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Abstract Details
Selecting the Appropriate Downstaging and Bridging Therapies for Hepatocellular Carcinoma: What Is the Role of Transarterial Radioembolization? A Pooled Analysis
1Department of General and Digestive Surgery, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, 30120 Murcia, Spain.
2Digestive and Endocrine Surgery and Transplantation of Abdominal Organs Research Group, Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain.
3Department of General, Visceral and Transplantation Surgery, University Hospital Virgen de la Arrixaca. Ctra., Madrid-Cartagena, s/n, El Palmar, 30120 Murcia, Spain.
4Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 950-2181, Japan.
5Department of Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, 4052 Basel, Switzerland.
6Department of Vascular Intervenional Radiololy, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, 30120 Murcia, Spain.
7Department of Surgery and Transplantation, Swiss Hepato-Pancreato-Biliary (HPB) Center, University Hospital Zurich, 8091 Zurich, Switzerland.
8Department of Hepatology, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, 30120 Murcia, Spain.
9Department of Nuclear Medicines, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, 30120 Murcia, Spain.
Abstract
Background: Transarterial radioembolization in HCC for LT as downstaging/bridging has been increasing in recent years but some indication criteria are still unclear.
Methods: We conducted a systematic literature search of primary research publications conducted in PubMed, Scopus and ScienceDirect databases until November 2022. Relevant data about patient selection, HCC features and oncological outcomes after TARE for downstaging or bridging in LT were analyzed.
Results: A total of 14 studies were included (7 downstaging, 3 bridging and 4 mixed downstaging and bridging). The proportion of whole liver TARE was between 0 and 1.6%. Multiple TARE interventions were necessary for 16.7% up to 28% of the patients. A total of 55 of 204 patients across all included studies undergoing TARE for downstaging were finally transplanted. The only RCT included presents a higher tumor response with the downstaging rate for LT of TARE than TACE (9/32 vs. 4/34, respectively). Grade 3 or 4 adverse effects rate were detected between 15 and 30% of patients.
Conclusions: TARE is a safe therapeutic option with potential advantages in its capacity to necrotize and reduce the size of the HCC for downstaging or bridging in LT.