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Prajapati et al. TACE in recurrent HCC after OLT

occurs after OLT. Many studies have reported on the evaluations. The eastern cooperative oncology group
[2]
patterns and prognostic factors for recurrence of HCC (ECOG) performance status (PS) of each patient was
after liver transplantation. [3-6] However, the reported documented before the DEB TACE procedure. The
prognostic factors investigated have been focused functional liver status was determined by using the
more on histopathologic and postoperative clinical data Child-Pugh criteria. The American Association for the
after HCC who did not receive chemoembolization. [3-6] Study of Liver Disease-Journal of the National Cancer
Several studies have been reported on the efficacy of Institute guidelines were used to diagnose HCC.
[9]
conventional transcatheter arterial chemoembolization HCC was diagnosed if magnetic resonance imaging
(cTACE) in recurrent HCC after OLT. [7,8] Little is known (MRI) showed a mass with the typical vascular pattern
about the survivals, efficacy and prognostic factors of arterial enhancement and portal venous ‘‘washout’’.
following doxorubicin drug eluting beads transcatheter For the index lesions between 1 and 2 cm, two different
arterial chemoembolization (DEB TACE) in patients studies were used to detect the typical pattern and for
with recurrent HCC status post OLT. lesions > 2 cm in diameter, only one study was used.
Here, index lesion means the largest lesion in the liver.
The purposes of this study were, first, to investigate the Lesions with inconclusive features on imaging were
survivals and efficacy following DEB TACE in patients biopsied for pathologic confirmation.
with recurrent HCC status post OLT and second, to
identify the prognostic factors of survivals among these DEB TACE procedure
patients with recurrent tumors and to report the review There were 18 DEB TACE procedures performed in 8
of the literature. patients. The detail techniques of the procedure were
mentioned elsewhere. The third or fourth order
[10]
METHODS branches of feeding vessels supplying the tumor were
catheterized with a 2.8 F (Renegade Hi-Flo; Boston
This is a single institutional retrospective analysis Scientific, Natick, MA, USA) or a 2.1 F microcatheter
of prospective database with the patient’s consent, (STC Renegade Hi-Flo; Boston Scientific, Natick,
approved by the Local Institutional Review Board and MA, USA). Then, the tumors were treated with a slow
is Health Insurance Portability and Accountability Act fluoroscopy-guided injection of iodinated contrast mixed
compliant. 100-300 μm low compression beads impregnated with
50 mg of doxorubicin in each vial. The first and second
Study objective order branches of the right or left hepatic arteries were
The primary objective of the study was to assess the kept patent and documented on post-embolization
survivals and efficacy following DEB TACE in patients completion angiogram. The endpoint for treatment
with recurrent HCC status post OLT. And the second included the administration of the 2 vials of DEB or
objective was to identify the prognostic factors of sluggish flow in the subsegmental branches of the
survival among these patients with recurrent HCC after hepatic artery to the region of the tumor, without an effect
OLT who were treated with DEB TACE and to report on the flow in the main or lobar hepatic artery. After 2 vials
the review of the literature on the similar studies. of DEB TACE, no additional embolization was performed
despite persistent high flow within the tumor.
Patient selection
There were 420 consecutive patients with unresectable Follow-up
HCC who received DEB TACE therapies from Patients with large tumors of more than 5 cm or
December 2005 to September 2012. A total of 56 multifocal disease were re-treated in 4 weeks and the
patients underwent OLT after downstaging of HCC remainders of the patients were followed up in the clinic
from DEB TACE. Patients who developed recurrent in 4 weeks with liver function tests and an MRI of the
HCC after OLT were identified. Those patients who liver. Follow-up cross-sectional imaging was performed
underwent DEB TACE for recurrent HCC were included at 4 weeks from the last single or repeat DEB TACE
in the study. A total of 8 patients met the inclusion criteria treatment. Further treatments were based on clinical
and included in the study. None of the HCC tumor was evaluation, laboratory values, and imaging response.
feasible for surgery or ablation treatment due to size or If there was a progressive disease on follow up MRI at
close proximity with liver capsule or hepatic vasculature. 4 weeks, then the patients were assessed for systemic
All patients had cirrhosis before OLT. One patient therapy. Simultaneously, these patients were re-
was alive at the end of the study. The patients who treated with DEB TACE unless the disease progressed
received treatment with sorafenib were also included to the Barcelona-Clinic Liver Cancer D stage. If follow
in the study. All patients had an initial outpatient clinical up MRI demonstrated residual or recurrent HCC, then
evaluation, including pertinent medical and physical the patients were retreated with DEB TACE. If patients

Hepatoma Research ¦ Volume 3 ¦ August 17, 2017 183