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Abstract Details
High rate of complete histopathological response in hepatocellular carcinoma patients after combined transarterial chemoembolization and stereotactic body radiation therapy
World J Gastroenterol. 2021 Jun 28;27(24):3630-3642.doi: 10.3748/wjg.v27.i24.3630.
Ulrike Bauer1, Sabine Gerum2, Falk Roeder2, Stefan Münch3, Stephanie E Combs3, Alexander B Philipp4, Enrico N De Toni4, Martha M Kirstein5, Arndt Vogel5, Carolin Mogler6, Bernhard Haller7, Jens Neumann8, Rickmer F Braren9, Marcus R Makowski9, Philipp Paprottka10, Markus Guba11, Fabian Geisler1, Roland M Schmid1, Andreas Umgelter1, Ursula Ehmer
Author information
1Internal Medicine II, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany.
2Department of Radiotherapy and Radiation Oncology, University of Salzburg, Salzburg 5020, Austria.
3Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany.
4Department of Medicine II, Liver Centre, University Hospital, LMU Munich, Munich 81377, Germany.
5Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover 30625, Germany.
6Institute of Pathology, Technical University of Munich, Munich 81675, Germany.
7Institute of Medical Informatics, Statistics and Epidemiology, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany.
8Institute of Pathology, Faculty of Medicine, University Hospital of Munich, Munich 81377, Germany.
9Institute of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany.
10Institute of Diagnostic and Interventional Radiology, Section for Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany.
11Department of General-, Visceral-, Vascular- and Transplant-Surgery, University hospital of Munich, Campus Großhadern, LMU Munich, Munich 81377, Germany.
12Internal Medicine II, Klinikum rechts der Isar, Technical University of Munich, Munich 81675, Germany. ursula.ehmer@tum.de.
Abstract
Background: Liver transplantation (LT) presents a curative treatment option in patients with early stage hepatocellular carcinoma (HCC) who are not eligible for resection or ablation therapy. Due to a risk of up 30% for waitlist drop-out upon tumor progression, bridging therapies are used to halt tumor growth. Transarterial chemoembolization (TACE) and less commonly stereotactic body radiation therapy (SBRT) or a combination of TACE and SBRT, are used as bridging therapies in LT. However, it remains unclear if one of those treatment options is superior. The analysis of explant livers after transplantation provides the unique opportunity to investigate treatment response by histopathology.
Aim: To analyze histopathological response to a combination of TACE and SBRT in HCC in comparison to TACE or SBRT alone.
Methods: In this multicenter retrospective study, 27 patients who received liver transplantation for HCC were analyzed. Patients received either TACE or SBRT alone, or a combination of TACE and SBRT as bridging therapy to liver transplantation. Liver explants of all patients who received at least one TACE and/or SBRT were analyzed for the presence of residual vital tumor tissue by histopathology to assess differences in treatment response to bridging therapies. Statistical analysis was performed using Fisher-Freeman-Halton exact test, Kruskal-Wallis and Mann-Whitney-U tests.
Results: Fourteen patients received TACE only, four patients SBRT only, and nine patients a combination therapy of TACE and SBRT. There were no significant differences between groups regarding age, sex, etiology of underlying liver disease or number and size of tumor lesions. Strikingly, analysis of liver explants revealed that almost all patients in the TACE and SBRT combination group (8/9, 89%) showed no residual vital tumor tissue by histopathology, whereas TACE or SBRT alone resulted in significantly lower rates of complete histopathological response (0/14, 0% and 1/4, 25%, respectively, P value < 0.001).
Conclusion: Our data suggests that a combination of TACE and SBRT increases the rate of complete histopathological response compared to TACE or SBRT alone in bridging to liver transplantation.