scholarly journals Transcatheter arterial chemoembolization of hepatocellular carcinoma on liver cirrhosis in patients awaiting liver transplantation

2021 ◽  
Vol 179 (6) ◽  
pp. 18-23
Author(s):  
A. S. Polekhin ◽  
T. P. Gadelgaraevich ◽  
I. I. Tileubergenov ◽  
I. O. Rutkin ◽  
D. A. Granov
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Liver Cirrhosis ◽  
Transcatheter Arterial Chemoembolization ◽  
Staging System ◽  
Complete Response ◽  
Cancer Staging ◽  
Milan Criteria ◽  
Waiting Periods ◽  
Arterial Chemoembolization

Transcatheter arterial chemoembolization of hepatocellular carcinoma on liver cirrhosis in patients awaiting liver transplantation OBJECTIVE. To evaluate the role of TACE as a method of neoadjuvant antitumor therapy of HCC before LT.METHODS AND MATERIALS. From January 1998 to April 2020, we performed 245 OLTs in 229 patients, among them in 25 (10.2 %) for HCC associated with LC. We analyzed treatment results of 16 patients who received 49 TACE sessions as neoadjuvant therapy. 10 (62.5 %) patients fell under Milan criteria, 6 (37.5 %) – beyond them. According to the Child – Pugh score of LC, two (12.5 %) patients matched A stage, 12 (75 %) – B stage, two (12.5 %) – C stage. According to the BCLC (Barcelona Clinic Liver Cancer) staging system, 10 patients matched A1–A4 stage and 6 – B stage. Totally, we performed 49 TACE sessions, both classical with lipiodol and hemostatic sponge, and with drug-eluting beads from 1 to 7 (on average 3) times. In all cases Doxorubicin was used.RESULTS. Technical success was 100 %. There were no complications. We performed RFA in three patients as an adjunct, in two patients – laparoscopic RFA-assisted atypical liver resection and in one patient – sequential resection and RFA. According to the m-Recist criteria, a complete response was observed in 6 (37.5 %), partial – in 7 (43.75 %), and stabilization – in 3 (18.75 %) patients. It was possible to achieve a tumor response to the treatment in 4 patients and return them to the Milan criteria. LT was performed in all 16 patients, among them – 14 (87.5 %) within the Milan criteria. The waiting periods for LT from the beginning of TACE were from 2 to 30 (on average 12.5) months. According to the histological studies, in 13 (81 %) patients, total and subtotal necrosis of HCC was revealed in excised organs.CONCLUSION. The results of the performed study indicate that neoadjuvant TACE delays the growth of HCC masses and prolongs (up to 30 months) a safe waiting period for the donor liver.

scholarly journals Successful Treatment of Hepatocellular Carcinoma with Transcatheter Arterial Chemoembolization followed by Radical Liver Transplantation in a Patient with Severe Liver Damage

2019 ◽  
Vol 12 (1) ◽  
pp. 289-296
Author(s):  
Hajime Nakamura ◽  
Yutaka Kawano ◽  
Koji Miyanishi ◽  
Kazuma Ishikawa ◽  
Tomohiro Kubo ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Liver Damage ◽  
Esophageal Varices ◽  
Transcatheter Arterial Chemoembolization ◽  
Multidisciplinary Treatment ◽  
Milan Criteria ◽  
Severe Liver ◽  
Severe Liver Damage ◽  
Arterial Chemoembolization

Introduction: Liver transplantation for hepatocellular carcinoma (HCC) has been established as a curative therapy of underlying liver disease and cancer. However, the role of liver transplantation remains controversial for patients with HCC beyond Milan criteria. Case Presentation: A man in his 50s who was diagnosed as having two foci of HCC and advanced liver cirrhosis was referred to our hospital for further examination and treatment. Both foci of HCC were located in segment 8 of the liver and measured 39 and 9 mm. Endoscopy showed esophageal varices that had a high risk of bleeding. After endoscopic ligation of the esophageal varices, he underwent transcatheter arterial chemoembolization (TACE) for downstaging of the advanced HCCs. No further liver deterioration was observed after TACE, and HCC staging was successfully downstaged to within the Milan criteria. One hundred ten days after TACE, he underwent liver transplantation; at 2.5 years after transplantation, he remains alive without HCC recurrence. Discussion/Conclusion: There are only a few treatment options available for patients with advanced HCC and severe liver damage. Multidisciplinary treatment such as locoregional treatments and prophylaxis of variceal bleeding may result in tumor downstaging, enabling radical liver transplantation without further exacerbation of liver damage.

scholarly journals Transcatheter Arterial Chemoembolization of Hepatocellular Carcinoma as a Bridge to Liver Transplantation: A Retrospective Study

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Antoine Bouchard-Fortier ◽  
Réal Lapointe ◽  
Pierre Perreault ◽  
Louis Bouchard ◽  
Gilles Pomier-Layrargues
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Transcatheter Arterial Chemoembolization ◽  
Milan Criteria ◽  
Tumor Extension ◽  
Impaired Liver Function ◽  
Transplant Patients ◽  
Impaired Liver ◽  
Cirrhotic Patients ◽  
Arterial Chemoembolization

Background. Transcatheter arterial lipiodol chemoembolization (TACE) can be used in cirrhotic patients with hepatocellular carcinoma to avoid tumor progression before transplantation.Objective. To evaluate the efficacy and safety of TACE used as a bridge to liver transplantation.Methods. TACE was performed in 30 cirrhotic patients with hepatocellular carcinoma. Milan criteria were used to select patients for transplant. Patients had a good or moderately impaired liver function, no arterioportal fistulae, and a good portal perfusion.Results. 48 TACE were performed in 30 patients. Before transplantation, 4 patients were dropped off the list due to tumor extension or liver failure. Complete necrosis of the tumor was observed in 11 patients and partial necrosis in 15 patients. After transplantation, 6 patients died and tumor recurrence was observed in 5 patients with a tumor beyond Milan criteria or no response to TACE.Conclusion. TACE is useful as a bridge to liver transplantation in a selected group of cirrhotic patients with hepatocellular carcinoma. A combined therapeutic approach before surgery might improve the prognosis in these patients.

