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Definitive locoregional therapy versus neoadjuvant locoregional therapy and transplant for unresectable very small hepatocellular carcinoma-1:30 PM Abstract No. 240

Journal of Vascular and Interventional Radiology
DOI: 10.1016/j.jvir.2013.12.310
  • Medicine


Purpose Unresectable very small HCC (vsHCC, <2cm) can be treated with either definitive locoregional therapy (dLRT) at diagnosis or liver transplant listing (TXP) and delayed neoadjuvant LRT (naLRT) when the tumor demonstrates growth or exceeds 2 cm, as dictated by transplant exception point rules. The current study compares the intention to treat survival of patients with unresectable vsHCC treated with each treatment strategy. Materials and Methods Retrospective review of patients with vsHCC evaluated in multidisciplinary liver tumor clinic between 2003-11 were examined. Tumor size, time to treatment, severity of liver disease, recurrence and survival from time of detection were reviewed. Sample size was of sufficient power to detect a 10% difference in survival with type 1 error of 0.05. Results Eighty-one patients were evaluated; 19 received dLRT (Group 1) and 62 were treated with TXP and naLRT (Group 2). Results are summarized in the table. Median length of follow up was 1235 days. In group 1, all received dLRT (10 TACE, 9 RFA). In Group 2, 34/62(55%) received naLRT (32 TACE, 2 RFA), and 46/62(74%) underwent TXP. Twelve listed patients did not undergo TXP because of tumor progression (2), medical illness (3), or death (7). Four patients were alive on the TXP waiting list at last follow-up. Time from diagnosis to LRT was significantly less in the dLRT group (see table). Recurrence rate in patients receiving a transplant was lower than after dLRT (see table), however the 4-year intention to treat survival from diagnosis was not different between the two groups (p=0.77). Conclusion Despite higher rates of tumor recurrence, the 4-year intention to treat survival of patients with unresectable vsHCC treated with definitive LRT is not significantly different from those patients receiving neoadjuvant LRT and TXP. Continued follow up is needed to compare long-term survival of patients receiving these two treatment strategies. Median Age (years)Male GenderCalculated MELD at the time of diagnosisTumor diameter @ diagnosis (mm)Tumor diameter @ LRT (mm)Median time from diagnosis to LRT (days)Tumor RecurrenceOverall survival @ 4 years (95% CI)Definitive LRT (Group 1, N=19)71+/-1010 (53%)11.1+/-417.1+/-3.419.4+/-4.874+/-2039 (47.4%)66.7% (34.5 – 85.7)Neoadjuvant LRT and TXP (Group 2, N=62)59+/-649 (79%)11.7+/-4.413.5+/-2.822.9+/-8225+/-1843 (6.5%)70.5% (56.7 – 80.70)p value<<0.010.0540.02<0.010.77

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