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Radioembolization for Hepatocellular Carcinoma in Downstaging and Bridging for Liver Transplantation

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Abstract

Purpose

Hepatocellular carcinoma (HCC) is the most common primary liver tumor. Only about one third of them are eligible for curative treatments like liver transplantation. Various interventional oncologic treatment options could be employed for some of the HCC patients outside the acceptable liver transplantation criteria to make them suitable for transplantation by downstaging and keeping them inside the criteria by bridging to transplantation.

Methods

We reviewed the literature by the terms of downstaging and bridging therapy for liver transplantation.

Results

About only 30% of the patients are suitable for curative procedures like transplantation at the time of diagnosis of HCC. Even the Milan Criteria is expanded or new criteria are defined, still there are many patients who need downstaging to be eligible for transplantation. There are different procedures in interventional oncology for primary and metastatic liver lesions. Radioembolization (RE) is one of the locoregional therapies which is more effective than others for downstaging and bridging for liver transplantation.

Conclusion

Downstaging by RE is an effective and reasonable method for unresectable HCC cases initially beyond established criteria for liver transplantation by selecting suitable and favorable tumor biology.

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References

  1. Makary MS, et al. Locoregional therapy approaches for hepatocellular carcinoma: recent advances and management strategies. Cancers (Basel). 2020;12(7).

  2. Tabone M, Calvo A, Russolillo N, Langella S, Carbonatto P, Tesoriere RL, et al. Downstaging unresectable hepatocellular carcinoma by radioembolization using 90-yttrium resin microspheres: a single center experience. J Gastrointest Oncol. 2020;11(1):84–90.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Viveiros P, et al. Current state of liver-directed therapies and combinatory approaches with systemic therapy in hepatocellular carcinoma (HCC). Cancers. 2019;11(8).

  4. O'Leary C, Mahler M, Soulen MC. Curative-intent therapies in localized hepatocellular carcinoma. Curr Treat Options in Oncol. 2020;21(4).

  5. Titano J, Voutsinas N, Kim E. The role of radioembolization in bridging and downstaging hepatocellular carcinoma to curative therapy. Semin Nucl Med. 2019;49(3):189–96.

    Article  PubMed  Google Scholar 

  6. Gans JH, Lipman J, Golowa Y, Kinkhabwala M, Kaubisch A. Hepatic cancers overview: surgical and chemotherapeutic options, how do Y-90 microspheres fit in? Semin Nucl Med. 2019;49(3):170–81.

    Article  PubMed  Google Scholar 

  7. Kulik L, Heimbach JK, Zaiem F, Almasri J, Prokop LJ, Wang Z, et al. Therapies for patients with hepatocellular carcinoma awaiting liver transplantation: a systematic review and meta-analysis. Hepatology. 2018;67(1):381–400.

    Article  CAS  PubMed  Google Scholar 

  8. Ettorre GM, Laurenzi A. Other “Bridge” therapies for liver transplantation: RFA, TACE, and TARE. Liver Transpl Hepatobiliary Surg. 2020:183–91.

  9. Lingiah VA, Niazi M, Olivo R, Paterno F, Guarrera JV, Pyrsopoulos NT. Liver transplantation beyond Milan criteria. J Clin Transl Hepatol. 2020;8(1):69–75.

    PubMed  PubMed Central  Google Scholar 

  10. Khreiss, M.G., D.A., Downstaging hepatocellular carcinoma for liver transplantation, in contemporary liver transplantation : the successful liver transplant program, C. Doria, Editor. 2019, Springer International Publishing imprint, Springer: Cham.

    Google Scholar 

  11. Sandri GBL, Rayar M, Qi X, Lucatelli P. Liver transplant for patients outside Milan criteria. Transl Gastroenterol Hepatol. 2018;3:81.

    Article  Google Scholar 

  12. Wehrenberg-Klee E, Gandhi RT, Ganguli S. Patient selection and clinical outcomes of Y90 in hepatocellular carcinoma. Tech Vasc Interv Radiol. 2019;22(2):70–3.

    Article  PubMed  Google Scholar 

  13. Ma J, et al. Intraarterial liver-directed therapies: the role of interventional oncology. Ochsner J. 2017;17(4):412–6.

    PubMed  PubMed Central  Google Scholar 

  14. Kishore S, Friedman T, Madoff DC. Update on embolization therapies for hepatocellular carcinoma. Curr Oncol Rep. 2017;19(6):40.

    Article  PubMed  Google Scholar 

  15. Somma F, Stoia V, Serra N, D’Angelo R, Gatta G, Fiore F. Yttrium-90 trans-arterial radioembolization in advanced-stage HCC: the impact of portal vein thrombosis on survival. PLoS One. 2019;14(5):e0216935.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Lewandowski RJ, Kulik LM, Riaz A, Senthilnathan S, Mulcahy MF, Ryu RK, et al. A comparative analysis of transarterial downstaging for hepatocellular carcinoma: chemoembolization versus radioembolization. Am J Transplant. 2009;9(8):1920–8.

    Article  CAS  PubMed  Google Scholar 

  17. Gabr A, Polineni P, Mouli SK, Riaz A, Lewandowski RJ, Salem R. Neoadjuvant radiation lobectomy as an alternative to portal vein embolization in hepatocellular carcinoma. Semin Nucl Med. 2019;49(3):197–203.

    Article  PubMed  Google Scholar 

  18. Radunz S, Treckmann J, Baba HA, Best J, Müller S, Theysohn JM, et al. Long-term outcome after liver transplantation for hepatocellular carcinoma following yttrium-90 radioembolization bridging treatment. Ann Transpl. 2017;22:215–21.

    Article  CAS  Google Scholar 

  19. Kollmann D, Selzner N, Selzner M. Bridging to liver transplantation in HCC patients. Langenbeck's Arch Surg. 2017;402(6):863–71.

    Article  Google Scholar 

  20. Mouli SK, Goff LW. Local arterial therapies in the management of unresectable hepatocellular carcinoma. Curr Treat Options in Oncol. 2017;18(11):67.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Inonu University School of Medicine & Liver Transplantation Institute, 44280, Malatya, Turkey

    Ramazan Kutlu & Sinan Karatoprak

Authors
  1. Ramazan Kutlu
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  2. Sinan Karatoprak
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Correspondence to Ramazan Kutlu.

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Kutlu, R., Karatoprak, S. Radioembolization for Hepatocellular Carcinoma in Downstaging and Bridging for Liver Transplantation. J Gastrointest Canc 51, 1157–1164 (2020). https://doi.org/10.1007/s12029-020-00492-y

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