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Combined transarterial chemoembolization and thermal ablation in candidates to liver transplantation with hepatocellular carcinoma: pathological findings and post-transplant outcome.
- Source :
-
La Radiologia medica [Radiol Med] 2024 Jul; Vol. 129 (7), pp. 1086-1097. Date of Electronic Publication: 2024 Jun 03. - Publication Year :
- 2024
-
Abstract
- Objectives: Evaluating the pathological response and the survival outcomes of combined thermal ablation (TA) and transarterial chemoembolization (TACE) as a bridge or downstaging for liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) > 3 cm.<br />Materials and Methods: A retrospective review encompassed 36 consecutive patients who underwent combined TA-TACE as bridging or downstaging before LT. Primary objectives included necrosis of the target lesion at explant pathology, post-LT overall survival (OS) and post-LT recurrence-free survival (RFS). For OS and RFS, a comparison with 170 patients subjected to TA alone for nodules <3 cm in size was also made.<br />Results: Out of the 36 patients, 63.9% underwent TA-TACE as bridging, while 36.1% required downstaging. The average node size was 4.25 cm. All cases were discussed in a multidisciplinary tumor board to assess the best treatment for each patient. Half received radiofrequency (RF), and the other half underwent microwave (MW). All nodes underwent drug-eluting beads (DEB) TACE with epirubicin. The mean necrosis percentage was 65.9% in the RF+TACE group and 83.3% in the MW+TACE group (p-value = 0.099). OS was 100% at 1 year, 100% at 3 years and 94.7% at 5 years. RFS was 97.2% at 1 year, 94.4% at 3 years and 90% at 5 years. Despite the different sizes of the lesions, OS and RFS did not show significant differences with the cohort of patients subjected to TA alone.<br />Conclusions: The study highlights the effectiveness of combined TA-TACE for HCC>3 cm, particularly for bridging and downstaging to LT, achieving OS and RFS rates significantly exceeding 80% at 1, 3 and 5 years.<br /> (© 2024. The Author(s).)
- Subjects :
- Humans
Male
Female
Retrospective Studies
Middle Aged
Treatment Outcome
Aged
Combined Modality Therapy
Adult
Neoplasm Staging
Survival Rate
Microwaves therapeutic use
Catheter Ablation methods
Carcinoma, Hepatocellular therapy
Carcinoma, Hepatocellular pathology
Carcinoma, Hepatocellular surgery
Liver Neoplasms therapy
Liver Neoplasms pathology
Liver Neoplasms surgery
Chemoembolization, Therapeutic methods
Liver Transplantation
Subjects
Details
- Language :
- English
- ISSN :
- 1826-6983
- Volume :
- 129
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- La Radiologia medica
- Publication Type :
- Academic Journal
- Accession number :
- 38829544
- Full Text :
- https://doi.org/10.1007/s11547-024-01830-x