scholarly journals Bridging therapy effectiveness in the treatment of hepatocellular carcinoma prior to orthotopic liver transplantation

2017 ◽  
Vol 8 (6) ◽  
pp. 1051-1055 ◽  
Author(s):  
Maria M. Rubinstein ◽  
Andreas Kaubisch ◽  
Milan Kinkhabwala ◽  
John Reinus ◽  
Qiang Liu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Bridging Therapy ◽  
Therapy Effectiveness

Bridging therapy effectiveness in the treatment of hepatocellular carcinoma prior to orthotopic liver transplantation.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 401-401
Author(s):  
Maria M Zlobinsky Rubinstein ◽  
Andreas Kaubisch ◽  
Milan Kinkhabwala ◽  
John Reinus ◽  
Qiang Liu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Radiation Therapy ◽  
Orthotopic Liver Transplantation ◽  
Histopathological Examination ◽  
Complete Response ◽  
Aggressive Approach ◽  
Alcohol Ablation ◽  
Therapy Effectiveness ◽  
Explant Analysis

401 Background: Orthotopic liver transplantation (OLT) is the only curative intervention for both hepatocellular carcinoma (HCC) and underlying cirrhosis. OLT is limited by both donor organ shortages and long waitlists for transplant. In order to halt tumor progression, various bridging therapies (BT) have been utilized. Despite complete radiologic responses following BT, viable tumor is often present on explant analysis. We present an update of our experience and include novel bridging modalities. Methods: 35 patients were retrospectively evaluated in a transplant center prior to OLT for HCC. A total of 68 locoregional therapies were utilized. Success of BT was assessed by radiologic response and histopathological examination of the explanted livers. Results: 61 nodules were studied in liver explants. Pre-transplant treatments included: TACE, alcohol ablation (ETOH), radiofrequency ablation (RFA), microwave ablation, selective internal radiation therapy (SIRT) and stereotactic body radiation therapy (SBRT). Radiologically, 36 nodules (59 %) achieved complete response compared to 20 nodules (33%) on explant analysis. Approximately 1/3 of treated nodules with complete tumor necrosis (CTN) were treated with TACE + RFA. 60% of nodules (12/20) with CTN were treated with more than one bridging modality. 75% of nodules (3/4) treated with SIRT alone showed CTN. Patients underwent a mean of 2.2 BT. Four out of 35 (11%) patients had no residual HCC on explant analysis. Conclusions: Although favorable radiologic responses are seen following BT, viable HCC is often seen in liver explants. Newer strategies like SIRT may enhance locoregional control and should be explored as part of an aggressive approach for patients awaiting transplant. [Table: see text]

Effect of bridging therapy for hepatocellular carcinoma prior to orthotopic liver transplantation on disease control and response.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 343-343
Author(s):  
J. W. Chuy ◽  
M. Kinkhabwala ◽  
J. Reinus ◽  
K. Tanaka ◽  
A. Kaubisch
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Disease Control ◽  
Orthotopic Liver Transplantation ◽  
Tumor Necrosis ◽  
Pathological Examination ◽  
Bridging Therapy ◽  
Alcohol Ablation ◽  
Viable Tumor ◽  
Complete Tumor

343 Background: Orthotopic liver transplantation (OLT) is curative for both hepatocellular carcinoma (HCC) and underlying cirrhosis, but this option is limited by lengthy waiting times and donor organ shortages. Various bridging therapies have been employed to slow tumor progression, with reported results radiographically confirming local control with variable rates of tumor necrosis on pathologic examination of explants. Methods: We retrospectively studied 11 patients who underwent a total of 26 locoregional therapies prior to OLT for HCC. One patient was also maintained on sorafenib. The effectiveness of bridging therapies was assessed by radiologic response and histopathological examination of the explanted livers. Results: Sixteen tumor nodules identified in liver explants were evaluated. Pretransplant treatments included: TACE alone (5), TACE + sorafenib (2), RFA alone (1), TACE + RFA (6), or TACE + alcohol ablation (2) prior to OLT. Two nodules (13%) achieved complete tumor necrosis on explant analysis; these had been treated with TACE + RFA. Among 11 patients who underwent bridging therapies, 5 patients (45%) had no radiologic evidence of viable tumor prior to OLT. Among these patients, explant examination showed 2 patients with partial necrosis, 2 patients with at least 90% necrosis, and one patient with no evidence of viable tumor. Three patients with enhancing lesions on imaging prior to OLT had 100% concordance rate on pathological examination of the liver explant with respect to number of nodules identified. Conclusions: Although bridging therapy prior to OLT is effective in achieving disease control, most patients have viable tumor present upon assessment of explanted livers. Absence of viable tumor by radiologic evaluation following bridging therapy does not correspond to complete tumor necrosis. [Table: see text] No significant financial relationships to disclose.

