Result of treatment of hepatocellular carcinoma in patients who require a liver transplant

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Congress:

ECR 2016

Poster Number:

C-0159

Type:

Scientific Exhibit

Keywords:

Interventional non-vascular, Interventional vascular, Liver, Percutaneous, Catheter arteriography, Ablation procedures, Chemoembolisation, Treatment effects, Cancer, Cirrhosis, Transplantation

Authors:

E. Villacastin Ruiz¹, R. Pintado Garrido¹, H. Calero¹, A. Ginés Santiago¹, M. Hernández¹, F. X. Brunie¹, M. Fajardo¹, S. Plaza Loma², I. Peñas Herrero¹; ¹Valladolid/ES, ²Valladolid, VA/ES

DOI:

10.1594/ecr2016/C-0159

DOI-Link:

https://dx.doi.org/10.1594/ecr2016/C-0159

Fig. 1: (A) Ultrasound guided percutaneous microwave ablation. (B) 2 cm nodule in...

Fig. 2: (A) Solid nodule corresponding to hepatocellular carcinoma 3x2.3 cm in liver...

Fig. 3: (A) Liver arteriography, two hypervascular nodules are seen in the right...

Fig. 4: (A) Liver arteriography. One hypervascular nodule is seen in IVa segment. It...

Aims and objectives

The presence of hepatocellular carcinoma (HCC) in cirrhotic liver is a common indication for liver transplantation (LT). The best LT results for HCC patients were obtained following the Milan criteria (≤ 3 nodules ≤ 3 cm or a single tumor ≤ 5 cm) and advanced liver dysfunction. [1] The main drawback of LT as a treatment for HCC is the shortage of donors. Increases in waiting times have led to 20% of transplant candidates abandonment lists before receiving treatment. For this reason the International Conference...

Methods and materials

273 consecutive patients with 218 hepatocellular carcinoma nodules, who underwent imaging (ultrasound (US), multidetector computed tomography (MDCT) and magnetic resoance imaging (MRI)), and subsequent transplantation, were examined. Patients at risk of exceeding the Milan criteria either by the number or the size of HCC were treated by microwave ablation or chemoembolization. We analyze the size of the nodules before treatment (according to the description of imaging techniques) and after treatment (according to the morphological study of the explanted liver) and compared their growth with those...

Results

Pathology analysis detected HCC in 109 (39.9%) explant livers, with a total of 218 HCC. In 54 patients, there was a single nodule present and in the rest (55) multiple nodules, between 2 and 9, most frequently 2 or 3 nodules (28 and 15 patients respectively). The principal features of the sample are summarised in table 1. The average size of HCC was 20.54 mm ± 12.78 mm (range 3-70 mm). 71 HCC (32.57%) were treated between the time of imaging and liver explant. The...

Conclusion

32.7% of HCC (71) were treated between the time of image-based diagnosis and explant, using microwave ablation or chemoembolization. This percentage is similar to other recent series reported; between 30% and 34.8%. [5,6]. However, it is common that in the work design, the treated HCC were excluded from the sample.[7-10.] We observe that nodules undergoing treatment are larger than those which have not, with a statistically significant difference. (p = 0.005). (Table 2). We attribute this to the fact that larger nodules are treated before...

Personal information

References

1.- Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996; 334: 693-699. 2.- Clavien PA, Lesurtel M, Bossuyt PM, Gores GJ, Langer B, Perrier A, et al. Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report. Lancet Oncol 2012; 13:e11–e22. 3.- Lu DS, Yu NC, Raman SS, Lassman C, Tong MJ, Britten C, et al. Percutaneous radiofrequency ablation of...