scholarly journals TRANSCATHETER ARTERIAL CHEMOEMBOLIZATION IN THE TREATMENT OF PATIENTS WITH HEPATOCELLULAR CARCINOMA ON ADVANCED LIVER CIRRHOSIS

2020 ◽  
Vol 178 (6) ◽  
pp. 29-35
Author(s):  
A. S. Polekhin ◽  
P. G. Tarazov ◽  
A. A. Polikarpov ◽  
D. A. Granov
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Survival Rate ◽  
Liver Failure ◽  
Transcatheter Arterial Chemoembolization ◽  
Intermediate Stage ◽  
Complete Response ◽  
Response To Treatment ◽  
Advanced Liver Cirrhosis ◽  
Arterial Chemoembolization

OBJECTIVE was to evaluate the results of transcatheter arterial chemoembolization (TACE) in the treatment of patients with hepatocellular carcinoma (HCC) on advanced liver cirrhosis (LC) and intermediate stage (B) according to BCLC classification (Barcelona Clinic Liver Cancer classification).METHODS AND MATERIALS. We evaluated results of TACE in 54 patients. Of them, 12 (22 %) had stage A of cirrhosis and 42 (78 %) – stage B of cirrhosis according to the Child-Pugh score. Nine (17 %) patients matched stage A4 and 45 (83 %) – stage В according to BCLC classification. The TACEs was performed according to the conventional practice with using Lipiodol + gelfoam (n=40) and with a drug-eluting beads (n=14) from 1 to 16 (average 6) times. The Doxorubicin was used as a first-line therapy in all cases.RESULTS. After TACE, two patients died of liver failure (3.7 %). According to the m-RECIST, complete response to treatment was observed in 9 (16.5 %), partial response – in 13 (24 %), stabilization – in 19 (35.5 %) and progression – in 13 (24 %) patients. At present, 22 (41 %) patients are alive for 1 to 51 (average 16.2) months. 32 patients (59 %) died between 2 to 62 months: 13 (24 %) – from HCC progression, 19 (35 %) – from liver failure. The 1– 2–3-year survival rate was 75–44–15 %; only one patient survived > 5 years. The median survival rate was (22.0±3.0) months, overall survival rate according to Kaplan – Meier was 26 months.CONCLUSION. TACE is a relatively safe and effective treatment in patients with HCC on advanced LC and intermediate stage (B). 

Randomized clinical trial of transcatheter arterial chemoembolization plus radiofrequency ablation versus transcatheter arterial chemoembolization for hepatocellular carcinoma with intermediate stage (BCLC stage B) hepatocellular carcinoma beyond Milan criteria.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 4077-4077
Author(s):  
Xin Yin ◽  
Bei Tang ◽  
Yu-Hong Gan ◽  
Yan-hong Wang ◽  
Yi Chen ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Clinical Trial ◽  
Overall Survival ◽  
Radiofrequency Ablation ◽  
Randomized Clinical Trial ◽  
Transcatheter Arterial Chemoembolization ◽  
Intermediate Stage ◽  
Milan Criteria ◽  
Tace Group ◽  
Arterial Chemoembolization

4077 Background: To determine treatment efficacy and safety of transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) (hereafter, TACE+RFA) in patients with intermediate stage (BCLC stage B) hepatocellular carcinoma (HCC) beyond Milan criteria. Methods: In this randomized clinical trial, 110 patients with intermediate stage HCC beyond Milan criteria (single tumor with diameter 5-7cm, median; 3-5 multiple nodules with diameter less than 5cm) were included and randomly assigned to TACE+RFA group (n=55) and TACE group (n=55) at liver cancer institute, Zhongshan hospital. The primary endpoint was overall survival (OS). The secondary end point was progression-free survival (PFS) , time to progress (TTP) and best objective response (BOR). Results: The median OS in TACE+RFA and TACE group were 29 and 18 months, respectively. The median TTP and BOR were 15.7 months and 69.1 % in TACE+RFA group and 12.4 months and 40.0 % in TACE group (P=0.004). The 1-, 3-, and 4-year overall survivals for TACE+RFA group and TACE group were 97.2%, 67.9% and 59.4% versus 84.0%, 46.7% and 37.3% , respectively (P = 0.008). The corresponding PFS were 47.3%, 27.2% and 21.7% versus 35.6%,15.3% and 11.4% , respectively (P = 0.04).The incidences of major complications in TACE+RFA group were comparable to those in TACE group (P=0.14). Conclusions: TACE+RFA was superior to TACE in improving tumor response and overall survival for patients with intermediate stage (BCLC stage B) hepatocellular carcinoma beyond Milan criteria. Clinical trial information: NCT03636620.

scholarly journals Tolvaptan was effective in preventing edema during hydration after transcatheter arterial chemoembolization in four patients with hepatocellular carcinoma and liver cirrhosis

Kanzo ◽  
2017 ◽  
Vol 58 (10) ◽  
pp. 582-588
Author(s):  
Masafumi Hashiguchi ◽  
Tsutomu Tamai ◽  
Naruhiro Yamasaki ◽  
Susumu Hasegawa ◽  
Kunio Fujisaki ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Transcatheter Arterial Chemoembolization ◽  
Arterial Chemoembolization
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