WCIO 2011 – June 9 – 12 , New York

Is RFA still the standard of treatment for patients with HCC awaiting liver

transplantation?RM Lauro*, A Nicolini**

IRCCS Cà Granda FondationPoliclinico Hospital – Milan - Italy

General Surgery & Liver Transplant Unit* Interv. Radiology Unit**

Aim of our experience

To assess the final histological pattern after

RFA and DEB-TACE performed as “Bridge

Treatment” for HCC before Liver

Transplantation.

HCC Bridge Treatment before Liver Transplantation According to BCLCA

GuidelinesCurativeTreatments

• Surgery in very early (O) and early stage (A)

(Laparaoscopy)

• PEI (early stage)

• Thermoablation (RFA) in early stage

• Other Ablation procedures, even though not yet

approved with the need of further investigations (MW,

CrioAbl, Laser-LITT etc..) (early stage)

• TACE in intermediate stage Palliative TreatmentNamiki Izumi, J of Gastroenterol & Hepatol 26 (2011) Suppl. 1 ; 115-122J Bruix and M Sherman, Hepatology 2011; 53 N.3: 1020-1022Belghiti J, Lencioni R et al., Ann Surg Oncol 2008; 15: 993-1000Bharat et al, Am J Coll Surg 2006; pp. 411-420Xian-Jie Shi et al.,Hepatobiliary Pancreat Dis Int. 2011; 10: 143-150T Livraghi et al., Scandinavian Journal of Surgery 2011; 100: 22–29

TACE

• In recent years TACE procedures have been

improved

• The recent introduction of microsphere loaded

with Epirubicin or Doxorubicin (DEB-TACE) has

improved TACE efficacy, extending tumor necrosis

Varela M et al., J Hepatol 2007; 46: 474-481Malagari K et al., Abdom Imaging 2008; 33: 512-519Nicolini A et al., Dig Liver Dis 2009; 41: 143-149Nicolini A et al., JVIR 2010; 21: 327-332Mike SL Liem et al., World J Gastroenterol 2005;11(29):4465-4471A G Singal & J A Marrero, Current Opinion in Gastroenterology 2010,26:189–195

MethodsJanuary 2005 – December 2010

Patients with HCCin BCLCA A1-A4 selected for LT

61

Sex 24M,6F

Age 55.6 (57±3.8)

Patients selected for the “Bridge Treatment”

30 (49.2%)

RFA 18 pts

DEB-TACE 10 pts

Patients excluded 2 pts (both treatments)

Based on a Clinical Basis , we have investigated a significant group of patients within the “Milano Criteria”.

Methods• According to BCLC guidelines all patients were

considered for RFA.

• Only patients with at least a lesion in critical sites

or more than 30 mm in diameter not treatable

with RFA , were cured using DEB-TACE

• The pathological specimen of the native

unhealthy liver was analyzed by the pathologists

Baseline Characteristics of the Patients Enrolled in the Study

Pts Characteristics DEB-TACE

10 pts

RFA

18 pts

Child-PughAB

64

126

HCC size 30±12.2 mm 30±15.0 mm

N° of HCC Nodules-1 N-2 N-3 N

7 (70%)***1 (10%)2 (20%)

Lap. 13 pts , Perc. 5 pts

1 (6%)11 (61%)

6 (33%) Lap. **

EthiologyHBVHCVETHMixed

0514

11025

N. of Nodules DEB-TACE10 pts

RFA18 pts

1N ***7 pts (70%)

- Critical Sites-Close to main vessels

-Size > 30 mm-Less Invasive impact

before LT

1 pts (6%)

2N 1 pts (10%) 11 pts (61%)

3N 2 pts (20%) **6 pts (33%)

Third nodule always detected as

occasional finding >>Laparoscopic US

Treatment RFA DEB-TACE p<

N° of Pts 18 10

N° of Treatments

1.30 (1-3) 1.5 (1-3) n.s.

WT to LT after the 1st

treatment

12.8 (1-24 M) 8.0 (3-18 M) n.s.

CT-scan Complete

Necrosis (3 months)

91% 88% 0.941

Complete Pathological Response

82% 78% 0.963

Partial Pathological Response

18% 22% n.s.

Results

Topic of Discussion

DEB-TACE : Is it only for Palliative

Treatment?

Question?

Conclusion• Our results suggests that RFA and DEB-TACE have similar

results

• Both RFA and DEB-TACE are good therapeutic approaches to

limit HCC progression in stable LT candidates.

• DEB-TACE has a better cost/benefit ratio (less invasive,

lower costs, excellent efficacy)

• DEB-TACE in expert hands, might be also considered as

“Curative Treatment” very soon.

• A wider comparison of the two procedures seems warranted

in the light of Clinical Effectiveness Research

… improve is to change!…be perfect is to change often!

Sir Winston Churchill (1874-1965)

Thank you very much indeed for your attention!!