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Title:

High rate of complete histopathological response in hepatocellular carcinoma patients after combined transarterial chemoembolization and stereotactic body radiation therapy.

Document type:
Journal Article
Author(s):
Bauer, Ulrike; Gerum, Sabine; Roeder, Falk; Münch, Stefan; Combs, Stephanie E; Philipp, Alexander B; De Toni, Enrico N; Kirstein, Martha M; Vogel, Arndt; Mogler, Carolin; Haller, Bernhard; Neumann, Jens; Braren, Rickmer F; Makowski, Marcus R; Paprottka, Philipp; Guba, Markus; Geisler, Fabian; Schmid, Roland M; Umgelter, Andreas; Ehmer, Ursula
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.
Journal title abbreviation:
World J Gastroenterol
Year:
2021
Journal volume:
27
Journal issue:
24
Pages contribution:
3630-3642
Fulltext / DOI:
doi:10.3748/wjg.v27.i24.3630
Pubmed ID:
http://view.ncbi.nlm.nih.gov/pubmed/34239274
Print-ISSN:
1007-9327
TUM Institution:
II. Medizinische Klinik und Poliklinik (Gastroenterologie); Institut für Allgemeine Pathologie und Pathologische Anatomie; Institut für Diagnostische und Interventionelle Radiologie; Institut für Medizinische Statistik und Epidemiologie; Klinik und Poliklinik für RadioOnkologie und Strahlentherapie; Professur für Interventionelle Radiologie (Prof. Paprottka)
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