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Role of transarterial chemoembolization for hepatocellular carcinoma before liver transplantation with special consideration of tumor necrosis
Author(s) -
Schaudt André,
Kriener Susanne,
Schwarz Wolfram,
Wullstein Christoph,
Zangos Stephan,
Vogl Thomas,
Mehrabi Arianeb,
Fonouni Hamidreza,
Bechstein Wolf O.,
Golling Markus
Publication year - 2009
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2009.01111.x
Subject(s) - medicine , hepatocellular carcinoma , liver transplantation , tumor progression , percutaneous ethanol injection , transplantation , gastroenterology , population , percutaneous , surgery , orthotopic liver transplantation , radiofrequency ablation , cancer , ablation , environmental health
Several authors suggest that local ablative therapies, specifically transarterial chemoembolization (TACE), may control tumor progression of hepatocellular carcinoma (HCC) in patients who are on the waiting list for liver transplantation (orthotopic liver transplantation, OLT). There is still no evidence if TACE followed by OLT is able to prevent recurrence of tumor, to prolong survival rate of the patients on the waiting list, or to improve the survival after OLT. We report 27 patients with HCC who underwent OLT. From these patients, 15 were pre‐treated with TACE alone or in combination with percutaneous ethanol injection (PEI) or laser‐induced thermo therapy (LITT). Mean time on the waiting list was 214 d for treated patients and 133 d for untreated patients. Comparing pre‐operative imaging and histopathological staging post‐transplant, we found 13 patients with tumor progression out of which five were treated with TACE. In two of the TACE patients a decrease of lesions could be achieved. In a single patient, there was no evidence of any residual tumor. Only one patient displayed tumor progression prior to OLT despite undergoing TACE. Comparison of outcome in patients undergoing TACE or having no TACE was not statisitically significant (p = 0.5). In addition, our analysis showed that progression either in the total study population or in the TACE group alone is associated with a significant poorer outcome concerning overall survival (p = 0.02 and p = 0.02).