Conventional TACE and drug-eluting bead TACE as locoregional therapy before orthotopic liver transplantation: comparison of explant pathologic response.
BACKGROUND
Hepatocellular carcinoma (HCC) is responsible for significant morbidity and mortality worldwide. Despite its increasing incidence, significant progress has been made in the clinical management of HCC. Transarterial chemoembolization (cTACE) has been shown to improve survival in patients with unresectable HCC; it has also been successfully used as bridging therapy before orthotopic liver transplantation (OLT) in efforts to delay tumor growth or to downstage HCC. TACE with drug-eluting beads (DEB-TACE), a novel drug delivery system that produces a slow and sustained release of chemotherapeutic agent, has recently been shown to have similar efficacy to conventional TACE (cTACE); it also exhibits fewer adverse effects resulting from reduced systemic drug concentrations. To date, the pathologic response rate to cTACE compared with DEB-TACE in patients undergoing OLT has not been well described.


METHODS
A total of 111 consecutive patients with HCC who underwent cTACE (n=76) or DEB-TACE (n=35) before OLT at a single center between January 2005 and December 2010 were evaluated.


RESULTS
Complete necrosis was achieved in 50.9% and 57.1% of cTACE and DEB-TACE patients, respectively; at least 50% necrosis was evident in approximately three fourths of patients in both groups. Rates of necrosis and tumor recurrence did not differ between groups. Dropout from the transplant list was equal in both groups.


CONCLUSIONS
Either modality is an acceptable treatment to achieve tumor control for patients awaiting OLT and can be expected to result in excellent necrosis rates in the majority of patients.
1 Center for Organ and Cell Transplantation, Scripps Green Hospital, La Jolla, CA. 2 Department of Transplantation, California Pacific Medical Center, San Francisco, CA. 3 Department of Surgery, The Methodist Hospital, Houston, TX. 4 Department of Radiology, California Pacific Medical Center, San Francisco, CA. 5 Address correspondence to: Catherine Frenette, M.D., Scripps Green Hospital Center for Organ and Cell Transplantation, 10666 N. Torrey Pines Rd N200, La Jolla, CA 92037.
Catherine T
CT
Frenette
Robert C
RC
Osorio
Jessica
J
Stark
Brandon
B
Fok
Maha R
MR
Boktour
Jennifer
J
Guy
John
J
Rhee
Robert W
RW
Osorio
D000368:Aged; D000970:Antineoplastic Agents / Q000737:chemistry*; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D016503:Drug Delivery Systems; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009364:Neoplasm Recurrence, Local; D016896:Treatment Outcome
D000970:Antineoplastic Agents