Radioembolization for Hepatocellular Carcinoma in Downstaging and Bridging for Liver Transplantation
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REVIEW ARTICLE
Radioembolization for Hepatocellular Carcinoma in Downstaging and Bridging for Liver Transplantation Ramazan Kutlu 1 & Sinan Karatoprak 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Hepatocellular carcinoma (HCC) is the most common primary liver tumor. Only about one third of them are eligible for curative treatments like liver transplantation. Various interventional oncologic treatment options could be employed for some of the HCC patients outside the acceptable liver transplantation criteria to make them suitable for transplantation by downstaging and keeping them inside the criteria by bridging to transplantation. Methods We reviewed the literature by the terms of downstaging and bridging therapy for liver transplantation. Results About only 30% of the patients are suitable for curative procedures like transplantation at the time of diagnosis of HCC. Even the Milan Criteria is expanded or new criteria are defined, still there are many patients who need downstaging to be eligible for transplantation. There are different procedures in interventional oncology for primary and metastatic liver lesions. Radioembolization (RE) is one of the locoregional therapies which is more effective than others for downstaging and bridging for liver transplantation. Conclusion Downstaging by RE is an effective and reasonable method for unresectable HCC cases initially beyond established criteria for liver transplantation by selecting suitable and favorable tumor biology. Keywords Downstaging . Hepatocellular carcinoma . Liver transplant . Radioembolization
Introduction Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the sixth most common tumor occurring internationally, and the third leading cause of cancer-related mortality worldwide [1, 2]. Despite the advances in surveillance, diagnosis, and treatment, its prognosis is poor especially for advanced stage patients of whom only one-third of them might benefit from curative therapies [1, 2]. The underlying liver diseases, which predispose to new tumor formation, contribute to the prognosis of HCC [3, 4]. Liver transplantation (LT) is one of the available curative treatment modalities for early-stage patients. Some of the HCC patients could be eligible for LT by employing various locoregionally applied interventional oncologic procedures for downstaging and bridging to LT [1]. Radioembolization
* Ramazan Kutlu [email protected] 1
Department of Radiology, Inonu University School of Medicine & Liver Transplantation Institute, 44280 Malatya, Turkey
(RE) is one of the important locoregional treatment (LRT) options for downstaging and bridging. There are various staging systems for the management of HCC. Although none of them is perfect yet, Barcelona Clinic Liver Cancer (BCLC) staging is most commonly used one. These systems direct the management of HCC in different stages, but an important consideration is that each patient might require individual modifications. Therefore, the treatment
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