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A Comparison of Local-Regional Modalities for Pre-transplant Treatment of Hepatocellular Carcinoma (HCC): A single center experience.
*Armando Salim Munoz-Abraham, *Jonathan Merola, *Roger Patrón-Lozano, *Giffrey Babas, Sanjay Kulkarni, Sukru Emre, David C Mulligan, Peter S Yoo, Manuel I. Rodríguez-Dávalos
Yale University School of Medicine, New Haven, CT

Objective:
Compare local-regional therapies (LRT): radiofrequency ablation (RFA), trans-catheter arterial chemoembolization (TACE) or both for treatment of hepatocellular carcinoma (HCC) prior to liver transplantation (LTx).
Design:
Single center, retrospective cohort.
Setting:
All patients who received LRT for HCC prior to LTx from August 2007-March 2015.
Patients:
Of 82 patients who underwent LTx for HCC, 49 patients underwent LRT prior to LTx (60%).
Interventions:
Prior to LTx, twelve patients underwent RFA, 18 TACE, and 19 both RFA/TACE. Percutaneous ethanol injection and resection were inadequate for analysis.
Main Outcome Measures:
Presence of HCC in liver explant, recurrence, post-LTx survival at 1 and 3-years.
Results:
Forty-nine HCC patients, mean age 63y, 69% male, were grouped by LRT type, primary diagnosis HCV (70%) or alcoholic cirrhosis (11%). RFA patients had significantly smaller tumor burden (tumor size, tumor number, AFP level) compared with TACE and RFA/TACE (P<0.01). There were no statistical differences in these outcomes between TACE and RFA/TACE. Presence of tumor in explanted liver did not differ between groups (P=0.2960). Recurrence rates did not differ between groups (RFA 0%, TACE 16%, RFA/TACE 10.5%, p =0.4749). Survival at 1 and 3-years was similar in all 3 groups: RFA (91% and 85%), TACE (100% and 73%), and RFA/TACE (95% and 79%).
Conclusions:
While RFA patients had a smaller tumor burden, recurrence and survival at 1 and 3-years did not differ between groups. Aggressive LRT is vital in New England, due to long wait times to LTx. Although there is a trend towards combined LRT in many centers, our results suggest no difference in outcomes between modalities. The authors favor a multimodal, multidisciplinary approach to bridge therapy prior to LTx for HCC.


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