Page 188 - ebook HCC

186 PROGRAMME AND ABSTRACTS GENEVA, SWITZERLAND EASL HCC SUMMIT 187
FEBRUARY 13 - 16, 2014

MANAGEMENT OF HCC ON THE OLT PATIENT SELECTION FOR TACE IN
WAITING LIST INTERMEDIATE STAGE HCC
Chris Verslype , Fredeik Nevens 1
1
1 Division of Hepatology, University Hospitals Leuven, Leuven, Belgium Wolfgang Sieghart 1
1 Department of Internal Medicine III, Division of Gastroenterology/Hepatology, Liver
Corresponding author’s e-mail: chris.verslype@uzleuven.be Cancer (HCC)-Study Group, Medical University Vienna, Vienna, Austria

Corresponding author’s e-mail: wolfgang.sieghart@meduniwien.ac.at

In most transplant centers, patients with HCC within the Milan criteria are treated
with loco-regional therapies (e.g. radiofrequency ablation, resection, trans-arterial Transarterial chemoembolization (TACE) is the standard of care for patients with
chemoembolization) while on the waiting list for LT (“bridging strategy”). In addition to intermediate stage HCC (BCLC-B). However, intermediate stage HCC patients comprise
country specific priority rules for listing, the main driver for these neo-adjuvant bridging a very heterogeneous patient population concerning tumor load and liver function.
strategies is to prevent dropout from the waiting list. To evaluate however the full impact Furthermore, TACE rarely achieves complete radiologic response with a single session,
of a neo-adjuvant strategy, other factors should also be considered, such as the response so most patients need to be retreated with TACE. Thus, both, patient selection criteria
to neo-adjuvant treatments, the recurrence of HCC after LT, the survival after LT and the at baseline and for re-treatment with TACE are needed in order to avoid TACE induced
intention-to-treat survival after listing. Interpretation of the current literature data is difficult, harm and to maximize the survival benefit for HCC patients. This presentation focuses on
mainly because of the lack of information on all of these outcome parameters. However, recent advancements of patient selection at baseline as well as for retreatment with TACE
there is a consensus that there is a limited benefit of a bridging therapy in patients with in patients with intermediate HCC.
small tumors (T1) and a short anticipated waiting list to LT (< 6 months).
In addition to the bridging strategy, many centers also consider patients as candidates
for liver transplantation once they have been successfully “down-staged” to the country
CLINICAL SPEAKERS ABSTRACTS outcome parameters, it is difficult to define specific decision criteria on the most effective CLINICAL SPEAKERS ABSTRACTS
specifc listing criteria for HCC. Due to the low number of prospective studies with well-
defined entry criteria, and the lack of information on several of the above mentioned
treatment plan.
Nevertheless, many studies have identified risk factors for tumor progression and poor
outcomes, such as the lack of a (sustained) response to neo-adjuvant treatments, poor
tumor differentiation, vascular invasion and high values of alfa-foetoprotein. In the near
future, more insights in tumor biology may provide us with better prognostic and predictive
markers.
The implementation of some of these factors in transplant allocation systems is likely to
optimize the results of liver transplant programs.