Effect of bridging therapy for hepatocellular carcinoma prior to orthotopic liver transplantation on disease control and response.

Abstract

343 Background: Orthotopic liver transplantation (OLT) is curative for both hepatocellular carcinoma (HCC) and underlying cirrhosis, but this option is limited by lengthy waiting times and donor organ shortages. Various bridging therapies have been employed to slow tumor progression, with reported results radiographically confirming local control with variable rates of tumor necrosis on pathologic examination of explants. Methods: We retrospectively studied 11 patients who underwent a total of 26 locoregional therapies prior to OLT for HCC. One patient was also maintained on sorafenib. The effectiveness of bridging therapies was assessed by radiologic response and histopathological examination of the explanted livers. Results: Sixteen tumor nodules identified in liver explants were evaluated. Pretransplant treatments included: TACE alone (5), TACE + sorafenib (2), RFA alone (1), TACE + RFA (6), or TACE + alcohol ablation (2) prior to OLT. Two nodules (13%) achieved complete tumor necrosis on explant analysis; these had been treated with TACE + RFA. Among 11 patients who underwent bridging therapies, 5 patients (45%) had no radiologic evidence of viable tumor prior to OLT. Among these patients, explant examination showed 2 patients with partial necrosis, 2 patients with at least 90% necrosis, and one patient with no evidence of viable tumor. Three patients with enhancing lesions on imaging prior to OLT had 100% concordance rate on pathological examination of the liver explant with respect to number of nodules identified. Conclusions: Although bridging therapy prior to OLT is effective in achieving disease control, most patients have viable tumor present upon assessment of explanted livers. Absence of viable tumor by radiologic evaluation following bridging therapy does not correspond to complete tumor necrosis. [Table: see text] No significant financial relationships to disclose.