title: Multimodality treatment for early-stage hepatocellular carcinoma: a bridging therapy for liver transplantation.
abstract: OBJECTIVE
  To evaluate the efficiency of a multimodality approach consisting of transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) as bridging therapy for patients with hepatocellular carcinoma (HCC) awaiting orthotopic liver transplantation (OLT) and to evaluate the histopathological response in explant specimens.
  
  
  METHODS
  Between April 2001 and November 2011, 36 patients with 50 HCC nodules (1.4-5.0 cm, median 2.8 cm) on the waiting list for liver transplantation were treated by TACE and RFA. The drop-out rate during the follow-up period was recorded. The local efficacy was evaluated by histopathological examination of the explanted livers.
  
  
  RESULTS
  During a median follow-up time of 29 (4.0-95.3) months the cumulative drop-out rate for the patients on the waiting list was 0, 2.8, 5.5, 11.0, 13.9 and 16.7% at 3, 6, 12, 24, 36 and 48 months, respectively. 16 patients (with 26 HCC lesions) out of 36 (44.4%) were transplanted by the end of study with a median waiting list time of 13.7 (2.5-37.8) months. The histopathological examination of the explanted specimens revealed a complete necrosis in 20 of 26 HCCs (76.9%), whereas 6 (23.1%) nodules showed viable residual tumor tissue. All transplanted patients are alive at a median time of 29.9 months. Imaging correlation showed 100% specificity and 66.7% sensitivity for the depiction of residual or recurrent tumor.
  
  
  CONCLUSIONS
  We conclude that TACE combined with RFA could provide an effective treatment to decrease the drop-out rate from the OLT waiting list for HCC patients. Furthermore, this combination therapy results in high rates of complete tumor necrosis as evaluated in the histopathological analysis of the explanted livers. Further randomized trials are needed to demonstrate if there is a benefit in comparison with a single-treatment approach.
authors.affiliation: Department of Clinical Radiology, Ludwig Maximilians University-Munich, Campus Grosshadern, Munich, Germany. n.ashoori@radiologie-ukw.de
authors.forename: N
authors.initials: N
authors.lastname: Ashoori
authors.forename: F
authors.initials: F
authors.lastname: Bamberg
authors.forename: P
authors.initials: P
authors.lastname: Paprottka
authors.forename: M
authors.initials: M
authors.lastname: Rentsch
authors.forename: F T
authors.initials: FT
authors.lastname: Kolligs
authors.forename: S
authors.initials: S
authors.lastname: Siegert
authors.forename: A
authors.initials: A
authors.lastname: Peporte
authors.forename: J A
authors.initials: JA
authors.lastname: Al-Tubaikh
authors.forename: M
authors.initials: M
authors.lastname: D'Anastasi
authors.forename: R T
authors.initials: RT
authors.lastname: Hoffmann
authors.forename: M F
authors.initials: MF
authors.lastname: Reiser
authors.forename: T F
authors.initials: TF
authors.lastname: Jakobs
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D018365:Neoplasm, Residual; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors; D014850:Waiting Lists