scholarly journals Hepatocellular carcinoma in patients undergoing orthotopic liver transplantation: radiological findings with anatomopathological correlation in Brazil

2006 ◽  
Vol 43 (1) ◽  
pp. 24-29 ◽  
Author(s):  
Antônio Carlos Maciel ◽  
Carlos Thadeu Cerski ◽  
Roger Klein Moreira ◽  
Vinicius Labrea Resende ◽  
Maria Lúcia Zanotelli ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Orthotopic Liver Transplantation ◽  
Imaging Techniques ◽  
Arterial Phase ◽  
Hepatitis C Virus Infection ◽  
Cirrhotic Patients

BACKGROUND: Hepatocellular carcinoma is one of the most common malignant tumors worldwide. Imaging techniques, specially computed tomography and ultrasound, are among the most useful diagnostic tools, although the accuracy of these methods may have a significant variability. AIMS: To determine the prevalence of hepatocellular carcinoma in cirrhotic patients undergoing orthotopic liver transplantation at "Santa Casa de Misericórdia" of Porto Alegre, RS, Brazil; to estimate the sensitivity of computed tomography and ultrasound in pretransplantation detection of hepatocellular carcinoma in this population; to correlate the radiological characteristics with anatomopathological findings. MATERIALS AND METHODS: Retrospective prevalence study. Population: adult, cirrhotic patients undergoing orthotopic liver transplantation from January 1990 to July 2003. Among the 292 transplanted patients, 31 cases of hepatocellular carcinoma were diagnosed, of which 29 were included in the study. Tumor characteristics in both ultrasound and computed tomography were compared to those observed in anatomopathological examination. RESULTS: Prevalence of hepatitis C virus infection among patients with diagnosis of hepatocellular carcinoma was 93.5%, and the prevalence of hepatocellular carcinoma among transplanted patients was 10.6%. The overall sensitivity of the imaging techniques was 70.3% for computed tomography and 72% for ultrasound. CONCLUSION: The prevalence of hepatocellular carcinoma at our institution, as well as the sensitivity of both ultrasound and computed tomography to detect such tumors at pretransplantation screening were similar to those found by other authors, while the prevalence of hepatitis C virus infection, the most common etiological agent for liver disease in our patients, is one of the highest ever reported in literature. Factors influencing hepatocellular carcinoma detection rates were: time from examination to liver transplantation; acquisition of computed tomography images during arterial phase; lesion size. Arterial phase proved to be the most useful part of computed tomography examination in this study.

scholarly journals Progression of Neurovisceral Storage Disease With Supranuclear Ophthalmoplegia Following Orthotopic Liver Transplantation

PEDIATRICS ◽  
1986 ◽  
Vol 77 (1) ◽  
pp. 104-106
Author(s):  
J. Carlton Gartner ◽  
Ira Bergman ◽  
J. Jeffrey Malatack ◽  
Basil J. Zitelli ◽  
Ronald Jaffe ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Bone Marrow ◽  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Storage Disease ◽  
Initial Period ◽  
Storage Material ◽  
Neurologic Symptoms ◽  
Progressive Ataxia

A 7-year-old girl with progressive ataxia, spasticity, supranuclear ophthalmoplegia, and sea-blue histiocytes in her bone marrow underwent orthotopic liver transplantation for hepatocellular carcinoma. After an initial period of stabilization, she has shown progression of neurologic symptoms with recurrence of storage material in the transplanted liver.

Sign in / Sign up

Export Citation Format

Share Document