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Tumor response to transcatheter arterial chemoembolization in recurrent hepatocellular carcinoma after living donor liver transplantation.

Ko HK, Ko GY, Yoon HK, Sung KB - Korean J Radiol (2007 Jul-Aug)

Bottom Line: The 1-, 3- and 5-year survival rates following TACE were 47.9, 6.0 and 0%, respectively, with a mean survival of nine months in all patients.There were no significant complications related to TACE.However, the survival rate of patients with r-HCC after LDLT is poor due to extrahepatic metastasis and intrahepatic recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Severance Hospital, University of Yonsei College of Medicine, Seoul 120-752, Korea. kbsung@amc.seoul.kr

ABSTRACT

Objective: To evaluate the tumor response and patient survival rate following transcatheter arterial chemoembolization (TACE) in recurrent hepatocellular carcinoma (r-HCC) after living donor liver transplantation (LDLT).

Materials and methods: Twenty-eight patients with r-HCC underwent one or more cycles of TACE after LDLT (mean, 2.5 cycles). After a mixture of iodized oil and anti-cancer drugs was injected via the arteries feeding the tumors, these vessels were embolized with a gelatin sponge. Tumor response was determined by follow-up CT imaging on all patients four weeks after each TACE procedure. Patient survival was calculated using the Kaplan-Meier survival curve.

Results: After TACE, targeted tumor reduced in size by 25% or more in 19 of the 28 study patients (67.9%). However, intrahepatic recurrence or extrahepatic metastasis occurred in 21 of the 28 patients (75.0%) during the 3-month follow-up period and in 26 of the 28 patients (92.9%) during the 6-month period following TACE. Extrahepatic metastasis was noted in 18 of the 28 patients (64.3%). The 1-, 3- and 5-year survival rates following TACE were 47.9, 6.0 and 0%, respectively, with a mean survival of nine months in all patients. There were no significant complications related to TACE.

Conclusion: TACE produces an effective tumor response for targeted r-HCC after LDLT. However, the survival rate of patients with r-HCC after LDLT is poor due to extrahepatic metastasis and intrahepatic recurrence.

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Overall cumulative survival curve of 28 patients with recurrent hepatocellular carcinoma calculated from the time of living donor liver transplantation.
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Figure 4: Overall cumulative survival curve of 28 patients with recurrent hepatocellular carcinoma calculated from the time of living donor liver transplantation.

Mentions: Survival was measured from the date of LDLT, r-HCC diagnosis after LDLT, or TACE treatment until death or until December 2005. At the time of this writing, 25 patients have died and three are still living. The causes of deaths were pneumonia and sepsis (n = 18), hepatic failure (n = 5), and organ failure due to extensive metastasis (n = 2). The actual 1-, 3-, and 5-year survival rates after LDLT were 71.4%, 31.5%, and 6.0%, respectively (Fig. 4). The estimated median survival after LDLT in the included patients was 28 months (95% CI, 12.4-43.5 months). The actual 1-, 3-, and 5-year survival rates after TACE for r-HCC were 47.9%, 6.0%, and 0%, respectively (Fig. 5). The estimated median survival after TACE for r-HCC was nine months.


Tumor response to transcatheter arterial chemoembolization in recurrent hepatocellular carcinoma after living donor liver transplantation.

Ko HK, Ko GY, Yoon HK, Sung KB - Korean J Radiol (2007 Jul-Aug)

Overall cumulative survival curve of 28 patients with recurrent hepatocellular carcinoma calculated from the time of living donor liver transplantation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627154&req=5

Figure 4: Overall cumulative survival curve of 28 patients with recurrent hepatocellular carcinoma calculated from the time of living donor liver transplantation.
Mentions: Survival was measured from the date of LDLT, r-HCC diagnosis after LDLT, or TACE treatment until death or until December 2005. At the time of this writing, 25 patients have died and three are still living. The causes of deaths were pneumonia and sepsis (n = 18), hepatic failure (n = 5), and organ failure due to extensive metastasis (n = 2). The actual 1-, 3-, and 5-year survival rates after LDLT were 71.4%, 31.5%, and 6.0%, respectively (Fig. 4). The estimated median survival after LDLT in the included patients was 28 months (95% CI, 12.4-43.5 months). The actual 1-, 3-, and 5-year survival rates after TACE for r-HCC were 47.9%, 6.0%, and 0%, respectively (Fig. 5). The estimated median survival after TACE for r-HCC was nine months.

Bottom Line: The 1-, 3- and 5-year survival rates following TACE were 47.9, 6.0 and 0%, respectively, with a mean survival of nine months in all patients.There were no significant complications related to TACE.However, the survival rate of patients with r-HCC after LDLT is poor due to extrahepatic metastasis and intrahepatic recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Severance Hospital, University of Yonsei College of Medicine, Seoul 120-752, Korea. kbsung@amc.seoul.kr

ABSTRACT

Objective: To evaluate the tumor response and patient survival rate following transcatheter arterial chemoembolization (TACE) in recurrent hepatocellular carcinoma (r-HCC) after living donor liver transplantation (LDLT).

Materials and methods: Twenty-eight patients with r-HCC underwent one or more cycles of TACE after LDLT (mean, 2.5 cycles). After a mixture of iodized oil and anti-cancer drugs was injected via the arteries feeding the tumors, these vessels were embolized with a gelatin sponge. Tumor response was determined by follow-up CT imaging on all patients four weeks after each TACE procedure. Patient survival was calculated using the Kaplan-Meier survival curve.

Results: After TACE, targeted tumor reduced in size by 25% or more in 19 of the 28 study patients (67.9%). However, intrahepatic recurrence or extrahepatic metastasis occurred in 21 of the 28 patients (75.0%) during the 3-month follow-up period and in 26 of the 28 patients (92.9%) during the 6-month period following TACE. Extrahepatic metastasis was noted in 18 of the 28 patients (64.3%). The 1-, 3- and 5-year survival rates following TACE were 47.9, 6.0 and 0%, respectively, with a mean survival of nine months in all patients. There were no significant complications related to TACE.

Conclusion: TACE produces an effective tumor response for targeted r-HCC after LDLT. However, the survival rate of patients with r-HCC after LDLT is poor due to extrahepatic metastasis and intrahepatic recurrence.

Show MeSH
Related in: MedlinePlus