Multimodal treatment for hepatocellular carcinoma on cirrhosis: the role of chemoembolization and alcoholization before liver transplantation.
The results of combined trans-arterial chemoembolization (TAE) and percutaneous ethanol injection (PEI) followed by liver transplantation for hepatocellular carcinoma (HCC) are described. Fourteen patients (G2) with tumour stages I-III received a mean of 2 times TAE and 4 times PEI prior to transplantation. Six patients (G1) received no pre-transplant therapy. Tumor size reduced from 37 +/- 16 to 28 +/- 16 mm and alpha-FP from 339 +/- 1057 to 224 +/- 711 ng/mL (p = n.s.). On histopathologic examination (G2 vs. G1) a 100% necrosis of the tumour nodules was seen in 80 vs. 0% (p = 0.001); 60-90% in 3 vs. 1 and 10-50% in 3 vs. 2. Eighty six percent of nodules in G2 and 36% in G1 had a tumour capsule (p = 0.02). After a median follow-up of 26 months (3-60), 2 patients in G1 developed a recurrence of HCC as compared to 0 in G2 (p = 0.0005). The actuarial patient disease-free survival after 48 months was 82% in G2 and 65% in G1. It is concluded that combined treatment with TAE and PEI is inducing necrosis in HCC associated with improved patient disease-free survival following liver transplantation.
Department of General, Abdominal and Transplant Surgery, University of Gent, Belgium.
R
R
Troisi
L
L
Defreyne
U J
UJ
Hesse
M
M
Praet
J
J
Decruyenaere
B
B
De Hemptinne
D000206:Actuarial Analysis; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D002945:Cisplatin / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006499:Hepatic Artery; D006801:Humans; D007269:Injections, Intra-Arterial; D015552:Injections, Intralesional; D008103:Liver Cirrhosis / Q000601:surgery*; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging
D000970:Antineoplastic Agents; D000431:Ethanol; D002945:Cisplatin