title: Efficacy of transarterial chemoembolization prior to liver transplantation for hepatocellular carcinoma as found in pathology.
abstract: OBJECTIVE
  To analyze the efficacy of chemoembolization prior to liver transplantation in liver explants.
  
  
  METHODS
  We reviewed pathological findings in the explanted livers of 21 patients with histologically proven hepatocellular carcinoma and liver cirrhosis who underwent transarterial chemoembolization (TACE) prior to liver transplantation. Nine patients had solitary nodules with a median diameter of 4 cm (range 1.5-7 cm), 7 patients had 2 or 3 tumors with a median total diameter of 5.9 cm (range 3-9 cm) and 5 patients had a multifocal tumor prior to TACE. Pathological up-staging of the clinical tumor classification was documented as "tumor-progression." Concurrence of clinical and pathological findings was documented as "steady disease". "Tumor regression" described those cases in which the pathological classification downgraded the clinical findings.
  
  
  RESULTS
  There was no treatment-related morbidity in these patients' group. Tumor regression was proved in 11/21 patients (52.4%) whereas steady disease was observed in 7/21 patients (33.4%). In 5 patients (23.8%) no vital tumor was found by pathological examination. Tumor regression was observed only in one of the five patients having a multifocal tumor prior to TACE. Tumor progression was observed in 3/21 patients (14.3%).
  
  
  CONCLUSIONS
  Our data show that TACE provides acceptable local tumor control as bridging treatment before liver transplantation. Although the majority of our patients (15/21, 71.4%) had 2 or more tumor lesions at the beginning of treatment, tumor progression was observed in only a minority (14.3%) of patients. However, multifocal tumors could not be successfully under-staged through this treatment and, furthermore, vital tumor was always observed in pathology; the usefulness of TACE in multifocal disease has to be re-estimated.
authors.affiliation: Department of General Surgery and Transplantation, University Hospital Essen, Germany.
authors.forename: Georgios C
authors.initials: GC
authors.lastname: Sotiropoulos
authors.forename: Massimo
authors.initials: M
authors.lastname: Malagó
authors.forename: Ernesto
authors.initials: E
authors.lastname: Molmenti
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
authors.forename: Silvio
authors.initials: S
authors.lastname: Nadalin
authors.forename: Eirini I
authors.initials: EI
authors.lastname: Brokalaki
authors.forename: Rudiger
authors.initials: R
authors.lastname: Verhagen
authors.forename: Olaf
authors.initials: O
authors.lastname: Dirsch
authors.forename: Guido
authors.initials: G
authors.lastname: Gerken
authors.forename: Hauke
authors.initials: H
authors.lastname: Lang
authors.forename: Christoph E
authors.initials: CE
authors.lastname: Broelsch
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D016461:Chemoembolization, Therapeutic; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D011300:Preoperative Care; D016896:Treatment Outcome