Role of Locoregional Therapy and Predictors for Dropout in Patients with Hepatocellular Carcinoma Listed for Liver Transplantation

Sheth, Rahul A.; Patel, Madhukar S.; Koottappillil, Brian; Shah, Jigesh A.; Öklü, Rahmi; Müeller, Peter R.; Vagefi, Parsia A.; Ganguli, Suvranu

doi:10.1016/j.jvir.2015.08.015

Cited by 33 publications

(24 citation statements)

References 18 publications

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“…Patients were excluded if they had incidental HCCs (discovered on explant pathology; n = 78) or had an incomplete data set (including patients with fewer than two pre‐LT imaging evaluations, given that longitudinal assessment could not occur in those cases; n = 157). The approach at both the Cleveland Clinic Foundation (CCF) and the Massachusetts General Hospital (MGH) is holistic evaluation of all HCC patients at presentation and aggressive downstaging of those patients outside of MC through LRT, including transarterial catheter ablation (TACE), radiofrequency ablation (RFA), and less commonly others (microwave‐ or cryoablation, external beam/proton radiation, and, in select patients, hepatectomy) . Patient selection was decided by a multidisciplinary group at Liver Tumor Board meetings.…”

Section: Methodsmentioning

confidence: 99%

“…Patient selection was decided by a multidisciplinary group at Liver Tumor Board meetings. Management, transplantation, and follow‐up were described . Response to LRT was evaluated using the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria around 4 weeks post‐LRT using the provided guidelines .…”

Section: Methodsmentioning

confidence: 99%

“…The approach at both the Cleveland Clinic Foundation (CCF) and the Massachusetts General Hospital (MGH) is holistic evaluation of all HCC patients at presentation and aggressive downstaging of those patients outside of MC through LRT, including transarterial catheter ablation (TACE), radiofrequency ablation (RFA), and less commonly others (microwaveor cryoablation, external beam/proton radiation, and, in select patients, hepatectomy). (17,18) Patient selection was decided by a multidisciplinary group at Liver Tumor Board meetings. Management, transplantation, and follow-up were described.…”

Section: Study Populationmentioning

confidence: 99%

“…Management, transplantation, and follow-up were described. (17,18) Response to LRT was evaluated using the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria around 4 weeks post-LRT using the provided guidelines. (13) A control cohort (n = 68) was included to assess natural variation in the HALTHCC score without LRT intervention to more readily attribute changes in HALTHCC post-LRT to LRT and not random fluctuation in the levels of contributing factors.…”

Section: Study Populationmentioning

confidence: 99%

See 3 more Smart Citations

Reframing the approach to patients with hepatocellular carcinoma: Longitudinal assessment with hazard associated with liver transplantation for HCC (HALTHCC) improves ablate and wait strategy

et al. 2018

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HALTHCC is superior in assessing tumor risk in candidates awaiting LT, and its utility increases over time. Peri-LRT relative change in HALTHCC outperforms mRECIST in stratifying risk of dropout, mortality, and recurrence post-LT. With improving estimates of post-LT outcomes, it is reasonable to consider allocation using HALTHCC and not just waiting time. Furthermore, this study supports a shift in perspective, from listing to allocation, to better utilize precious donor organs. (Hepatology 2018).

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

See 2 more Smart Citations

Reframing the approach to patients with hepatocellular carcinoma: Longitudinal assessment with hazard associated with liver transplantation for HCC (HALTHCC) improves ablate and wait strategy

et al. 2018

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“…A retrospective study assessed the effectiveness of neo-adjuvant treatment in decreasing dropout rate and found that the 49% of patients with a complete response to LRT had a significant reduction in dropout at 3, 6, and 12 months (6). Other studies showed that bridge therapies are successful in keeping patients on the waitlist and they increase the likelihood of LT, specifically in longer waitlist time (7,8). The currently available evidence about survival benefit in HCC patients receiving pre-transplant LRT remains heterogeneous and contradictory.…”

mentioning

confidence: 99%

Bridging patients with hepatocellular cancer waiting for liver transplant: all the patients are the same?

Coletta

Nicolini

Cacciaguerra

et al. 2017

Transl. Gastroenterol. Hepatol.

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Hepatocellular carcinoma (HCC) is the fifth more frequent cancer worldwide and the most common primary liver tumor. Liver transplant (LT) is considered the best curative treatment for patients with cirrhosis and HCC within Milan criteria (1 tumor ≤5 cm and up to 3 tumors ≤3 cm). It removes all the liver affected by cancer and at the same time it treats the underlying liver disease, with a survival rate of 70% and a 5 years recurrence rate of less than 20%. Unfortunately, the applicability of LT for HCC patients is limited by the shortage of liver grafts, determining a longer time on waitlist and high dropout rate. Bridging treatments are neo-adjuvant antitumoral therapies given to patients on the waitlist for LT, affected by HCC within the criteria, with the aim to reduce the disease progression and therefore the dropout rate. Indeed, these treatments act as a "bridge" until a suitable donor organ becomes available. Most of bridging therapies are locoregional treatments (LRTs). Dropout rate for HCC progression increases in a time-dependent way (1) and evidences show higher dropout rates in patients with tumor >3 cm and an expected waiting time longer than 3-6 months (2). In different reports, if HCC is left untreated, the risk of drop out at 6 months and at 1 year has been estimated to be respectively 12% and 15-30% (3,4). Risk factors for dropout include: tumor diameter greater than 3 cm or multifocal disease, serum α-fetoprotein (AFP) level greater than 200 ng/mL, waiting time longer than 6 months and lack of response to bridging therapy (5). Although there are no randomized control trials (RCT) evaluating the efficacy of neo-adjuvant therapies in reducing dropout rate and improving survival after LT, LRT is accepted as the standard of care for patients expected to stay on the waitlist for more than 6 months. In patients with HCC within Milan criteria, bridging therapy is estimated to reduce dropout rate to 0-10%. A retrospective study

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Advances in Biomaterials and Technologies for Vascular Embolization

et al. 2019

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Minimally invasive transcatheter embolization is a common nonsurgical procedure in interventional radiology used for the deliberate occlusion of blood vessels for the treatment of diseased or injured vasculature. A wide variety of embolic agents including metallic coils, calibrated microspheres, and liquids are available for clinical practice. Additionally, advances in biomaterials, such as shapememory foams, biodegradable polymers, and in situ gelling solutions have led to the development of novel pre-clinical embolic agents. The aim here is to provide a comprehensive overview of current and emerging technologies in endovascular embolization with respect to devices, materials, mechanisms, and design guidelines. Limitations and challenges in embolic materials are also discussed to promote advancement in the field.

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Role of Locoregional Therapy and Predictors for Dropout in Patients with Hepatocellular Carcinoma Listed for Liver Transplantation

Abstract: LRT increased the likelihood of a patient with HCC achieving liver transplant, particularly in patients facing prolonged waiting times. CR after LRT significantly increased the likelihood of liver transplantation.

Cited by 33 publications

References 18 publications

Reframing the approach to patients with hepatocellular carcinoma: Longitudinal assessment with hazard associated with liver transplantation for HCC (HALTHCC) improves ablate and wait strategy

Reframing the approach to patients with hepatocellular carcinoma: Longitudinal assessment with hazard associated with liver transplantation for HCC (HALTHCC) improves ablate and wait strategy

Bridging patients with hepatocellular cancer waiting for liver transplant: all the patients are the same?

Advances in Biomaterials and Technologies for Vascular Embolization

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