Outcomes of Neoadjuvant Transarterial Chemoembolization to Downstage Hepatocellular Carcinoma Before Liver Transplantation

• DOI: 10.1097/sla.0b013e31818a07d4
• Publication Date: 2008-10-20T07:09:07Z
• Authors: William C. Chapman; M B. Majella Doyle; Jourdan E. Stuart; Neeta Vachharajani; Jeffrey S. Crippin; Christopher D. An...; Jeffrey A. Lowell; Surendra Shenoy; Michael D. Darcy; Daniel B. Brown
• Keywords: Milan criteria; Liver disease

In Brief Purpose: To evaluate outcomes of downstaging patients with advanced (American liver tumor study group stage III/IV) hepatocellular carcinoma (HCC) transarterial chemoembolization (TACE) to allow eligibility for orthotopic transplant (OLT). Methods: From 1999 2006, 202 HCC were referred evaluation. Seventy-six (37.6%) III/IV potential candidates if was achieved by TACE. OLT considered based on follow-up imaging findings. The number who successfully downstaged within the Milan criteria, response using Response Evaluation Criteria in Solid Tumors findings at explant, and after tracked. Results: Eighteen 76 (23.7%) had adequate qualify under criteria. By Tumors, 27/76 (35.5%) a partial response, 22/76 (29%) stable disease, progressive disease. Seventeen (22.4%) met other qualifications underwent successful (13/38 III;4/38 IV). Explant review demonstrated 28 identifiable tumors which post-TACE necrosis greater than 90% 21 (75%). At median 19.6 months (range 3.6–104.7), 16/17 (94.1%) are alive. One patient expired 11 secondary medical comorbidities. 17 (6%) recurrent HCC. This resection pulmonary metastasis is alive, 63.6 from OLT. Conclusion: Selected can be criteria Importantly, transplanted have excellent midterm disease-free overall survival, similar II We our experience treating cirrhosis. third III 10% IV meet listing transplantation performed 18 patients. more 19 follow-up, there only 1 recurrence among patients, demonstrating medium-term results this selected