Neo-adjuvant therapy for hepatocellular carcinoma before liver transplantation: where do we stand?
Liver transplantation (LT) for hepatocellular carcinoma (HCC) within Milan criteria is a widely accepted optimal therapy. Neo-adjuvant therapy before transplantation has been used as a bridging therapy to prevent dropout during the waiting period and as a down-staging method for the patient with intermediate HCC to qualify for liver transplantation. Transarterial chemoembolization and radiofrequency ablation are the most commonly used method for locoregional therapy. The data associated with newer modalities including drug-eluting beads, radioembolization with Y90, stereotactic radiation therapy and sorafenib will be discussed as a tool for converting advanced HCC to LT candidates. The concept "ablate and wait" has gained the popularity where mandated observation period after neo-adjuvant therapy allows for tumor biology to become apparent, thus has been recommended after down-staging. The role of neo-adjuvant therapy with conjunction of "ablate and wait" in living donor liver transplantation for intermediate stage HCC is also discussed in the paper.
Masato Fujiki, Federico Aucejo, Transplant Center, Cleveland Clinic, Cleveland, OH 44195, United States.
Masato
M
Fujiki
Masato Fujiki, Federico Aucejo, Transplant Center, Cleveland Clinic, Cleveland, OH 44195, United States.
Federico
F
Aucejo
Masato Fujiki, Federico Aucejo, Transplant Center, Cleveland Clinic, Cleveland, OH 44195, United States.
Minsig
M
Choi
Masato Fujiki, Federico Aucejo, Transplant Center, Cleveland Clinic, Cleveland, OH 44195, United States.
Richard
R
Kim
D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D017024:Chemotherapy, Adjuvant; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation; D019520:Living Donors; D020360:Neoadjuvant Therapy / Q000379:methods; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D013997:Time Factors; D016896:Treatment Outcome
Ablation; Bridging therapy; External beam radiotherapy; Intermediate stage; Living donor liver transplantation; Locoregional therapy; Neo-adjuvant therapy; Transarterial chemotherapy; Transarterial radioembolization