title: Living Donor Liver Transplantation for Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis after Concurrent Chemoradiation Therapy.
abstract: Locally advanced hepatocellular carcinoma (HCC) with portal vein thrombosis carries a 1-year survival rate <10%. Localized concurrent chemoradiotherapy (CCRT), followed by hepatic arterial infusion chemotherapy (HAIC), was recently introduced in this setting. Here, we report our early experience with living donor liver transplantation (LDLT) in such patients after successful down-staging of HCC through CCRT and HAIC. Between December 2011 and September 2012, eight patients with locally advanced HCC at initial diagnosis were given CCRT, followed by HAIC, and underwent LDLT at the Severance Hospital, Seoul, Korea. CCRT [45 Gy over 5 weeks with 5-fluorouracil (5-FU) as HAIC] was followed by HAIC (5-FU/cisplatin combination every 4 weeks for 3-12 months), adjusted for tumor response. Down-staging succeeded in all eight patients, leaving no viable tumor thrombi in major vessels, although three patients first underwent hepatic resections. Due to deteriorating liver function, transplantation was the sole therapeutic option and offered a chance for cure. The 1-year disease-free survival rate was 87.5%. There were three instances of post-transplantation tumor recurrence during follow-up monitoring (median, 17 months; range, 10-22 months), but no deaths occurred. Median survival time from initial diagnosis was 33 months. Four postoperative complications recorded in three patients (anastomotic strictures: portal vein, 2; bile duct, 2) were resolved through radiologic interventions. Using an intensive tumor down-staging protocol of CCRT followed by HAIC, LDLT may be a therapeutic option for selected patients with locally advanced HCC and portal vein tumor thrombosis.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.|Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Dai Hoon
authors.initials: DH
authors.lastname: Han
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.|Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea.|Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Dong Jin
authors.initials: DJ
authors.lastname: Joo
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.|Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Myoung Soo
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.|Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea.|Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Gi Hong
authors.initials: GH
authors.lastname: Choi
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.|Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea.|Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jin Sub
authors.initials: JS
authors.lastname: Choi
authors.affiliation: Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea.|Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young Nyun
authors.initials: YN
authors.lastname: Park
authors.affiliation: Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea.|Department of Radiological Oncology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jinsil
authors.initials: J
authors.lastname: Seong
authors.affiliation: Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea.|Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. gihankhys@yuhs.ac.
authors.forename: Kwang Hyub
authors.initials: KH
authors.lastname: Han
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.|Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea. soonkim@yuhs.ac.
authors.forename: Soon Il
authors.initials: SI
authors.lastname: Kim
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011169:Portal Vein; D020246:Venous Thrombosis / Q000150:complications*
chemical_list: D002945:Cisplatin; D005472:Fluorouracil
keywords: Concurrent chemoradiation; down-staging; hepatocellular carcinoma; living donor liver transplantation; thrombus