title: Bridging locoregional therapy for hepatocellular carcinoma prior to liver transplantation.
abstract: BACKGROUND
  The impact of locoregional therapy prior to liver transplantation for hepatocellular carcinoma utilizing either transcatheter arterial chemoembolization (TACE), yttrium-90 ((90)Y), radiofrequency ablation (RFA), or resection prior to orthotopic liver transplantation (OLT) is largely unknown. We sought to examine locoregional therapies and their effect on survival compared with transplantation alone.
  
  
  METHODS
  A retrospective review of a prospectively collected database.
  
  
  RESULTS
  123 patients were included. Patients were analyzed in two groups. Group I consisted of 50 patients that received therapy (20 TACE; 16 (90)Y; 13 RFA, 3 resections). Group II consisted of 73 patients transplanted without therapy. Median list time was 28 days (range 2-260 days ) in group I, and 24 days (range 1-380 days) in group II. Median time from therapy to OLT was 3.8 months (range 9 days to 68 months). Twelve patients (24%) were successfully downstaged (8 TACE, 2 (90)Y, 2 RFA/resection). Overall 1-, 3-, and 5-year survival were 81%, 74%, and 74%, respectively. Survival was not statistically significantly different between the two groups (P = 0.53). The 12 patients downstaged did not have a significant difference in survival as compared with the patients who received therapy but did not respond or the patients who were transplanted without therapy (P = 0.76).
  
  
  CONCLUSIONS
  Our report addresses locoregional therapy for hepatocellular carcinoma as a bridge to transplant. There was no statistical difference in overall survival between patients treated and those not treated prior to transplant. We provide further evidence that locoregional therapy is a safe tool for patients on the transplant list, does not impact survival, and can downstage selected patients to allow life-saving liver transplantation.
authors.affiliation: Division of Transplantation, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Heckman
authors.forename: Michael B
authors.initials: MB
authors.lastname: Devera
authors.forename: J Wallis
authors.initials: JW
authors.lastname: Marsh
authors.forename: Paulo
authors.initials: P
authors.lastname: Fontes
authors.forename: Nikhil B
authors.initials: NB
authors.lastname: Amesur
authors.forename: Shane E
authors.initials: SE
authors.lastname: Holloway
authors.forename: Michael
authors.initials: M
authors.lastname: Nalesnik
authors.forename: David A
authors.initials: DA
authors.lastname: Geller
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Steel
authors.forename: T Clark
authors.initials: TC
authors.lastname: Gamblin
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology / Q000628:therapy; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D015021:Yttrium Radioisotopes
chemical_list: D000970:Antineoplastic Agents; D015021:Yttrium Radioisotopes; D002945:Cisplatin