Liver Transplantation After Transarterial Chemoembolization and Radiotherapy for Hepatocellular Carcinoma with Vascular Invasion
- 355 Downloads
The study aims to analyze the oncologic outcomes of living donor liver transplantation (LDLT) after combined transarterial chemoembolization (TACE) and radiotherapy for hepatocellular carcinoma (HCC) with major vascular invasion.
We retrospectively reviewed 17 HCC patients with major vascular invasion who underwent LDLT after combined treatment modality between May 2007 and September 2014. The LDLT timing was determined by the surgeons depending on the disease status and liver function. The intrahepatic recurrence-free survival, disease-free survival (DFS), and overall survival (OS) rates were estimated from the date of the LDLT.
The median follow-up period was 24.5 months (range, 6.4–66.0 months) after the LDLT. The interval between the combined treatment and the LDLT was a median of 5 months (range, 0.4–65.3 months). On the explanted liver, total necrosis was shown in five patients (29.4 %). The 1- and 3-year DFS rates were 70.6 and 57.8 %, respectively. The 1- and 3-year OS rates were 87.4 and 60.5 %, respectively. The major pattern of failure was distant metastasis (35.3 %), and intrahepatic recurrence occurred in three patients (17.6 %) who experienced distant metastasis.
In the selected HCC patients with major vascular invasion, LDLT after combined TACE and radiotherapy showed acceptable oncologic outcomes.
KeywordsHepatocellular carcinoma Vascular invasion Living donor liver transplantation Radiotherapy Transarterial chemoembolization
Conceived and designed the experiments: YJ MHS SMY GWS KHK CSA DBM SH JHP JHK SGL. Performed the experiments: YJ MHS SMY GWS. Analyzed the data: YJ MHS SMY GWS. Contributed reagents/materials/analysis tools: YJ MHS SMY GWS KHK CSA DBM SH JHP JHK SGL. Wrote the paper: YJ MHS SMY GWS JHK SGL
Compliance with Ethical Standards
Every case of transplantation was evaluated and approved by the local authorities as well as the Korean Network for Organ Sharing affiliated by the Ministry of Health and Welfare of Korea. This study was approved by the Institutional Review Board of Asan Medical Center, and written informed consent was waived due to the retrospective nature of the study. However, all information was treated as anonymous and securely protected so as to prevent any invasion of privacy.
Conflict of Interest
The authors declare that they have no conflict of interest.
- 10.Ravaioli M, Grazi GL, Piscaglia F, Trevisani F, Cescon M, Ercolani G, Vivarelli M, Golfieri R, D’Errico Grigioni A, Panzini I, Morelli C, Bernardi M, Bolondi L, Pinna AD. Liver transplantation for hepatocellular carcinoma: results of down-staging in patients initially outside the Milan selection criteria. Am J Transplant 2008;8:2547–2557.CrossRefPubMedGoogle Scholar
- 11.Otto G, Herber S, Heise M, Lohse AW, Monch C, Bittinger F, Hoppe-Lotichius M, Schuchmann M, Victor A, Pitton M. Response to transarterial chemoembolization as a biological selection criterion for liver transplantation in hepatocellular carcinoma. Liver Transpl 2006;12:1260–1267.CrossRefPubMedGoogle Scholar
- 18.Yamada K, Izaki K, Sugimoto K, Mayahara H, Morita Y, Yoden E, Matsumoto S, Soejima T, Sugimura K. Prospective trial of combined transcatheter arterial chemoembolization and three-dimensional conformal radiotherapy for portal vein tumor thrombus in patients with unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 2003;57:113–119.CrossRefPubMedGoogle Scholar
- 19.Yoon SM, Lim YS, Won HJ, Kim JH, Kim KM, Lee HC, Chung YH, Lee YS, Lee SG, Park JH, Suh DJ. Radiotherapy plus transarterial chemoembolization for hepatocellular carcinoma invading the portal vein: long-term patient outcomes. Int J Radiat Oncol Biol Phys 2012;82:2004–2011.CrossRefPubMedGoogle Scholar
- 20.Zeng ZC, Fan J, Tang ZY, Zhou J, Qin LX, Wang JH, Sun HC, Wang BL, Zhang JY, Jiang GL, Wang YQ. A comparison of treatment combinations with and without radiotherapy for hepatocellular carcinoma with portal vein and/or inferior vena cava tumor thrombus. Int J Radiat Oncol Biol Phys 2005;61:432–443.CrossRefPubMedGoogle Scholar
- 24.Chuma M, Taguchi H, Yamamoto Y, Shimizu S, Nakanishi M, Ogawa K, Sho T, Horimoto H, Kobayashi T, Nakai M, Terashita K, Sakuhara Y, Abo D, Tsukuda Y, Tsunematsu S, Hige S, Kato M, Shirato H, Asaka M. Efficacy of therapy for advanced hepatocellular carcinoma: intra-arterial 5-fluorouracil and subcutaneous interferon with image-guided radiation. J Gastroenterol Hepatol 2011;26:1123–1132.CrossRefPubMedGoogle Scholar
- 25.Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, de Oliveira AC, Santoro A, Raoul JL, Forner A, Schwartz M, Porta C, Zeuzem S, Bolondi L, Greten TF, Galle PR, Seitz JF, Borbath I, Haussinger D, Giannaris T, Shan M, Moscovici M, Voliotis D, Bruix J, Group SIS. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 2008;359:378–390.CrossRefPubMedGoogle Scholar
- 27.Salem R, Lewandowski RJ, Mulcahy MF, Riaz A, Ryu RK, Ibrahim S, Atassi B, Baker T, Gates V, Miller FH, Sato KT, Wang E, Gupta R, Benson AB, Newman SB, Omary RA, Abecassis M, Kulik L. Radioembolization for hepatocellular carcinoma using Yttrium-90 microspheres: a comprehensive report of long-term outcomes. Gastroenterology 2010;138:52–64.CrossRefPubMedGoogle Scholar
- 30.Taketomi A, Sanefuji K, Soejima Y, Yoshizumi T, Uhciyama H, Ikegami T, Harada N, Yamashita Y, Sugimachi K, Kayashima H, Iguchi T, Maehara Y. Impact of des-gamma-carboxy prothrombin and tumor size on the recurrence of hepatocellular carcinoma after living donor liver transplantation. Transplantation 2009;87:531–537.CrossRefPubMedGoogle Scholar
- 32.Lee KW, Suh SW, Choi Y, Jeong J, Yi NJ, Kim H, Chul Yoon K, Kyun Hong S, Shin Kim H, Lee KB, Suh KS. Macro-vascular invasion is not an absolute contraindication for living donor liver transplantation. Liver Transpl 2016 Aug 19. doi: 10.1002/lt.24610.