, Créteil, France
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Abstract
Over the past twenty-five years, hepatic resection has evolved from a high risk, resource-intensive procedure with limited application to a safe and commonly performed operation with broad indications. This period has seen dramatic improvements in perioperative outcome, including reductions in mortality, blood loss, transfusion rates, and hospital stay. These improved perioperative results are largely responsible for the emergence of hepatic resection as a viable and effective treatment option for selected patients with 1 degree and 2 degrees hepatobiliary malignancy. Continued advances in imaging technology, along with a heightened awareness of the clinical and tumor-related variables that dictate outcome, have allowed better preoperative assessment of disease extent and improved patient selection. Advances in other areas, such as minimally invasive and ablative techniques, have increased the treatment options and have had some impact on the approach to patients with malignant hepatobiliary disease; however, resection remains the most effective therapy. Although the long term results after resection are better than with other modalities, recurrence rates remain high, and further improvements in survival will require more effective systemic agents. As better adjuvant and neo-adjuvant therapies emerge, the results of resection are likely to improve and the indications for its application perhaps will extend to patients currently considered to have unresectable disease.
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Affiliation(s)
- David A Kooby
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, USA
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Gerber DA, Arcement C, Carr B, Towbin R, Mazariegos G, Reyes J. Use of intrahepatic chemotherapy to treat advanced pediatric hepatic malignancies. J Pediatr Gastroenterol Nutr 2000; 30:137-44. [PMID: 10697131 DOI: 10.1097/00005176-200002000-00009] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND To evaluate the effect of intrahepatic arterial chemotherapy (IAC) on children with primary hepatic malignancies. METHOD A nonrandomized inception cohort of 11 pediatric patients was referred for treatment of advanced primary hepatic malignancies at Children's Hospital of Pittsburgh. None of the patients was a candidate for resection before the initiation of IAC. Tumor response to treatment was observed by determining serum alpha-fetoprotein (AFP) levels and by abdominal computed tomographic scan. The patients received hepatic artery infusions of cisplatin and/or doxorubicin. The last five also received gelfoam embolization. RESULTS Eight of 11 patients had multiple IAC treatments. Eight patients had AFP-producing tumors, and five of the eight had dramatic reductions in serum levels after IAC treatment. Five of the 11 patients underwent successful orthotopic liver transplantation after receiving IAC therapy, and the five explanted specimens showed varying degrees of tumor necrosis. One-year survival in patients in the authors' center is 67% for those with hepatoblastoma and 40% for those with hepatocellular carcinoma. Three-year survival is 60% and 30% for patients with hepatoblastoma and hepatocellular carcinoma, respectively. CONCLUSION Intrahepatic arterial chemotherapy therapy can halt the progression and possibly down-stage advanced pediatric hepatic malignancies. This therapy can also be used as a successful adjunct in altering a patient's chance for successful liver transplantation.
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Affiliation(s)
- D A Gerber
- Department of Surgery, University of North Carolina, Chapel Hill 27599, USA
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18
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Abstract
The past 25 years have seen a dramatic improvement in results of treatment of children with HBL; formerly, < 25% were cured, and today, 65 to 75% may be cured. New, active agents are still needed, and the late effects of therapy, especially on the heart and kidneys, remain a concern. Nevertheless, it is clear that treatment of HBL is indeed "a bit of a success story" (42).
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Affiliation(s)
- B Raney
- Department of Pediatrics, M.D. Anderson Cancer Center, University of Texas, Houston, Texas 77030, USA
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Farinati F, De Maria N, Marafin C, Herszènyi L, Del Prato S, Rinaldi M, Perini L, Cardin R, Naccarato R. Unresectable hepatocellular carcinoma in cirrhosis: survival, prognostic factors, and unexpected side effects after transcatheter arterial chemoembolization. Dig Dis Sci 1996; 41:2332-9. [PMID: 9011438 DOI: 10.1007/bf02100123] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
To evaluate the efficacy of transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma, the prognostic factors, and the side effects, 72 patients undergoing 170 chemoembolizations with lipiodol-mediated injection of adriamycin were investigated. The 1-, 2-, and 3-year survivals are 83, 61, and 56%, respectively. Significant prognostic factors for survival (by Mantael-Haenszel) are Child-Pugh and Okuda status (p = 0.00001 and p = 0.01 respectively), number of TACE courses (p = 0.002) and of courses completed with embolization (p = 0.05), stabilization or reduction of alpha-fetoprotein (p = 0.003), and concurrent tamoxifen treatment (p = 0.04). Side effects included fever, pain, increased serum amylase and transaminase levels, and one liver abscess with death of liver failure. In addition, mild hyperglycemia was observed in 19% of patients and severe in 8% (with one hyperosmolar diabetic coma), in the absence of pancreatic damage. In conclusion, transcatheter arterial chemoembolization is useful in patients with unresectable hepatocellular carcinoma. Prognostic factors are Child-Pugh and Okuda status, number of TACE courses and of embolizations, changes of alpha-fetoprotein levels, and association with tamoxifen treatment. The development of mild to severe changes of glucose metabolism suggests that glucose tolerance should be evaluated before and glycemia strictly monitored after each TACE course.
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Affiliation(s)
- F Farinati
- Cattedra Malattie Apparato Digerente, Istituto di Medicina Interna, Università di Padova, Italy
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21
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Bhattacharya S, Novell JR, Winslet MC, Hobbs KE. Iodized oil in the treatment of hepatocellular carcinoma. Br J Surg 1994; 81:1563-71. [PMID: 7827876 DOI: 10.1002/bjs.1800811105] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
When injected into the hepatic artery the contrast agent Lipiodol (iodized poppy seed oil) is selectively retained by hepatocellular carcinoma (HCC) for a prolonged period of time. Liver computed tomography (CT) performed after Lipiodol angiography is more sensitive than ordinary CT at imaging HCC. Arterial administration of cytotoxic drugs and radioisotopes conjugated to Lipiodol has been shown to be reasonably safe in patients with irresectable HCC. These therapies, often combined with embolization, provide effective palliation, better tumour response and improved survival compared with other available treatments. Their use as a preoperative adjunct to surgical resection of HCC is controversial.
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Affiliation(s)
- S Bhattacharya
- University Department of Surgery, Royal Free Hospital and School of Medicine, London, UK
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